EXAM #2: OSTEOPATHIC CONSIDERATIONS IN GI Flashcards
What nerve provides 75% of the PNS influence on the body?
CN X (Vagus)
What nerves compose the cranial portion of the PNS?
CN III, VII, IX, X
What nerves compose the sacral portion of the PNS?
S2, S3, S4
What are the effects of increased PNS stimulation on the glands, GI, Liver, Gallbladder/ ducts, GI arterioles?
Glands= copious secretions
GI= stimulation of peristalsis and sphincter relaxation
Liver= promote glycogen synthesis
Gallbladder= contraction
GI arterioles= NO innervation
What ganglia are associated with the SNS?
T1 - L2
How does the SNS supply the head and upper extremity?
Cervical ganglia (CN II, V, VII)
What is the SNS supply to the lower extremity?
Lumbar splanchnic nerves
What is the SNS effect on the Glands, Blood Vessels, GI, Liver, Gallbladder, and GI arterioles?
Glands= decrease secretion
BV= constriction
GI= decrease peristalsis and increase sphincter tone
Liver= promote glycogen breakdown
Gallbladder= relax
GI arterioles= constriction
What type of tone is typically seen during disease or trauma?
Increased SNS tone
What are the effects of increased SNS tone in a disease state?
1) Vasoconstriction leading to decreased nutritional supply to tissue
2) Thickened secretions causing tissue congestion
3) Decreased lymphatic drainage
Clinically, what is the osteopathic viewpoint on the clinical impact of increased SNS tone in disease?
Impaired medication delivery
How do patients present with lymphatic congestion in regards to their appearance and palpatory ques?
- Appearance= uncomfortable
- Palpation= boggy/soggy
What is proper lymphatic motion dependent on?
Contractions of the diaphragm
What is the most important diaphragm to treat to improve lymphatic flow?
TI
What types of receptors relay the stretch that happens in the GI tract?
- Pacinian corpusles
- Free nerve endings
Describe the viscero-somatic relationship.
- Visceral pain is carried by visceral afferent”
- There is “spill-over” into the somatic afferents
What thoracic levels are associated with the Upper GI System?
T5-11
What throacic levels are associated with the Lower GI System?
T9-L2
In the thoracic vertebrae, what type of SD is commonly seen with a chronic GI issue?
- Extension
- Rotation
- Sidebending
All TOWARD the SAME side of the organ involved.
What is post-op ileus a consequence of?
Viscero-visceral reflex in response to handling of the bowel during during surgery
What ganglia will afferents from the thoracic splancnic nerves go to?
Celiac ganglion
What ganglion will afferents from lumbar splancnic nerves go to?
Inferior mesenteric ganglion
What is the outcome of hyperactivity of both the SNS and PNS?
IBS
What are the three main elements that will hinder lymph flow?
1) Flattened diaphragm
2) Fascial torsion
3) Thoracic inlet impairment
What lumbar segments correspond to the left crus?
L1- L2
What lumbar segments correspond to the right crus?
L1-L3
What viscero-somatic reflexes correspond to the stomach?
SNS= T5-9 on left PNS= OA
What viscero-somatic reflexes correspond to the gallbladder?
SNS= T9 PNS= OA
What viscero-somatic reflexes correspond to the liver?
SNS= T6-T9 PNS= OA
What viscero-somatic reflexes correspond to the pancreas?
SNS= T5-T11 PNS= OA
What viscero-somatic reflexes correspond to the small intestine?
SNS= T9-T11 PNS= OA
What viscero-somatic reflexes correspond to the ascending and transverse colon?
SNS= T10-T12 PNS= OA
What viscero-somatic reflexes correspond to the descending colon and rectum?
SNS= L1-2 PNS= S2-4
What viscero-somatic reflexes correspond to the appendix?
SNS= T12 right with rib PNS= OA
What viscero-somatic reflexes correspond to regional ileitis?
T10-T12
What viscero-somatic reflexes correspond to chronic constipation?
Erector spinae mass in the mid-lumbar region
Where can the gallbladder refer pain?
Right shoulder
Where can the pancreas refer pain?
Back
