Final Exam Flashcards

Question

coronal plan

Answer 1

vertical axis

Answer 2

sacrum on ilia

Answer 3

craniosacral

Answer 4

ilia on sacrum

Answer 5

Page 39-40

Answer 6

Pages 109-110

Answer 7

page 43-45

Answer 8

page 92-94

Answer 9

page 39-40

Answer 10

Page 39-40

Answer 11

page 76-77

Answer 12

- Improve arterial supply - Improve venous and lymphatic drainage - Reduce muscle spasm and improve breathing - Reduce discomfort - Balance autonomic reflex disturbances - Improve immune function

Answer 13

Approximately 85% of the venous drainage from the head courses through the internal jugular veins. They pass through the jugular foramen, which is formed at the junction of the occiput and temporal bones along the occipitomastoid suture. The venous drainage through this low pressure system can be impaired by increased tension in the suboccipital region resulting from OA and AA dysfunction.

Answer 14

treating upper thoracic and upper rib dysfunction first will make the cervical spine and cranial mechanism easier to treat

Answer 15

the HVLA techniques covered today can be easily modified into muscle energy techniques (Chicago-style muscle energy). The setups are somewhat different than the muscle energy techniques already covered for OA and AA and both are clinically effective.

Answer 16

* Same setup as HVLA. * After engaging the barrier, instruct the patient to gently turn their head to the right. Maintain contraction for approximately 3 seconds. * Instruct patient to relax. * Wait until the muscles completely relax (approximately 2 seconds). * Re-engage the barrier. * Repeat above sequence a total of 3-5 times (until no further improvement of motion noted). * Reassess.

Answer 17

* Same setup as HVLA above. * After engaging the barrier, instruct the patient to gently turn their head to the right. Maintain contraction for approximately 3 seconds. * Instruct patient to relax. * Wait until the muscles completely relax (approximately 2 seconds). * Re-engage the barrier. * Repeat above sequence a total of 3-5 times (until no further improvement of motion noted). * Reassess.

Answer 18

anterior between ribs 3-4 close to the sternal border; posterior between T3-T4 near spinous processes

Answer 19

anterior between ribs 4-5 close to the sternal border; posterior between T4-T5 near spinous processes

Answer 20

anterior between ribs 3-4 close to the sternal border; posterior midway between the TP and SP of T2 on the posterior aspect of the TP

Answer 21

anterior costochondral junction of 1st rib; posterior, place finger under the jaw angle, like you are drawing a line across the face to parallel the line of the mouth and pushing the finger backward until you come in line with the TP of the vertebrae

Answer 22

1st and 2nd intercostal space close to the sternum; posterior surface of C1 TP, midway between the median line of the neck and the tip of the TP sinuses: 3 ½” from the sternum, on the upper edge of 2nd rib and in the 1st intercostal space above; posterior midway between the TP and SP of C2 on the superior aspect of the TP

Answer 23

upper edge of the clavicle, just beyond where it crosses the 1st rib; posterior upper edge of the posterior aspect of the tip of C1 TP

Answer 24

front of 1st rib ¾-1” toward the sternum from where the clavicle crosses the rib; posterior midway between the SP and TP of C2, on the post aspect of the TP

Answer 25

upper surface of 2nd rib, 2-3” from the sternum; posterior midway between the TP and SP of C2 on the superior aspect of the TP

Answer 26

along with cervical spine 3-5/phrenic nerve

Answer 27

especially extended segments palpatory changes at T2-T4 on the left with respiratory problems (viscerosomatic changes)

Answer 28

associated with upper thoracic dysfunction

Answer 29

affecting the superior, middle and inferior cervical ganglia

Answer 30

Cord segments T1-6 | Synapses occur in the upper thoracic and/or cervical chain ganglia

Answer 31

(especially flexed segment T10- L2) can facilitate increased sympathetic tone to the adrenal glands which can lead to weakening of the immune system if chronically present. Can also impair toxin excretion via the kidneys and intestines with chronic somatic dysfunction.

