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92 Cards in this Set
- Front
- Back
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What causes a "loose kidney"?
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almost always faulty posture
the drooped thorax obliterates the forward thrust to the ribs and relaxes the diaphragm, thus pushing the liver downward on the kidney to the right |
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Are the kidneys intra or retroperitoneal?
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retroperitoneal
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What is the relationship of other structures to the kidneys?
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quadratus lumborum
12th rib diaphragm psoas courses obliquely causing lateral displacement of the lower poles of the kidney ureters descend across the psoas fascia |
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How does movement of the diaphragm affect the kidneys?
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diaphragm pushes kidney inferiorly during inhalation
**chief factor in venous and lymphatic return |
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How does the psoas affect the position the kidneys?
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displaces inferior poles of kidney laterally
lumbar/psoas spasm causes fascial restriction of kidney mobility and ureteral function impairment |
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What is the origin and insertion of the quadratus lumborum? How is this related to the kidney?
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origin = iliolumbar ligament
insertion = tips of TP L1-4 and 12th rib **Kidney dysfunction can affect the quadratus lumborum because it attaches to the 12th rib |
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What is the effect of quadratus spasm?
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flattened diaphragm
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Describe the pain of a kidney stone
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starts as flank pain and then moves with the stone around to the front and down the side of the leg
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Which structure passes underneath the crus of the diaphragm?
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aorta
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Are chapman's reflexes sympathetic or parasympathetic? What type of reflex do they represent?
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sympathetic
viscerosomatic reflex |
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adrenal anterior chapman points
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one inch lateral and two inches superior to the umbilicus ipsilaterally
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adrenal posterior chapman points
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intertransverse space on both sides of T11 and T12 midway between the spinous processes and transverse processes
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kidneys anterior chapman points
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one inch lateral and one inch superior to umbilicus ipsilaterally
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kidneys posterior chapman points
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intertransverse space midway between spines and transverse process tips T12-L1
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Bladder anterior chapman points
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umbilical area (periumbilical)
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Bladder posterior chapman points
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intertransverse space (midway between spines and transverse process tips of L1-2)
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Urethra anterior chapman points
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in myofacial tissues along the superior margin of the pubis ramus about 2cm lateral to the symphysis
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T10-11 Sympathetic innervation
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Lesser Splanchnic nerve
- small intestine - right colon - adrenals - gonads - kidney - upper half of ureter |
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T12-L2 sympathetic innervation
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Least splanchnic nerve
- left colon - lower half of ureter - bladder - genitalia |
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Vagus parasympathetic innervation to GU
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kidney and proximal portion of ureters
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S2-4 parasympathetic innervation to GU
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pelvic splanchnic nerves
- distal portion of ureters - bladder |
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Sympathetic effects on Renal physiology
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vasoconstriction of afferent arterioles = decrease GFR and decrease urine volume
decreaesd ureteral peristaliss relaxation of the bladder wall (detrussor muscle) facilitates contraction of trigone muscle stimulates internal urethral sphincter to remain tightly closed inhibits parasympathetic stimulation micturition reflex is inhibited response is exacerbated by emotional stress |
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Parasympathetic effects on the GU system
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Ureters = maintains normal peristalsis
Bladder: - maintains bladder wall tonicity - excitatory to detrusor muscle - inhibitory to trigone muscle - works in concert with pudendal nerve in micturition = controls the bladder wall musculature; pudendal is voluntary control with the external urethral sphincter |
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Path of kidney lymph flow
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intrarenal plexi --> lateral aortic nodes --> thoracic duct --> left lymphatic duct --> subclavian vein
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Sibson's facia
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anterior cervical fascia--thoracic inlet
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Lymphatic OMT for Renal disease
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Goal = maximize renal drainage via the thoracic and pelvic diaphragms
- diaphragm - first rib restriction - anterior cervical facia (Sibson's facia) = thoracic inlet - lymphatic pump - rib raising - cervicothoracic junction |
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Direct OMT treatment of the kidney
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direct kidneys up and out
relaxes surrounding blood vessels, nerves and lymphatics may also relax tissues around the ureters |
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Symptoms of UTI
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Fever
Chills Nausea Fatigue Urinary Frequency or burning and pain |
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Pain in UTI
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bladder = suprapubic pain
kidney (pyelonephritis) = lower thoracic pain or flank pain |
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Lloyd's sign
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pain felt on the back at the level of the kidneys when you push on them = pancreatitis
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Who gets UTIs more: little girls or little boys?
