PPOM 2 Week 1 LEC 1-11 WORK IN PROGRESS

This first lecture is straight pseudoscience. I tried my damn hardest to make sense of it but...ngl just take the L on it at this point

(1) Balanced Ligamentous Tension

Treatment principle taught by WG Sutherland In which an area of strain is brought to a point of balanced tension to engage and utilize the inherent forces within the patient's body to make the correction

(1) Ligamentous Articular Strain

Concept that went into the development of Balanced Ligamentous Tension; not a myofascial technique. Refers to somatic dysfunctions in the spine involving the ligaments as well as the joints

(1) Membranous Articular Strain

Concept that refers to cranial somatic dysfunctions, includes the intracranial membranes as well as the articulations

(1) Ligamentous Articular Mechanism

Process in which ligaments in their tension regulate the movements in the spinal articulations, as check agents to voluntary muscular action.

(1) Natural agencies

Involuntary action within the skeletal system itself underlying the neuromuscular system. “Powers within the patient's body” that can correct a somatic dysfunction by pulling the bones back into place.

(1) Primary respiratory mechanism

An involuntary motion that moves every part of our body when breathing. Can be used in conjunction with positioning of a patient (and the subsequent restoration of breathing) to work an articulation free and help restore normal tension in the body

(1) Microcirculation

The concept of somatic dysfunction affecting the body down to the cellular level, in which cellular exchange of oxygen and nutrients Is sensitive to tension in the body

(1) Point of balanced ligamentous/membranous tension

The point in the range of motion of an articulation where the ligaments and membranes are poised between the normal tension present throughout the free range of motion, and the increased tension preceding the strain (e.g. matching tension on multiple ligaments in the body so that their tension is balanced on both sides)

(3) Intermediate Mesoderm

Structure in embryo that ultimately forms the kidneys, differentiates into glomeruli and tubing; is well connected to the celom

(3) Celom

“Cavity”; folding space in lateral plate mesoderm where early liver, intestines, stomach are located; the kidney is a diverticulum of this structure and will eventually separate fully. Lateral plate mesoderm split in half.

(3) Mesonephric duct

structure that takes urine, eggs, and sperm and excretes them in an embryo

(3) Pronephros

Type of kidney found in embryos that is very primitive, develops in the neck, and never develops into functional excretory structures in the human. Lost after 4 days in human embryo

(3) Mesonephros

Type of kidney that is very strong and pervasive, its ducts and tubules remain in the adult while the glomeruli disappear

(3) Metanephros (Metanephric Kidney)

Type of kidney that is the adult kidney with new glomeruli; last stage of nephric structure development; Conglomerate of both mesonephric and metanephric structures

(3) The intermediate mesoderm is wedged between the _____ and the celom.

paraxial mesoderm

(3) The _____ is wedged between the paraxial mesoderm and the celom.

intermediate mesoderm

(3) The mesonephric ducts form the _____.

epididymis, vas deferens, trigone, ureter, metanephric calyces, trigone of the bladder

(3) The paramesonephric ducts form the _____.

oviduct

(3) The _____ are NOT part of the mesonephric system.

paramesonephric ducts

(3) Paramesonephric Ducts

Structure that is formed from the uterus/branching-off from the uterus; in the adult it will make the oviduct

(3) The glomeruli are derived from the _____.

metanephric system

(3) The collecting tubules, the minor and major calyxes, and the ureter are derived from the _____.

mesonephric system

(3) Ureteric Bud

Mesonephric structure that forms the collecting portion of the metanephric kidney: ureter, renal pelvis, major and minor calyces, collecting ducts, collecting tubules; branch from the mesonephric ducts, and they interact with metanephric blastema

(3) Metanephric blastema

Structure that sends signals to the ureteric bud causing it to branch and grow, and the ureteric bud induces the blastema to condense and form tubules; will form metanephric kidney (Bowman’s capsule, proximal convoluted tubule, loop of henle, distal convoluted tubule)

(3) Urorectal septum

Structure that ultimately separates the cloaca into separate pathways (for bladder, vagina, anus, etc)

(3) The trigone of the bladder is made of _____.