Answer 32

compromises respiratory function

Answer 33

``` Vagus nerves (cranial nerve 10) Also have ipsilateral distribution ```

Answer 34

(SBS compression, occipitomastoid compression affecting jugular foramen), occiput, atlas and remainder of cervical spine may alter drainage of the sinuses, function of the diaphragm

Answer 35

the production of mucus and nasal congestion

Answer 36

``` Galbreath technique Thoracic inlet Respiratory diaphragm a. Lower thoracics b. Lower ribs c. Upper lumbars ```

Answer 37

anterior cervical fascia

Answer 38

increased sympathetic tone in the thoracic spinal region

Answer 39

sternum (thymus), right lower ribs (liver), left lower ribs (spleen)

Answer 40

during an acute exacerbation

Answer 41

1) No forceful direct treatments (depending on severity of illness) 2) HVLA to the thoracic spine relatively contra-indicated due to initial increase in sympathetic activity 3) Do not overtreat and tire the patient 4) Do not use treatment positions that aggravate patient’s breathing or pain (relative caution) 5) Thoracic pump technique in COPD patients 6) Visceral techniques in the acute phase

Answer 42

``` What is the most likely diagnosis? Which OPP treatment model will be helpful? Circulatory Biomechanical Metabolic Behavioral ```

Answer 43

Open Sibson’s fascia  Drain anterior and posterior cervical regions to enhance drainage of lymph

Answer 44

Patient is supine Stand on their right side facing the head Right hand fingers curl into Sibson’s fascia Left hand and arm support the right upper extremity Rhythmically abduct and flex the RUE while increasing pressure over Sibson’s fascia Repeat on the left side reversing hand holds

Answer 45

”The cervical fascia consists of fibrous connective tissue which invests the organs of the neck, ensheathesthe muscles, nerves and vessels, and fills the tissue interstices. It binds the cervical structures into functional units by dividing the neck into a series of planes and compartments”

Answer 46

Vertebral Compartment PrevertebraleFascia Visceral Compartment Buccopharyngealand PharyngobasilarFascia, PretrachealFascia and Fascia Alar Vascular Compartment Carotid Fascia MusculofascialCollar

Answer 47

compartments and fascial spaces for muscles, visceral, nerves, vascular and lymphatic structures and maintains the mechanical, neural and circulatory integrity of the cervical region. It further contributes to transmission of forces between head, neck and thorax

Answer 48

A.Subcutaneous tissue B.Masticator fascia, Submandibular fascia and Sternocleidomastoid-Trapezius Fascia C.Strap muscle fascia and Prevertebral(perivertebral) fascia D.Visceral fascia and carotid sheath

Answer 49

Stand on one side of the supine patient Rest cephalad hand on their forehead Gently grasp the posterior aspect of the neck Rhythmically turn their head toward the same side while pulling the musculature toward you Repeat on the other side

Answer 50

Stand on one side of the supine patient Rest cephalad hand on their forehead Gently grasp the anterior aspect of the neck Rhythmically turn their head toward the same side while gently pulling the musculature toward you Repeat on the other side

Answer 51

While seated behind the supine patient Place one hand on the mandible and the other on the ipsilateralclavicle to stretch the vascular compartment Use a rhythmic stretch Repeat on the other side

Answer 52

Address pressure points for the sinuses Finish with a thoracic lymphatic pump Treat Chapmans’ points (balance anterior to posterior points)

Answer 53

Sinus pressure How can you help that? Address the superior cervical ganglion (OA, AA) Why? Affects nasal congestion and mucous production

Answer 54

``` •Upper thoracic vertebrae –Mechanical effects –Sympathetically mediated viscerosomaticreflexes (T1-6) •Ribs •Sternum •OA –parasympatheticallymediated viscerosomaticreflexes •Accessory muscles of respiration •Anterior cervical fascia •Thoracic diaphragm –C3-5 (phrenic nerve) –Upper lumbars(diaphragmatic crus) •T10-12 and the lower ribs –Connection to diaphragm ```

Answer 55

•Over 150 joints are involved in the respiratory mechanism. * Somatic dysfunctions of the “pump” have direct effects on the viscera * decreased arterial supply * decreased venous drainage * decreased lymphatic drainage * decreased responsiveness of the respiratory mechanism to body demands (acid/base, oxygen demand, CO2 removal)

Answer 56

1. The child is seated with physician behind them. 2. The physician’s thumbs are placed on the transverse processes of the segments to be treated. The physician most often will have each thumb on a different segment. The fingers wrap around the thorax for stabilization. 3. This is a direct treatment. Engage the area focusing on the myofascial planes surrounding the vertebrae by working with rotation, sidebendingand flexion/extension. Then begin to work outwardly to engage the surrounding tissues of the diaphragmatic crus,andthe diaphragm. Remember, the focus is within the myofascial structures, not the articular.

