Gu Omm Lecture 2

Front 1

Male to female ratio with Urinary Stone?

Back 1

3 to 1

Front 2

What is the most common Urinary Stone ?

Back 2

calcium based and therefore, radio opaque (85%)

Front 3

incidence of symptomatic ureteral stones is greatest during____ months.

Back 3

hot summer

Front 4

Urinary Stone lodge at ____ may cause increased frequency and urgency

Back 4

ureterovesicular junction

Front 5

Pain usually anterior abdomen, may refer to___ or ___

Back 5

labium or ipsilateral testis

Front 6

Urinary Stone size does correlate with severity of symptoms T/F

Back 6

FALSE

Front 7

The most important factor in reducing urinary stone recurrence is an____

Back 7

increased fluid intake

Front 8

SNS levels for ureters

Back 8

T10-L1

Front 9

T-L Junction Referral Pattern

Back 9

Inguinal Ligament

Front 10

One main structural cause of groin or inguinal pain is___ somatic dysfunction

Back 10

inguinal ligament

Front 11

Inguinal Ligament Dysfunction is also implicated in ___.

Back 11

Meralgia Paresthetica

Front 12

In Meraligia Paresthetica, Paresthesia in the distribution of the ____ nerve due to compression of the nerve as it passes between the inguinal ligament and sartorius

Back 12

Lat. Femoral cutaneous

Front 13

Where is the Anterior Inguinal Tender Point?

Back 13

Located on the lateral border of the pubic bone near the attachment of the inguinal ligament

Front 14

Iliolumbar Ligament Role?

Back 14

Restricts lumbosacral side-bending and rotation

Front 15

Iliolumbar Ligament attaches to the transverse processes of____, extends to the iliac crest, and posterior and anterior regions of the ___

Back 15

L4, L5, SI joint

Front 16

Iliolumbar Ligament Syndrome Tender Point

Back 16

1 inch superior and lateral from the inferior margin of the PSIS and in the iliolumbar ligament

Front 17

Iliolumbar Ligament Syndrome Becomes tender with low back pain due to ____

Back 17

postural decompensation, It is the first ligament stressed with postural instability

Front 18

A 37-year-old female presents with dysuria, urinary urgency and frequency. She denies flank pain, fever, chills, nausea, and vomiting. She does admit to some mild suprapubic tenderness

Back 18

UTI (Acute Cystitis)

Front 19

The offending pathogen in Acute cystitis

Back 19

E.Coli (75-95%)

Front 20

Acute cystitis is unusual in what group of people?

Back 20

Unusual in men under 50 y/o

Front 21

Acute cystitis, Occur in 1-3% of ____ and increase with adolescence

Back 21

school girls

Front 22

What is the positive test result for Ecoli in UTI?

Back 22

E. coli—Nitrite Positive

Front 23

Which antibiotics do you use in UTIs?

Back 23

Bactrim, Quinolones, Macrodantin

Front 24

OMM in UTI, ____ affording an opportunity for chronic passive congestion

Back 24

Postural decompensation

Front 25

Remember that ____ stimulation of the bladder can lead to a functional urinary retention

Back 25

chronic sympathetic

Front 26

SNS levels of Bladder

Back 26

T12-L2

Front 27

SNS ___ ureteral peristalsis

Back 27

Decreases

Front 28

SNS ____ detrusor muscle

Back 28

Relaxes

Front 29

SNS ___ internal sphincter tone

Back 29

Increases

Front 30

PNS levels of Bladder

Back 30

S2=4

Front 31

PNS __ peristalsis

Back 31

Increases

Front 32

PNS ___ detrusor

Back 32

Contracts

Front 33

The apex of the bladder is attached to the anterior abdominal wall by the____.

Back 33

remnant of the urachus—the median umbilical ligament

Front 34

____ connects the bladder neck to the inferior aspects of the pubic bones

Back 34

Fibromuscular tissue

Front 35

Bladder drains to the___ nodes

Back 35

external iliac

Front 36

Median umbilical ligament is attached to the deep portion of the umbilicus, which is invested in the ___

Back 36

linea alba

Front 37

A 56 y/o female who presents with c/o urinary frequency. Pt describes that she is passing urine more often & states it is assoc. w/ laughing, coughing & jogging

Back 37

Incontinence

Front 38

___% of women and ___% of men up to age 64 have urinary incontinence

Back 38

10-30%, 1.5-5

Front 39

In people 65 years and older – ___% of individuals living in the community are incontinent

Back 39

15-30%

Front 40

In Urge Incontinence, Osteopathic condesideration includes sacral dysfunction leading to hyperstimulation of____ (remember detrusor contraction is a ___ controlled)