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little girls
if a young male gets recurrent UTIs you need to do imagining studies for congenital problems |
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Diagnosis and treatment for UTIs
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diagnosis = urine culture and sensitivity
tx: antibiotics, fluid, pain control, OMT |
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OMT for UTIs
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evaluated pubic symphysis and pelvis floor somatic dysfunction (urogenital diaphragm)
T10-L2 = normalize sympathetic activity S2-4 = normalize parasympathetic activity--pudendal nerves tx cervical dysfunction tx thoracic attachments rib dysfunctions diaphragm |
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Causes of UTI
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intrinsic = within the urinary tract
extrinsic = secondary to an external compression congenital or developmental = slow onset calculi = usually rapid onset |
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Goal of OMT with urinary tract obstruction
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decrease ureteral spasm
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Presenting symptoms of tumors in the urinary tract
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vague pain
hematuria pelvic obstruction **mass may not be evident on physical exam |
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Can OMT be used in renal neoplasm?
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yes, but cautiously
OMT is directed at: - active connective tissue techniques to thoracic, lumbar and sacral areas - relieve spasm, tension - aid in bowel function - sacral parasympathetics |
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What is the goal of OMT in chronic kidney disease?
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improve lymphatics
**you will not cure chronic kidney disease with OMT |
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Signs and symptoms of chronic kidney disease
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usually develop slowly and are non-specific = can remain asymptomatic until GFR reaches 10-15ml/min
fatigue weakness malaise GI complaints = anorexia, nausea, vomiting, metallic taste in the mouth, and hiccups anemia acid-base problems hyperkalemia |
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What is a good diagnostic test for GI bleeding?
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BUN is elevated
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Goodpastures syndrome
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antibody-antigen complexes accumulate in the lungs and kidneys; affects young men
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Which kidney concern is commonly seen in crash injuries or burn victims?
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rhabdomyolysis = breakdown of muscles
can overload the kidneys and cause acute kidney failure |
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How can OMT help in Acute Renal Failure?
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can help to relieve any structural hindrances to recovery, and again by optimizing the body's own forces for self-healing, self-regulation and health maintenance
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Five major types of urinary stone disease (urolithiasis)
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1. calcium oxalate
2. calcium phosphate 3. struvite 4. uric acid 5 cystine **calcium types most common = they are radio opaque |
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signs and symptoms of urinary stone disease
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"stones, groans and psychic overtones":
renal colic = peristalsis over the obstructing stone that causes pain nausea vomiting increased frequency and urgency of urination patient in constant motion |
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Describe the pain seen in urinary stone disease and to where it is can refer
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renal colic pain occurs suddenly and may awaken patient from sleep, usually severe
pain is usually anterior to abdomen may refer to labium or ipsilateral testes |
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Does stone size correlate to the severity of symptoms in urinary stone disease?
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NO
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Do you usually see hematuria in urinary stones?
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10% is macro blood in UA
absence of blood does not exclude stones |
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Autonomic innervation of ureters
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sympathetic = T10-L1(2)
parasympathetic = proximally by vagus; distally by S2-4 |
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Inguinal Ligament Somatic discution
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one main structural cause of groin or inguinal pain is inguinal ligament somatic dysfunction
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What causes inguinal ligament somatic dysfuction?
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tight jeans
pregnancy rapid weight gain major innominate dysfunction tight belt = policeman belts with gun |
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Meralgia Paresthetica
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paresthesia in the distribution of the lateral femoral cutaneous nerve due to compression of the nerve as it passes between the inguinal ligament and sartorius
may be caused by inguinal ligament dysfunction |
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Inguinal ligament TENDER POINT
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on the lateral border of the pubic bone near the attachment of the inguinal ligament
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Illiolumbar Ligament syndrome
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iliolumbar ligament becomes tender with low back pain due to postural decompensation
**It is the first ligament stressed with postural instability |
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iliolumbar ligament (attachments and function)
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attaches to the transverse processes of L4, L5 and extends to the iliac crest and posterior and anterior regions of SI joint
Function = restricts lumbosacral side-bending and rotation |
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iliolumbar ligament TENDER POINT
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located 1 inch superior and medial from the inferior margin of the PSIS and in the iliolumbar ligament
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Who described a referral pattern for triggerpoints in the psoas muscle? What are they?
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Travell
1. lateral to L2-3 2. medial to iliac crest 3. medial and superior to head of the femur, just below inguinal ligament |
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Sympathetic effects on the urinary tract
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Bladder = T12-L2
- decreases ureteral peristalsis - relaxes detrusor muscle - increases internal sphincter tone |
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Parasympathetic effects on the urinary tract
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bladder = S2-4
- increases peristalsis - contracts detrusor |
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facial/ligamentous attachments of the bladder
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apex of the bladder = attached to the anterior abdominal wall by the remnant of the urachus = median umbilical ligament
fibromuscular tissue connects the bladder of the neck to the inferior aspects of the pubic bones |
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Three types of incontinence
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urge incontinence
stress incontinence overflow incontinence |
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Which osteopathic considerations should you take into account when treating urge incontinence?