Answer 57

The upper rib-vertebral-sternal complex is often a hot-bed of somatic dysfunction in people with asthmatic and related disorders. 1. Contact the sternum, upper ribs, and upper vertebrae (if possible). 2. Directly engage the barrier by moving the ribs, sternum, and vertebrae in whatever way is necessary to bring myofascial release to the entire upper thoracic region.

Answer 58

1. Gently grasp both the anterior aspect of the rib, lateral to the costochondral junction, and the posterior aspect over the rib angle, as close to the costotransverse junction as possible. 2. Disengage the rib by using a pincer grasp (a gentle anterior-posterior force) 3. Once the rib is disengaged gently rock the rib along its long axis until a release is felt.

Answer 59

Assessment of the ribs should happen in conjunction with the thoracic vertebral evaluation TART changes over the rib angles Tenderness Asymmetry: prominent rib angles Tissue texture changes When you find motion restriction/somatic dysfunction of vertebral segments, you should automatically look at the ribs as well. The ribs attach to the vertebral segments at the same level and above (for example, rib 3 attaches at T2 and T3). Restricted motion of one will affect the other

Answer 60

``` Can be in the seated or supine position (we will do supine today) Observe global breathing patterns Chest v abdominal breathing Rate, rhythm, ease of breathing Assess motion of the following areas: Ribs 1-5 (Pump handle motion) Ribs 6-10 (Bucket handle motion) Assess for the anterior counterstrainpoints ```

Answer 61

Best done in the prone position Assess Ribs 11-12 (Caliper motion) Posterior counterstrainpoints

Answer 62

* Found along the mid clavicular line, or along the mid axillary line * Often associated with exhaled sd * Treated * Knee contralateral * flexion and side bending towards the tender point (more flexion with anterior points and more side bending with lateral points) * Rotation is usually towards the tender point. * Hold for 120 seconds!!

Answer 63

* Found along the posterior rib angles * Often associated with inhaled sd * Treated * Knee ipsilateral * slight extension, side bending away to elevate the posterior part of the rib, * Rotation usually away from the rib tender point. * Hold for 120 seconds!!!!

Answer 64

more flexion

Answer 65

more sidebending

Answer 66

rib 1 is middle and anterior scalene rib 2 is posterior scalene rib 1 hand straight on face rib 2 face is turned away with hand on forehead

Answer 67

pectoris minor picture

Answer 68

lats picutre

Answer 69

iliolumbar * Caudadhand over ASIS * Cephaladhand over posterior lateral aspect of ribs 11 or 12 * Anterior lateral vector

Answer 70

* Caudadhand over ASIS * Cephaladhand over posterior medial ribs 11 or 12 * Anterior vector

Answer 71

``` –Biomechanical •Need to make diaphragm more mobile •Need to improve the bellows function of the ribcage •Need to address scalenes/1strib –Respiratory/Circulatory/Lymph •Need better air exchange •Avoid thoracic lymphatic pump technique –Neurological •Viscerosomatics –Metabolic •Breathing is hard work and many with COPD cannot breathe while eating –Behavioral •smoking cessation ```

Answer 72

If one thinks of the hemi-diaphragm as an upside-down ladle, then the bowl is the domed portion of the upper diaphragm and the handle is the crus. Then the ribs outline the rim of the bowl. The handle is attached to the anterior lumbar vertebrae.

Answer 73

Direct: Identify the restrictive barrier in multiple planes. Engage the tissue in opposition to the pattern of dysfunction. Load a constant force on the area of greatest restriction. Wait for the tissues to unwind or release. Indirect: Identify the position of free motion in all planes. Place the tissue into the position of ease and maintain this until the tissues release.