Back 40

parasympathetics, parasympathetically

Front 41

Which Incontinence, Occurs when increase intra-abdominal pressure leads to sphincter opening in the absence of bladder contraction

Back 41

Stress Incontinence

Front 42

Stress Incontinence, Insufficient urethral support from the ___ and ____

Back 42

pelvic endofascia and muscles

Front 43

Stress Incontinence, Complete failure of urethral closure called____

Back 43

intrinsic sphincter deficiency (ISD)

Front 44

Stress Incontinence, Controversial consideration of ____

Back 44

urethral instability

Front 45

which incontinence, Typically small volume – continuous in nature

Back 45

Overflow Incontinence

Front 46

Which Incontinence, Post-void volume is elevated and maybe assoc. w/ weak stream, dribbling, frequency

Back 46

Overflow Incontinence

Front 47

Which Incontinence, Due to detrusor weakness and/or bladder outlet obstruction.

Back 47

Overflow Incontinence

Front 48

Which incontinence, Usually occurs when obstruction causes detrusor decompensation

Back 48

Overflow Incontinence

Front 49

Etiologies include replacement of the detrusor smooth muscle by fibrosis and connective tissue (as w/ chronic outlet obstruction), peripheral neuropathy (DM, Pernicious anemia, Parkinsons, Etoh abuse) and damage to spinal afferents by disc herniation, spinal stenosis, tumor, etc.

Back 49

Overflow Incontinence

Front 50

Voiding Reflex, ___ contracts the detrusor

Back 50

PNS

Front 51

Voiding Reflex, ___ relaxes the internal sphincter

Back 51

SNS

Front 52

Voiding Reflex, ___relaxes the external sphincter and pelvic floor

Back 52

Pudendal nerve

Front 53

What 3 muscles make up the levator ani muscle?

Back 53

Iliococcygeus, Puborectalis, Pubococcygeus muscles

Front 54

A 23 year old male presents with the complaint of fever and unilateral scrotal pain with tenderness and swelling, unprotect sex

Back 54

Acute Epididymitis

Front 55

Sexually Transmitted cause for Acute Epididymitis, age group

Back 55

Gonorrhea, Chlamydia. Males under 40

Front 56

Non-Sexually Transmitted cause for Acute Epididymitis, age group

Back 56

usually UTI or Prostatitis, Older men

Front 57

Treatment of Acute Epididymitis, ____ is important in the acute phase

Back 57

Bed rest with scrotal elevation

Front 58

Treatment of Acute Epididymitis, The sexually transmitted variety is treated with ___days of antibiotics

Back 58

10–21

Front 59

Treatment of Acute Epididymitis, Non-sexually transmitted forms are treated for ___days with appropriate antibiotics

Back 59

21–28

Front 60

Anterior Chapman’s points for Urethra located in ____

Back 60

myofascial tissues along the superior margin of the pubis ramus about 2cm lateral to the symphysis

Front 61

In Epidydymitis, ____ positive for somatic dysfunction

Back 61

Pelvic diaphragm

Front 62

SNS level for testes

Back 62

T10-T11

Front 63

What nerve to Superior Mesenteric Ganglion for testes?

Back 63

Lesser Splanchnic Nerve

Front 64

SNS levels for Prostate/Genitals

Back 64

T12-L2

Front 65

Nerve to To Inferior Mesenteric Ganglion for Prostate/Genitals

Back 65

Least/Lumbar Spl NN.

Front 66

PNS to Testes

Back 66

Vagus

Front 67

PNS to Prostate and Genitals

Back 67

S2-4 via the Pelvic Splanchnic Nerves

Front 68

Stimulation of the ___produces true glandular secretion from the prostate

Back 68

hypogastric plexus

Front 69

Stimulation of the___ forces secretions out of the urethra.

Back 69

pudendal nerve

Front 70

Somatic Nerve for Erection

Back 70

Pudendal N. S2-4

Front 71

Autonomic nerve for Erection

Back 71

Pelvic Splanchnic N S2-4 (PNS)

Front 72

Autonomic nerve for Orgasm

Back 72

Lumbar Splanchnic N L1-2 (SNS)

Front 73

Autonomic Nerve for Ejaculation

Back 73

Lumbar Splanchnic N via Hypogastric N (SNS) to Vas. And Seminal Vesicles

Front 74

In the Male Reproductive System, The Superficial Lymphatic is under the ____

Back 74

tunica vaginalis

Front 75

In the Male Reproductive System, The Deep Lymphatic Plexus is within the ____

Back 75

testis and epididymis

Front 76

In Male Reproductive System, Both Lymphatics Plexuses join and ascend in the spermatic cord to join the __and __ nodes

Back 76

lateral and pre-aortic

Front 77

The spermatic cord and all testicular vessels run on the surface of ___

Back 77

psoas major

Front 78

A 59 year old male presents with fatigue, malaise, urinary urgency, pain and difficulty with urination, and complains of perineal and low back pain for 10 days. Patient relates a history of urinating 5-6 times during the night

Back 78

Prostatitis

Front 79

Most common pathogen for Acute Bacterial Prostatitis?

