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Lecture 12, lmao...
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(12) Primary Respiratory Mechanism
Concept of 5 separate phenomena within movement of the cranial bones that Dr. Sutherland perceived; discovered as an involuntary motion in the body
(12) 5 Phenomena of the Primary Respiratory Mechanism
The inherent Motility of the brain and spinal cord; The fluctuation of the cerebrospinal fluid (The potency of the Tide); The mobility of the dural membranes; The mobility of the cranial bones; The involuntary mobility of the sacrum
(12) Cranial motions associated with inhalation
The cranium widens transversely and narrows both A/P and vertical dimensions
(12) Cranial motions associated with exhalation
The cranium widens A/P and narrows transversely
(12) Serrate suture
Interlocking spicules allow a rocking/hinge-like movement, necessary to allow a widening of the parietal bones. E.g. Sagittal Suture
(12) Squamous suture
Marked overlapping with little interdigitating. This allow a gliding movement, necessary to accommodate the increasing and decreasing transverse diameter during inhalation and exhalation.
(12) (13) The bones of the cranial base (petrous temporal, sphenoid body, and occiput below superior nuchal line) are formed in:
cartilage
(12) (13) The bones of the cranial vault (parietals, frontals, squamous temporal and occiput, etc) are formed in:
membrane
(12) Flexion (PRM)
The rotation of the midline bones during inhalation phase of the PRM
(12) Extension (PRM)
The rotation of the midline bones during Exhalation phase of the PRM
(12) Function of Dura
attaches to each of the bones of the cranial base; act as ligaments, guiding and limiting the motion of the bones
(12) The Falx Cerebri attaches to the:
occiput and ethmoid
(12) The Tentorium Cerebelli attaches to the:
occiput, temporals, and sphenoid
(12) The “core link”, or the spinal continuation of the dura, connects the:
occiput to the sacrum; includes the sacrum in the primary respiratory mechanism
(12) Circulation of CSF begins at:
Choroid Plexus
(12) Circulation of CSF ends at:
Arachnoid Granulations; empties into venous sinuses
(12) Motility of the CNS
Coiling and uncoiling of CNS which begin as its developmental movement. Moves synchronously with the phases of the PRM
(12) Fluctuation of the CSF
A to and fro movement involved in the physiology of the CNS produced by an unknown force
(12) Mobility of the Dural membranes
Act as check ligaments, guiding and limiting the movement of the cranial bones; Motion is arcing, like that of a sickle; Operates from a fulcrum, found along the straight sinus
(13) At birth, the Occiput is in ___ parts.
4
(13) At birth, the Sphenoid is in ___ parts.
3
(13) At birth, the Temporal is in ___ parts.
3
(13) At birth, the Maxillae is in ___ parts.
2
(13) At birth, there are ___ Fontanelles and no mastoid process.
6
(13) Sphenobasilar Synchodrosis (SBS)
The articulation between the Occiput and the Sphenoid; Similar motion can occur here as in the spine (flexion/extension, rotation and side bending)
(13) Flexion in Vault Contact
the greater wings of the sphenoid and occipital squama move inferiorly as SBS rises
(13) Extension in Vault Contact
the greater wings of the sphenoid and occipital squama move superiorly as SBS falls
(13) CN IX (Glossopharyngeal), X (Vagus), and XI (Spinal Accessory) exit through the:
Jugular Foramen
(13) CN XII (Hypoglossal) exits through the:
Hypoglossal Canal
(13) Plagiocephaly
Medical condition characterized by an asymmetrical distortion (flattening of one side) of the skull
(13) Brachycephaly
Medical condition also known as flat-head syndrome - shortened front-to-back diameter of the skull.
(13) Craniosynostosis
Medical condition of early closure of a cranial suture
(13) Duane’s Retraction Syndrome
Medical condition of Congenital absence or poor development of the abducens nuclei, with aberrant innervation by the oculomotor nerve, that leads to impaired ocular motility
(13) Physiologic SBS Cranial Strain patterns
Flexion (Inhalation), Extension (Exhalation), Torsion, Sidebending and rotation
(13) Non-Physiologic SBS Cranial Strain patterns
Vertical Shears, Lateral Shears, Compression
(13) Lateral Strains: “Parallelogram Head”
Medical condition in which the sphenoid and occiput rotate in the same direction; Can be due to compressive force, positional, in utero or plagiocephaly secondary to torticollis or trauma from a lateral force
(13) CN VII (Facial) and VIII (Vestibulocochlear) exit through the:
internal acoustic meatus
(13) CN I (Olfactory) exits through the:
Cribiform plate – ethmoid
(13) CN II (Optic) exits through the:
optic canal – sphenoid
(13) CN III (Oculomotor) exits through the:
superior orbital fissure (SOF) – sphenoid
(13) CN IV (Trochlear) exits through the:
superior orbital fissure (SOF) – sphenoid
(13) CN V (Trigeminal) exits through the:
V1 – SOF, V2 – Foramen Rotundum, V3 – Foramen Ovale – sphenoid
(13) CN VI (Abducens) exits through the:
SOF – sphenoid & petrosphenoid ligament
(13) Superior vertical strain
Occiput rotates into relative extension; Sphenoid rotates into relative flexion
(13) Inferior vertical strain
Occiput rotates into relative flexion; Sphenoid rotates into relative extension
(13) SBS compression - “Bowling Ball Head”
Medical condition often secondary to trauma with a compressive force directed towards midline, jamming the SBS together.
