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  1. renal lymphatics:
    draining capsule and parenchymal flow-->preaortic lymph nodes--> thoracic duct --> subclavian vein
  2. Diaphragm motion is a major factor in lymph and venous return for GU. Diaphragm motion can be influenced by:
    • SD of TL junction
    • SD of lower ribs
    • spasm of QL and psoas
    • hyperlordosis
    • SD of phrenic nerve
  3. Symphathetic innervation of kidney:
    • Kidney T10-L1
    • superior mesenteric artery
  4. sympathetic innervation of ureter:
    • ureter T10-L1
    • sup mes (upper urteter)
    • inf mes (lower ureter)
  5. sympathetic innervation of bladder:
    • bladder T10-L1
    • trigone
    • detrusor
    • transverse perineal m- Pudendal n. S2-4
  6. sympathetic innervation of prostatic urethra:
  7. sympathetic innervation of prostate:
  8. sympathetic innervation of cervix:
  9. sympathetic innervation of fallopian tubes:
  10. sympathetic innervation of epididymis:
  11. sympathetic innervation of ovaries and testes:
  12. sympathetic innervation of uterus:
  13. sympathetic innervation of adrenal:
  14. Ureters:
    • adhere to peritoneum and descend on psoas fascia
    • psoas laterally displaces lower pole of each kidney
  15. Bladder and Urethra:
    • spinchter/trigone/ureteral orifices
    • inhibited by parasympathetics
    • bladder wall
    • activated by parasympathetics
    • inhibited by sympathetics
  16. viscero-somatic reflex of kidney:
    • T9-L1 ipsi
    • sup mes
  17. viscero-somatic reflex of ureter:
    • T11-L3 ipsi
    • sup mes (upper ureter)
    • inf mes (lower ureter)
  18. viscero-somatic reflex of bladder:
    • T11-L3 bil
    • trigone
    • detrusor
    • transverse perineal m-pudendal n. S2-4
  19. viscero-somatic reflex of urethra:
    T11-L2 bil
  20. viscero-somatic reflex of fallopian tubes:
    T10-L2 bil
  21. viscero-somatic reflex of external genitalia:
    T12 bil
  22. viscero-somatic reflex of epididymis:
  23. viscero-somatic reflex of ovaries and testes:
    T10-T11 ipsi
  24. viscero-somatic reflex of uterus:
    T9-L2 bil
  25. viscero-somatic reflex of adrenal:
    T8-T10 ipsi
  26. Chapman points of urethra:
    • ant: superior aspect of superior pubic ramus
    • post: tp of L3
  27. chapman points of prostate:
    • ant: lateral femur
    • post: sacral sulcus
  28. chapman points of bladder:
    • ant: periumbilical
    • post: tp of L2
  29. chapman points of kidney:
    ant: 1 inch lateral and 1 inch superior from umbilicus
  30. chapman points of broad ligament:
    • ant: lateral femur
    • post: sacral sulcus
  31. chapman points of uterus:
    • ant: superior aspect of inferior pubic ramus
    • post: tp of L5 and sacral sulcus
  32. chapman point of vagina:
    post: sacral sulcus
  33. chapman point of ovaries:
    • ant: superior aspect of superior pubic ramus
    • post: inf facet of T10
  34. dysmennorhea:
    • chapman's pts along IT band, pubic bone, or sacral ala
    • (symp T10-L2, PS-S2-4)
    • relieve edema, balance, autonomic tone
    • pt may self-tx w/ knee to chest position to decompress pelvis and increase drainage
  35. PMS:
    • tx symptomatically
    • headaches--cervical and subocciptial areas
    • bloating and bowel frequency--tx segmentally related areas
    • tx should begin before sx begin
  36. endometriosis:
    • sacral rocking to reduce parasymp
    • tx dysfunction of T-L junction (T10-L2)
    • mobilization of resp. diaphragm to improve circulation
    • tx of pelvic diaphragm relieves congestion and lower extremity edema
    • cranial, cervical, and sacral eval and tx to assist neuroendocrine system
  37. pelvic floor dysfunction:
    • SD of pelvis, sacrum &/or the pelvic diaphragm, as well as chapman's pts
    • tx w/ bimanual relaxation of muscle contractions via inhibitory pressure, counterstrain, and myofascial techniques
    • injections
    • kegel excercises
  38. vas deferens/seminal vesicles:
    T12-L2 inf mes
  39. prostate:
    • secretory sympathetic fibers
    • T12-L2