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urge incontinence could be caused by hyperparasympathetic tone to the bladder = PNS is responsible for bladder wall contraction and ureteral peristalsis
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Causes of stress incontinence
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1. insufficient urethral support from pelvic endofascia and muscles
2. complete failure of urethral closure called intrinsic sphincter deficiency (ISD) 3. controversial consideration of urethral instability |
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Causes of overflow incontinence
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detrusor weakness and/or bladder outlet obstruction
replacement of detrusor muscle with fibrosis and connective tissue peripheral neuopathy (diabetes, pernicious anemia, parkinsons, alcohol abuse) damage to spinal afferents by disc herniation, spinal stenosis, tumor, etc. |
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Where should you focus OMT tx for urge incontinence?
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sacrum S2-4
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Where should you focus OMT tx for stress incontinence?
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pelvic diaphragm
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Where should you focus OMT tx for overflow incontinence?
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balancing autonomic tone and tx of the sacrum to optimize the voiding reflex and detrusor control
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Voiding reflex
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1. afferent signals to L1-2 senses "fullness"
2. Visceral afferents to S2-4 3. PNS relaxes the internal sphincter 4. SNS relaxes the internal sphincter 5. pudendal nerve relaxes the external sphincter and pelvic floor |
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What causes hypertonic bladder?
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cortical/cortical spinal lesions
can's feel fullness but increased pressure causes need to urinate |
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What causes autonomic bladder?
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transection above sacrum
can feel fullness but emptying is reflex (can't control it) |
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What causes hypotonic bladder?
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cauda equina/pelvic splanchnic lesion
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Causes of acute epididymitis
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VINDICATES:
Vascular Infectious Neoplastic Degenerative/Deficiency/Drugs Iatrogentic/Idiopathic Congenital Autoimmune Trauma Environmental/Endocrine pSychiatric/Something else |
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Essential features of acute epididymitis
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fever
irritative voiding symptoms painful enlargement of epididymis |
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Two types of epididymitis
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1. sexually transmitted (gonorrhea, chlamydia) = males under 40
2. non-sexually transmitted (usually UTI or prostatitis) = older men usually |
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Prehn sign
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elevation of hemiscrotum relieves pain = acute epididymitis
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Describe the pain seen in epididymitis
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pain develops in the scrotum and can radiate along the spermatic cord or to the flank
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Sympathetic innervation of the reproductive system
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T10-11 = gonads (testes and ovaries)
T12-L2: males = penis, prostate, vas deferens, seminal vesicles females = uterus, uterine tubes, cervix and vagina |
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Parasympathetic innervation of reproductive system
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Vagus = gonads
S2-4 = rest of reproductive tract |
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effects of sympathetics on the reproductive system
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T12-L2
primary function in smooth muscle contraction and secretions - vasoconstriction - ejaculation |
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effects of parasympathetics on the reproductive system
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Vagus = unknown role in gonadal secretion
S2-4 - vasodilation and stimulation of erectile tissue - role in erectile dysfunction |
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Lymphatics of reproductive system
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highly dependent on the motion of the thoracic and pelvic diaphragm
obstruction of flow leads to pelvic congestion |
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Impotence causes, functional etiology and OMT
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Primarily caused by psychic factors but organic and functional etiologies should be ruled out.
Functional etiology derived from S 2 – 4 Pudendal Nerve: somatic input Parasympathic reflexes OMT should focus on SI somatic dysfunction |
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Premature ejaculation
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primarily a sympathetically mediated event activated through L1-2 and aided by somatic influence of S2-4 (pudendal)
facilitation at L1-2 |
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Dysparenuria etiology and OMT
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spasm of pelvic floor or vagina, inadequate lubrication, genital tract abnormality
OMT = focus on pelvic diaphragm attachments and normalization of parasympathetic tone (S2-4) |
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Sympathetic innervation of the Testes
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T10-11
lesser splanchnic and superior mesenteric ganglion |
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Sympathetic innervation of the Prostate/Genitals
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T12-L2
Least Splanchnic and inferior mesenteric ganglion |
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Parasympathetic innervation of the testes
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vagus
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Parasympathetic innervation of the prostate/genitals
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S2-4
Pelvic Splanchnic nerves |
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Genital innervation of sexual function
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erection = pudendal nerve (somatic) and pelvic splanchnic (parasympathetic)
orgasm = lumbar splanchnic L1-2 (sympathetic) Ejaculation = lumbar splanchnic nerve via hypogastric nerve (symp) to vas and seminal vesicles |
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Which organism usually causes prostatitis?
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usually gram neg rods--E. coli or pseudomonas
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Anterior chapman's points for prostate
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located in myofascial tissues along the posterior margin of the iliotibial band
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Should you put in a catheter if patient develops urinary retention?
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NO
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