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126 Cards in this Set
- Front
- Back
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What forms the room of the abdominopelvic cavity?
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The diaphragm
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What forms the posterior wall of the abdominopelvic cavity?
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Psoas, quadratus, and iliacus
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What forms the floor of the Abdominopelvic cavity?
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Pelvic diaphragm
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What forms the anterior wall of the abdominopelvic diaphragm?
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Anterior abdominal musculature
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How do the kidneys move on inhalation?
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Inferiorly, they are retroperitoneal
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Where do the ureters travel?
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Along the medial aspect of the psoas
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At what spinal level is the sympathetic innervation of the kidneys and proximal ureters?
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Cell bodies in T10-L1 and synapse in the superior mesenteric collateral ganglion
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At what spinal level is the sympathetic innervation of the bladder and distal ureters?
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Cell bodies in T12-L2 and synapse in the inferior mesenteric collateral ganglion
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What is the result of increased sympathetic tone on the urinary system?
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Increased afferent arteriole constriction, decrease of ureter peristalsis, bladder wall relaxation, and increased external urinary sphincter tone
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What are effects of increased sympathetic tone?
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Decreased GFR -> Increase in BP, Uretospasms -> decrease flow through ureters and incomplete emptying of bladder, reflux
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What is the parasympathetic innervation to the kidneys and proximal ureters?
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Vagus nerve
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What is the parasympathetic innervation to the distal ureters and bladder?
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Pelvic splanchnic nerves from S2-4
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What are the effects of decreased parasympathetic tone?
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Incomplete voiding of bladder, tightened internal urinary sphincter
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What are effects of increased parasympathetic tone?
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Increased peristalsis of ureters, bladder wall tone and relaxation of internal urinary sphincter
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What is the purpose of lymphatics with respect to the urinary tract?
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Drain the capsule and parenchyme to aid in clearence of waste products, fluid, electrolytes, infectoius, and antibiotic products
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Where to renal lympatics drain to?
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Capsule & parenchyma -> preaortic nodes -> thoracic duct -> subclavian vein
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How do the thoracic and pelvic diaphragms contribute to lymphatic drainage in the urinary system?
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Synchronous motion is essential for drainage
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What is Lloyd's test?
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Tenderness in the thoracolumbar juction area - increased tonus in the TL junction
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What will indicate positive Renal Visceromotor Reflex?
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Lloyd's punch test
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What is the viscerosensory reflex?
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Ache, not pain, in the thoracolumbar and/or flank
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What is the ureteral viscerosensory reflex (uretorocolic)?
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Stagnant pain from ureters lumbar to iliac to genital, colic sensation
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What kind of reflex occurs with a kidney stone?
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Both visceromotor and viscerosomatic progressing from T10 to lumbar region
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What is the process for osteopathic treatment of UTI?
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Rule out pubic symphyseal and pelvic floor somatic disfunction (symptoms of dysuria and frequency), treat pelvic floor, and address T/L junction and SI joints to normalize autonomics
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What is ureterolithiasis?
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Pain of stone is made worse uterospasm which slows the stone, osteopathic treatment would focus on reducing hypersympathetic tone
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What would be a treatment for ureterolithiasis?
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Thoracolumbar paraspinal inhibition or gentle rib raising
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What area would one treat for acute glomerulonephritis or pyelonephritis?
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Somatic disfuctions at T11, T12, L1
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How would one treat renal failure w/azotemia and uremia?
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Maximizing renal circulation and urinary output treating T10-L2 region
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What can cause symptoms of cystitis or prostatitis?
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Tension on the pubovescicular and puboprostatic fascia
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What can be misconstrued as UTIs?
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Short leg syndrome, psoas spasm, and iliolumber ligament strain
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What can cause dysuria, urgency, frequency or nocturnal euresis?
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Pubic symphysis somatic disfunction, incorrect removal from stirrups following a procedure
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What could cause dysmenorrhea?
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Excessive lumbar lordosis, uterine contractions, ischeamia during endometrial separation, off center cervix
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What is the osteopathic treatment of dysmenorrhea?
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"- T12-L2 control uterine contraction and vasoconstriction, S2-4 relax
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What percentage of women experience PMS?
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10% of child bearing women
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What is related pathophysiology to PMS?
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Hormonal imabalance, vitamin deficiency, hypoglycemia
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What are symptoms of pelvic congestion?