Back 79

Usually gram neg rods—E. coli or Pseudomonas

Front 80

Anterior Chapman’s points for Prostate located in _______

Back 80

myofascial tissues along the posterior margin of the iliotibial band.

Front 81

Prostate Lymphatics drains to ___ and ___nodes

Back 81

internal iliac and sacral

Front 82

What ligament is important to consider in Acute Bacterial Prostatitis?

Back 82

Puboprostatic ligament

Front 83

a ligament from the pubic bone that attaches it to the prostate

Back 83

puboprostatic ligament

Front 84

Patients with recurrent urinary stones are encouraged to follow a low sodium/low protein diet. What are the Na/protein recommendations

Back 84

Sodium less than 100mEq/day
Protein less than 1g/kg/day

Front 85

PNS for ureters

Back 85

Proximally by Vagus
Distally by S2-4

Front 86

Dysuria
Frequency
Urgency
Suprapubic pain
Hematuria
On average associated with 6.1 d of symptoms, 1.2 d of missed work/school, 2.4 d of restricted activity

Back 86

Clinical Features of Acute Cystitis

Front 87

UA shows Pyuria and Bacteriuria with varying degrees of Hematuria.
Leukocyte Esterase usually positive
Levels of Pyuria and Bacteriuria do not positively correlate with severity of infection
Urine Culture to identify the organism

Back 87

Diagnosis and Treatment of UTI

Front 88

Abrupt mod-large leakage
Can be assoc. w/ frequency & nocturia
Presumed etiology is uninhibited bladder contractions of the detrusor

Back 88

Urge Incontinence

Front 89

Insufficient urethral support from the pelvic endofascia and muscles.
Complete failure of urethral closure called intrinsic sphincter deficiency (ISD).
Controversial consideration of urethral instability.

Back 89

Stress Incontinence

Front 90

Tx of Urge incontinence

Back 90

Behavioral treatment, drug therapy can be considered to decrease detrusor over activity (oxybutynin),
Osteopathic treatment of sacrum (S2-S4)

Front 91

Tx of Overflow incontinence

Back 91

Treatment of obstruction and withdrawal of meds that impair detrusor contractility
Balancing autonomic tone and treatment of the sacrum to optimize the voiding reflex and detrusor control

Front 92

Tx of Stress incontinence

Back 92

Pelvic muscle exercise, estrogen & alpha adrenergic agonists may be considered
OMT to PELVIC DIAPHRAGM!

Front 93

Essential Features
Fever.
Irritative voiding symptoms.
Painful enlargement of epididymis

Back 93

Acute Epididymitis

Front 94

Symptoms/Signs
Pain develops in the scrotum and can radiate along the spermatic cord or to the flank
Prehn Sign: elevation of hemiscrotum relieves pain
Diagnosis can be made with a positive urethral smear in the STD variety, and UA in the non-STD.

Back 94

Acute Epididymitis

Front 95

Essential Features
Fever
Dysuria
Perineal or Suprapubic Pain, and likely extreme tenderness on DRE
Positive Urine Culture

Back 95

Acute Bacterial Prostatitis

Front 96

Prostate warm and tender to palpation.
Pyuria and bacteriuria in UA with Culture & Sensitivity of expressed prostatic secretions or voided urine.
Asymmetry in tension of right and left sides of pelvic diaphragm is positive for dysfunction.

Back 96

Prostatitis

Front 97

Treatment of Acute Bacterial Prostatitis, Admission with IV Abx may be warranted
IV abx until ___ afebrile
Then a ___ course of oral tx, then follow up with ___

Back 97

1-2 days, 4-6 week, Cultures and Stool softeners

Front 98

Treatment of Acute Bacterial Prostatitis, If the pt develops urinary rentention—___

Back 98

DO NOT CATH!
Suprapubic percutaneous bladder catheterization (ouch)

Front 99

Where are the Psoas trigger points?

Back 99

Rt of Umbilicus
Rt ASIS
Rt femur head