Mesonephric material

(3) Imperforate Anus

Medical condition that is a dysfunction of urorectal septum; Rectum opens into urinary or reproductive tract, or ends in a blind pouch. Leads to failure of neonate to pass meconium (due to anus not being open)

(3) (6) Hydronephrosis

Medical condition that is fluid filled enlargement of one (or both) kidneys. In the fetus, this is likely due to anatomic abnormality/obstruction in the ureters. In adults, Dilation of renal pelvis and calyces due to obstructed outlet. Most common site for obstruction is ureteropelvic junction. Flank pain if acute

(3) Renal Agenesis

Medical condition in which Ureteric bud fails to contact the metanephric blastema, and kidney ultimately does not form. Unilateral will cause remaining kidney to undergo hypertrophy; Bilateral will cause severe oligohydramnios, incompatible with life

(3) Oligohydramnios

Medical condition in which Insufficient amounts of amniotic fluid are surrounding the fetus. Often presents with Potter sequence: deformed limbs, dry skin, abnormal faces. Can present with Pulmonary hypoplasia

(3) Polyhydramnios

Medical condition of excess accumulation of amniotic fluid. Caused by: lack of

fetal swallowing (GI malformations, anencephaly), maternal diabetes mellitus

(3) Horseshoe Kidney

Medical condition of fusion of the right and left metanephroi near midline. Unified kidney is prevented from reaching the abdominal location by the inferior mesenteric vein. Increased risk for UTIs and kidney stones

(3) Pelvic Kidney

Medical condition of failure of one kidney to ascend to its normal location. Functions normally

(3) VACTERL association

Developmental conditions that tend to occur together: vertebral anomalies, anal atresia, cardiovascular abnormalities, tracheoesophageal fistula, esophageal atresia, renal anomalies, limb defects

(4) Hemodynamics

The principles that govern/drive blood flow in the cardiovascular system.

(4) (5) Stroke Volume (SV)

volume of blood ejected by the ventricle in one contraction. (ml/beat) - Most commonly Left Ventricle

(4) (5) Cardiac Output (CO)

volume of blood pumped by the heart per minute; stroke volume (mL) x heart rate (beats/min). Usually ~5 L/min. Equals venous return to the heart

(4) Blood Flow (Q)

Volume of blood that passes a given point in circulation in a given period of time (mL/sec or cm³/sec) → volume/time. Always constant, because velocity changes with the changes in vessel radius

(4) Velocity

Measurement of distance moved in a given amount of time; distance of displacement of blood per unit time (cm/sec). Blood Flow (Q)/Cross-sectional Area (A)

(4) Compliance/Capacitance/Distensibility

Ability of a vessel to distend and increase volume with increasing transmural pressure (how much blood it can hold)

(4) _____ have highest total cross-sectional area and lowest blood velocity.

Capillaries

(4) Velocity of blood flow is highest in the _____.

Aorta

(4) Velocity of blood flow is lowest in the _____.

Capillaries

(4) Vascular resistance (R)

Resistance to flow offered by the blood vessel, occurs as a result of friction between the flowing blood and the intravascular endothelium

(4) Formula for Blood Flow (Q)

(P1 – P2)/R = ΔP (mL/min)/R. P1 is higher pressure (eg arteries), P2 is lower (eg veins)

(4) Systolic Pressure

Highest arterial pressure in the cardiac cycle

(4) Diastolic Pressure

Lowest arterial pressure in the cardiac cycle

(4) (5) Mean Arterial Pressure (MAP)

running average of arterial pressure in the body

(4) Pulse Pressure (PP)

difference between systolic pressure and diastolic pressure (Systolic – Diastolic); The magnitude reflects the volume of blood ejected on a single beat. Normal value 30-40 mmHg

(4) Poiseuille’s law

Q=(πr⁴ΔP)/​(8Lη) where Q = flow, 𝑟 = radius of the tube, ΔP = pressure difference, L = length of the tube, η = viscosity