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Heaviness, deep dysparunia
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What percentage of women experience endometriosis?
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1-34%, up 63% if chronic
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What are symptoms of a levator spasm?
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Lower back pain, midvaginal dyspareunia, incontinence
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What are symptoms of piriformis spasms?
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NOT related to cycle, pain on external rotation of lower extremity
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What is osteitis pubis?
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Inflammation of the pubic symphysis from shearing forces or childbirth. Symptom may be pain on turning
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What could cause impotence?
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Reduced parasympathetic tone
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What could cause premature ejactulation
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Hypersympathetic tone
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How can prostatitis be treated?
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Treat pelvic diaphragm, T12-L2 and S2-4
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What is the ischiorectal fossa?
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Space below pelvic diaphragm, filled with fat
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How does the pelvic diaphragm move with inhalation/exhalation?
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Inverior with inhalation, superiorly with exhalation
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How is the pelvic diaphragm treated?
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Fingers held at point of tissue tension, resist downward motion with inhalation, follow cephalad motion on exhalation until maximal lift is palpated
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What level are the spinous processes of the first three vertebrae?
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Same level
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What level are the spinous processes of the vertabrae 4-6?
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Half level lower
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At what level is the spinous process of T7-9?
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A full level lower
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At what level is the spinous process of T10-12?
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Transitioning from half a level lower to same level
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What is the epithelium of the pancreatic ducts?
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Simple cuboidal to columnar
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At what vertebral level is the spine of the spine of scapula?
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3rd
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At what spinal level is the inferior angle of the scapula?
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7th
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Where does the 2nd rib attach to?
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The juncture of the manubrium and the sternum
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At what spinal level does the xiphoid end?
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T7 or T8
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At what level is the third rib at posteriorly?
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Scapular spine
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What are the typical ribs?
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9-Mar
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What are the features of typical ribs?
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Have thin head, neck, tubercle and body
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How to typical ribs articulate?
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Costovertebral - same body and body above, costotransverse - tubercle articulates with transverse process
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What vertebral bodies does Rib 1 articulate with?
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Only T1j
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Which ribs have no neck or tubercles?
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11 and 12
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What ligament connects transverse process to next lower rib?
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Superior ligament
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What are the ligaments of the costotransverse joint?
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Superior, lateral, intertransverse, and costotransverse
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Where does the crura anchor?
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L1,2, and 3
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What are the muscles of exhalation?
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Rectus abdominus, internal/external obliques, and transverse abdominus
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What are the accessory muscles of inhalation?
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SCM, scalenes
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What is the only articular connection of the upper extremety to the axial spine?
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Sternoclavicular junction
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What are the primary muscles of active exhalation
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Internal intercostals (except interchondral part) and abdominal muscles
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What ribs primarily have a pump handle motion?
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Ribs 2-6
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What is the motion of the 11th and 12th ribs during breathing?
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Caliper motion - internal and external rotation
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What is pump handle motion?
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Analogous to flexion/extension - ribs move anteriorly and superiorly to increase A/P diameter
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What is bucket handle motion?
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Analagous to abduction/adduction - rib moves laterally to increase transverse diameter
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How do ribs 7-10 move predominantly during respiration?
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Primarily bucket handle motion
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What did A. J. Murphy demonstrate in his research?
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Increase in tital volume, respiratory rate, and lung perfusion after OMM treatment
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What did Doran's research show?
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Treatment for lumbar lordosis decreased lordosis and increased tidal volume due to increased abdominal component to respiration
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What it atelactasis?
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Collapse of lung tissue
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Are rib belts contraindicated for rib fractures?
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Indeed.
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What is costochondritis?
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Inflammation of the costochondral junction: point tenderness, pain with large inhalation, confused with heart attack
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Where would one see viserosomatic reflex for Pneumonia?
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T2-4
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What is OMM for pneumonia?
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Treat rib from coughing, lumbar for diaphragm, thoracic dysfunction, and lymphatic pump
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What muscle is functionally an extension of the diaphragm?
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Quadratus lumborum - trigger points/spasms effect quality of diaphragm excursion
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What are iatrogenic causes of thoracic dysfunction?
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Thoracotomy for lobectomy, sternotomy for coronary bypass
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What a major metabolic cause of thoracic dysfunction?