    • stimulation of hypogastric plexus (which carries fibers from T12-L2) causes true glandular secretions
    • pudendal nerve stimulation causes muscular contraction forcing secretions out of the urethra
  40. kidneys parasymp innervation:
  41. ureters parasymp:
    • (maintain nml peristaltic waves)
    • proximal vagus
    • distal pelvic splanchnics S2-4
  42. increased tone of symp to GU:
    • increased tone
    • Increased afferent arteriole constriction to kidney
    • Ureterospasm and decreased peristalsis of ureters
    • Relaxation of Bladder wall leading to reflux
    • Increased tone to external urinary sphincter
    • effects of increased tone
    • Decreased GFR
    • Decreased urinary output
    • Increased blood pressure
    • Uretero spasm-decreased urine flow through the ureters
    • Incomplete emptying of bladder
    • Encourages ureteral/prostatic reflux from bladder
    • Complaints of premature or retrograde ejaculation
  43. urologic parasympathetic pathophysiology:
    • increased tone
    • Increase peristalsis of ureters
    • Increased bladder wall tone
    • Relaxes external urinary sphincter
    • decreased tone
    • Incomplete bladder emptying
    • Impotence
    • TightensInternal Urinary Sphincter
  44. pudendal nerve S2-4:
    • External sphincter tone relies somewhat on innervation
    • When increase intra abdominal pressure pelvic diaphragm and external sphincter contract
  45. renal visceromotor:
    increased tonus to thoracolumbar junction (lloyd's punch)
  46. renal viscerosensory:
    (ache)--flank or thoracolumbar area
  47. ureteral visceromotor:
    hypertonus to abdominal, erector spinae, cremasteric muscles
  48. ureteral viscerosensory:
    (uterocolic) lumbar region to illiac fossa over front of abdomen to scrotum
  49. erection dependent on:
    • pudendal n. S2-4
    • parasymp S2-4
  50. premature ejaculation:
    • symp from L1-2
    • somatic S2-4
  51. micturition:
    • Distension of bladder walls initiates spinal reflexes that:
    • Stimulate contraction of the external urethral sphincter
    • Inhibit the detrusor muscle and internal sphincter (temporarily)
    • Voiding reflexes:
    • Stimulate the detrusor muscle to contract
    • Inhibit the internal and external sphincters
  52. SD of pubic symphysis:
    • Increased tension on urogenital diaphragm
    • Increased tension on Puboprostatic or pubovesicular ligaments may lead to dysuria(nocturnal enuresis?)
    • MFTrP-lower abdomen may cause-urinary frequency, urgency,sphincter spasm, residual urine, bladder pain Travel pp. 7671
  53. iliolumbar ligament:
    • old men
    • pain can refer to ipsilateral groin, testicles, rectum, hip, low back
  54. Chronic Pelvic Pain Syndrome (CPPS) prostadynia:
    • Symptoms
    • Irritative voiding symptoms and/or pain located in the groin, genitalia, or perineum in the absence of pyuria and bacteriuria
    • Absence of pus cells or bacteria seen on microscopic analysis of the urine.
    • Excess WBCs or bacteria seen on Gram stain and culture of expressed prostatic secretions (EPS) may be found.
    • Most common urological diagnosis males > 50 years old
    • Third most common diagnosis males < 50 years.
    • Diagnosis results in + 2 million office visits per year. Average urologist sees approximately 10 patients with prostatitis per month
    • Specific urinary pathogens are detected infrequently after culture.
    • Majority of these patients are categorized as having chronic nonbacterial prostatitis or prostatodynia, otherwise known as CPPS
    • etiology unknown:
  55. morning sickness/hyperemesis:
    • C2, T5-9
    • chapman's pts
  56. round ligament pain:
    L3-5 counterstrain points tx
  57. risk factors for low back pain during pregnancy:
    • heavy manual labor
    • smoking
    • parity
    • age
  58. symp labor & delivery:
    • uterine muscle contraction
    • vasoconstriction
    • sensation from fundus to uterus
  59. parasymp labor & delivery:
    • uterine muscle relaxation
    • vasodilation
    • sensation from uterine cervix
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