(4) LaPlace Law

Wall Tension in a Blood Vessel increases with the radius; Explains aneurysm risk in large arteries, compliance changes with stiffness/thickness

(4) (5) Formula for Arterial Blood Pressure (BP)

Cardiac Output x Total Peripheral Resistance

(4) (5) Formula for Mean Arterial Pressure (MAP)

(2 x Diastolic Pressure + Systolic Pressure)/3
OR
CO x TPR

(4) (5) Total Peripheral Resistance (TPR)

Resistance of the entire systemic vasculature; primary determinant is the adjustable arteriolar radius

(4) Formula for Total Peripheral Resistance

(Mean Arterial Pressure – Central Venous Pressure)/Cardiac Output

(4) Central Venous Pressure (CVP)

Blood pressure in thoracic vena cava, near right atrium. Normal = 0-7 mmHg

(4) Formula for Fick’s Principle

CO = [O₂ Consumption] / [O₂ Arterial] - [O₂ Venous]

(4) Preload

degree of stretch on the myocardium at the end of diastole (mL)

(4) Afterload

resistance against which blood is ejected (mmHg)

(4) Systemic Circuit Pressure

~120/80 mmHg

(4) Pulmonary Circuit Pressure

~20/8 mmHg

(4) Factors that decrease Stroke Volume

↓ Preload (less filling), ↑ Afterload (more resistance), ↓ Contractility

(4) Pulse Pressure is Influenced by:

Stroke volume, Speed of ejection (ventricular contraction rate), Arterial compliance (stretchiness)

(5) (6) Short-Term Blood Pressure Regulation

Occurs through Neural pathways that adjust vessel diameter, heart rate, and contractility. Within seconds to minutes, Sympathetic nervous system adjusts vascular tone very rapidly

(5) (6) Long-Term Blood Pressure Regulation

Occurs through hormonally-mediated pathways, primarily via renin-angiotensin-aldosterone system (RAAS) released by juxtaglomerular cells. Regulate blood pressure within hours to days; RAAS system provides sustained pressure regulation over time

(5) Baroreceptors

Primary sensors/detectors for Short-Term BP Regulation, Detect stretch of vascular wall/changes in BP. Send afferent signals to brain stem (NTS) via CN IX and CN X. Located in aortic arch & carotid sinus

(5) Chemoreceptors

Secondary sensors/detectors for Short-Term BP Regulation, Detect changes in blood PO2, PCO2, and pH. Located in aortic arch & carotid sinus

(5) CN IX (Glossopharyngeal Nerve)

Afferent Pathway for impulses; Located in carotid sinus

(5) CN X (Vagus Nerve)

Afferent Pathway for impulses; Located in aortic arch

(5) Nucleus Tractus Solitarius (NTS)

Control Center for Short-Term BP Regulation, Receives impulses and responds. Located in medulla

(5) Mechanism of Baroreceptor Reflex when BP is INCREASED:

Detect increased stretch, increase firing frequency, afferent signals sent via CN IX and CN X, signal received by NTS. Increased ACH, decreased NE, LOWER BP

(5) Mechanism of Baroreceptor Reflex when BP is DECREASED:

Detect decreased stretch, decrease firing frequency, afferent signals sent via CN IX and CN X, signal received by NTS. Decreased ACH, Increased NE, HIGHER BP

(5) Acetylcholine

Neurotransmitter that increases parasympathetic stimulation when released

(5) Norepinephrine

Neurotransmitter that increases sympathetic stimulation when released

(5) Valsalva Maneuver

Forceful exhalation against closed airway causing changes in intrathoracic pressure; can be used to decrease heart rate

(5) Carotid Massage

Stimulates the baroreceptors located in the carotid sinus, Can be used to decrease heart rate. Contraindicated with carotid bruits or history of TIA/CVA

(5) Carotid Sinus Hypersensitivity Syndrome

Medical condition in which there is increased carotid sinus sensitivity. common in older men with atherosclerotic disease. May cause syncope (fainting) during neck stimulation