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Osteoporosis - some techniques are contraindicated
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Note: testing motion of sternum by compression and by superior/inferior gliding
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Segmental evaluation of the manubrium
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What are the three ways ribs are classified?
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Based on landmarks, motion, and relation to the sternum
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What are the three type of rib motions?
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Pump handle, bucket handle, and caliper
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What motion do all ribs have?
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Pump handle and bucket handle. The first rib has 50/50
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What motion do the upper ribs predominantly have?
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Pump handle
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What motion do the lower ribs predominantly have?
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Bucket handle
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Pump handle motion
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Bucket handle motion of lower ribs
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What are components of typical ribs?
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Ribs 3-9: Shaft, head w/demifacets, tubercle, angle
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What is unique about rib 10?
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It has a unifacet, and a ruberosity for the serratus anterior
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What are the false ribs?
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8-12, 11/12 being floating ribs
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How are ribs 8-10 attached to the sternum?
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Through costal cartilage to the ribs above
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What are the two possibilities of rib disfunction?
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Stuck up in inhalation (exhalation dysfunction) or stuck down in exhalation (inhalation dysfunction)
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Which ribs tend to have bucket motion during respiration?
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10-Jul
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How are dysfunctional ribs named?
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For the freedom of motion - a rib stuck up on exhalation is an inhalation rib but has an exhalation disfuntion
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When dealing with a group of inhalataion ribs, which should be treated first?
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Bottom rib first to promote other ribs to fall into place
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If treating a group of exhalation ribs, which rib should be treated first?
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Top rib
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How many diaphragms are in the body?
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7
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What diaphragm does the tentorium cerebellie form?
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Attaches to the clinoid process creating the diaphragm sellae which cradles the pituitary with the infundibulum piercing the fascia
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What causes motion in the diaphragma sellae?
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Cranial rhythmic impulse
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Who is Harold Maguon?
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Described cranial motion through the tent to stimulate the pituitary
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What affects the thoracic inlet?
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The first rib
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What are the muscles of the pelvic diaphragm?
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Levator ani, coccygeus (pubo,ilio, and ischio)
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What is the diaphragm of the knee?
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Popliteal diaphragm - can hinder movement of fluids distally
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What is the diaphragm of the foot?
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Plantar diaphragm - aponeurosis
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What is the diaphragm of the hand?
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Palmar diaphragm - aponeurosis
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What are the anterior attachments of the abdominal diaphragm?
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Sterniod, xyphoid, internal surface of lower six ribs
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What are the posterior attachments of the abdominal diaphragm?
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T12, L1 and 2 on the left and L1-3 on the right (crura), ribs 6-12
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Does the central tendon of diaphragm have any bony attachments?
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No
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Where is the opening for the vena cava in the abdominal diaphragm?
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T8
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Where is the opening for the esophagus in the abdominal diaphragm?
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T10
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Where is the opening for the aorta in the diaphragm?
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T12
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What is the influence of the diaphragm on the esophagus and vena cava?
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On inspiration, the diaphragm contracts allowing the vena cava to dialate (more blood) and prevents gastro-esophogeal reflux, no influence on the aorta
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What three planes does the diaphragm increase thoracic volume?
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Vertical - depression of central tendon, Transverse - elevation of the lower 6 ribs, and Anteroposterior with elevation of sternum
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What is the relationship of the abdominal diaphragm to the pelvic diaphragm?
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Synchronized for optimum movement of interstitial fluids
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What happens during hypertonicity of the diaphragm?
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Increased tone causes diaphragm to flatten, may reverse motion of lower ribs -> less efficient breathing, decreased pressure gradient so less movement of lymph and venous return, utilization of accessory breathing muscles - scalenes
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What diseases can cause restricted thoracic cage mechanics?
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COPD, asthma, obesity, kyphosis
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What are the attachments of the anterior cervical fascia?
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base of skull, mandible, hyoid, scapula, and sternum
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What are the attachments of the pretacheal fascia?
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Hyoid cotinuous with the pericardial to T2 and the diaphragm
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How does cervical fascia move with exhalation and inhalation?
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Anterior with exhalation and posterior with inhalation
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What is Sibson's fascia?
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Scalene fascia
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What comprises the thoracic inlet?
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Prevertebral fascia and the scalene fascia
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What could compress the subclavian vein?
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Fascial restrictions, first rib and clavicle
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