(13) Absolute Contraindications to Osteopathic Cranial Manipulative Medicine (OCMM)
Acute intracranial bleeding, Skull fracture, Acute cerebrovascular accident
(13) Relative Contraindications to Osteopathic Cranial Manipulative Medicine (OCMM)
Coagulopathies, Space occupying lesion in cranium, Increased intracranial pressure
(15) Calcium (Ca²⁺)
Primary structural role in bone formation (99% stored in bone as hydroxyapatite). Critical for muscle contraction, blood clotting, nerve transmission, and cardiac conduction
(15) Phosphate (PO₄³⁻)
Major role in cell metabolism (ATP production), oxygen release from hemoglobin (2,3-BPG), buffering acid-base balance, and muscle contraction. Stored largely in bone (86%), with smaller portions in intracellular fluid (14%) and negligible in extracellular fluid
(15) Parathyroid Hormone (PTH)
Hormone that is released when serum calcium is low (Stimulated by hypocalcemia)
(15) Calcitriol (1,25-dihydroxyvitamin D)
Hormone that is Active vitamin D; formed in proximal tubules by 1-α-hydroxylase (stimulated by PTH); Inhibits PTH secretion
(15) Calcitonin
Produced by thyroid parafollicular (C) cells when calcium is high; “tones down” calcium
(15) Fibroblast Growth Factor 23 (FGF23)
Bone-derived hormone; decreases serum phosphate by decreasing renal phosphate reabsorption and decreasing calcitriol synthesis
(15) Parathyroid Hormone (PTH) effects on bone
Indirectly stimulates osteoclasts → bone resorption → ↑ Ca²⁺ and PO₄³⁻ release
(15) Calcitriol (1,25-dihydroxyvitamin D) effects on bone
↑ Osteoclast activity → ↑ release of Ca²⁺ and PO₄³⁻
(15) Calcitonin effects on bone
Inhibits osteoclasts which decreases bone resorption
(15) Parathyroid Hormone (PTH) effects on kidney
↑ Ca²⁺ reabsorption, ↓ PO₄³⁻ reabsorption, ↑ calcitriol synthesis (via 1-α-hydroxylase).
(15) Calcitriol (1,25-dihydroxyvitamin D) effects on kidney
↑ Ca²⁺ and PO₄³⁻ reabsorption
(15) Calcitonin effects on kidney
Decreases Ca²⁺ reabsorption
(15) Calcitriol (1,25-dihydroxyvitamin D) effects on GI tract
↑ Absorption of Ca²⁺ and PO₄³⁻
(15) rickets/osteomalacia
Medical condition of Vitamin D deficiency; presents with hypocalcemia, bone softening
(15) Thiazide diuretics
Medications that Reduce urinary calcium excretion so that there’s less calcium available to form kidney stones; Prescribed to patients with recurrent nephrolithiasis
(15) PTH effect on Ca²⁺
increases serum Ca²⁺
(15) PTH effect on PO₄³⁻
decreases reabsorption (phosphate-trashing hormone)
(15) FGF-23 function
lowers serum PO₄³⁻ by reducing reabsorption & calcitriol production
(15) Calcitriol primary role
↑ intestinal absorption of Ca²⁺ & PO₄³⁻
(15) Calcium handling in Proximal Tubule
70% reabsorbed; Paracellular reabsorption (passive), Na⁺-driven; Driven by positive lumen potential; Not hormonally regulated
(15) Phosphate handling in Proximal Tubule
80% reabsorbed (Minimal phosphate reabsorption in other nephron segments); Na⁺/PO₄³⁻ cotransporter
(15) Calcium handling in Loop of Henle
20% reabsorbed; Paracellular transport, driven by lumen-positive potential
(15) Calcium handling in Distal Convoluted Tubule
8% reabsorbed; transcellular, PTH & calcitriol regulated
(15) Mechanism of Action of Thiazide diuretics
Block Na⁺/Cl⁻ cotransporter in DCT, Cause mild volume contraction; Directly stimulate Ca²⁺ reabsorption in DCT