(5) Mechanism of Chemoreceptor Reflex when CO₂ is INCREASED:

Detect decreased pH, afferent signals sent via CN IX and CN X, Stimulation of medullary respiratory center & medullary VMC. Increased sympathetic activity, HIGHER BP

(5) Mechanism of CNS Ischemic Response

Severe decrease in cerebral blood flow leads to increased CO₂, causing Vasomotor center excitation, leading to powerful vasoconstriction and INCREASED BP

(5) Cushing Reflex

Medical condition of increased intracranial pressure (ICP) leading to decreased cerebral blood flow. Possible causes include head injury, intracranial hemorrhage, tumor, excess CSF, etc

(5) White Coat Hypertension

Medical condition of Elevated BP in the clinical setting, but normal readings when BP measured elsewhere

(5) Cushing's triad

Hypertension, bradycardia, respiratory depression; Sign of increased ICP

(5) Atrial (Bainbridge) Reflex

Physiologic reflex, mediated by stretch receptors in the atria (B-fibers). Maintain normal blood volume by attempting to eliminate excessive fluid in the circulation/maintain cardiovascular system homeostasis

(5) Mechanism of Atrial (Bainbridge) Reflex

Increased venous return to the heart results in atrial distension, Causing atrial stretch receptors to be stimulated. increases sympathetic activity and inhibits parasympathetic activity, leading to INCREASED HR

(5) Mechanism of Atrial Natriuretic Peptide (ANP) Release

Causes vasodilation (via cGMP), INCREASED renal Na⁺/water excretion, inhibits renin, dilates afferent & constricts efferent renal arterioles leading to DECREASED BP

(5) Mechanism of Long-Term Blood Pressure Regulation

Decrease in Renal perfusion pressure (detected by baroreceptors in afferent arteriole) leads to juxtaglomerular cells secreting renin, which converts angiotensinogen to angiotensinogen I then angiotensinogen II.

(5) Risk factors for hypertension

↑ Age (> Below age 65, > after menopause), Obesity, Diabetes, High-sodium diet, Excess EtOH, Higher rates in African American > White > Asian, Hispanic

(5) Primary Hypertension

~90% of cases in adults, increasing prevalence in children and adolescents. Related to ↑CO or ↑TPR

(5) Secondary Hypertension

~10% of cases; May be secondary to renal or renovascular diseases, such as fibromuscular dysplasia and atherosclerotic renal artery stenosis

(5) Integrated Response to Hypovolemic Shock (Acute Bleeding)

Baroreceptor Reflex stretch decrease (increases HR), RAAS Activation (leads to water retention), ADH Release (leads to water conservation); leads to restoration of BP toward normal

(6) Kidney’s Regulation of Blood Homeostasis

Blood pressure, Acid-Base Balance (with the lungs), Electrolyte balance, Erythropoiesis, Bone and mineral homeostasis, Waste elimination, Glucose Homeostasis

(6) Kidney disease

Medical condition that leads to long term loss of BP control even with normal heart function; Treatment of hypertension requires addressing kidney function

(6) In situations such as a sudden drop in blood pressure, or high stress the sympathetic nervous system will act to _____ renal blood flow (RBF) so that blood flow to other organs can be preserved.

DECREASE

(6) In a situation of volume expansion renal blood flow (RBF) will _____ to enhance sodium and water excretion.

INCREASE

(6) Intrinsic Control System of Renal Blood Flow

Autoregulation; Preserves filtration despite changes in heart rate and blood pressure

(6) Extrinsic Control System of Renal Blood Flow

Overrides autoregulation; Volume regulation and emergencies

(6) Renal Artery Stenosis

Medical condition in which narrowing of artery prevents oxygenated blood from reaching kidney. Usually asymptomatic. Can cause Hypertension, Kidney Failure

(6) Normal Renal Blood Flow

1200 mL/min

(6) Normal Glomerular Filtration Rate

60-120 mL/min, 180L/day

(6) Glomerular Filtration Rate - Kidney Failure

< 15 mL/min