Answer 74

* Stand behind seated patient. Placing patient so that their center of gravity is close to yours will make the biomechanics of the technique easier and allow you to use your arms and torso to support the patient. * Place finger pads under the anterior costal margin and contact the diaphragm. * Assess where the greatest area of restriction is. The restriction may be in the mediastinum or the lumbar spine. * Expand your anatomical awareness and try to think in 3 dimensions. * Use the patient’s torso to place them into the barrier (direct) or position of ease (indirect). * Use MFR principles to resolve the somatic dysfunction.

Answer 75

* Place the dysfunctional tissues into their position of ease. * Add a force vector (usually compression) through the dysfunctional tissues. * Move the tissues through the restrictive barrier. * It works better to correct the saggitalplane last.

Answer 76

Brace opposite hand on the table with the elbow locked in extension. Hand on affected side is placed on the anterior chest. Place medial hand on rib head to monitor it. The forearm becomes a fulcrum as the technique progresses. Lateral hand applies a compressive vector force from the elbow to the rib head to decrease tension on the joint capsule. Lift the elbow cephalad while maintaining the compressive force throughout the arc. This mimics the “up in front” position of the inhaled rib Continue moving the elbow cephalad and then posteriorly while maintaining the compressive force. As you move the elbow posteriorly and inferiorly, the rib head is now pushed through the physiologic barrier. You may feel it “clunk” back into place. Recheck to ascertain resolution of the somatic dysfunction.

Answer 77

Place medial hand on rib head to monitor it. Lateral hand applies a compressive vector force from the elbow to the rib head to decrease tension on the joint capsule. Place medial hand on rib head to monitor it. Lateral hand applies a compressive vector force from the elbow to the rib head to decrease tension on the joint capsule. Lift the elbow cephalad while maintaining the compressive force throughout the arc. This mimics the “up in back” position of the exhaled rib. Continue lifting the elbow cephalad and swing it anteriorly while maintaining the compressive force throughout the arc. This mimics the “up in back, down in front” position of the exhaled rib. As you move the elbow superiorly and anteriorly, the rib head is now pushed through the physiologic barrier. You may feel it “clunk” back into place. Recheck to ascertain resolution of the somatic dysfunction.

Answer 78

* Check for area of greatest restriction. * Identify the SD within the AGR. * Can use head & neck as a lever for treating upper Tswith compressive force coming from top of head, through neck to SD. * For lower Tsand Ls, place your hand on one of the patient’s shoulders and your opposite axilla on the other shoulder. Compress from both shoulders to the level of the SD. * If there are multiple SDs, treat the worst one first. Place it in the position of ease and then quickly check the other SDs. If they are not apparent, don’t treat them. They are compensatory SDs.

Answer 79

position of ease compression through restrictive barrier

Answer 80

* Rib(s) held in inhalation are more anterior and move more freely anteriorly. * Rotation of the thorax anteriorly to the opposite side of the affected rib should put the tissues into ease. * Hold the posterior portion of the rib to move it anteriorly. * Rotate the ipsilateral shoulder anteriorly to the opposite side. * Add compression with your hand on the shoulder (and your axilla on the other shoulder). * Return the ipsilateral shoulder posteriorly.

Answer 81

* Rib(s) held in exhalation are more posterior and move more freely posteriorly. * Rotation of the thorax posteriorly to the opposite side of the affected rib should put the tissues into ease. * Hold the anterior portion of the rib to move it posteriorly. * Rotate the ipsilateral shoulder posteriorly to the opposite side. * Add compression with your hand on the shoulder (and your axilla on the other shoulder). * Return the ipsilateral shoulder anteriorly.

Answer 82

* Breast * Prostate * Lung * Kidney * Thyroid * (BLT with kosher pickle)

Answer 83

(1) direct extension, (2) lymphatic or hematogenous dissemination, and (3) intraspinal seeding (Batson plexus of veins).

Answer 84

* Lung * Breast * Colon * Sarcoma

Answer 85

–Multiple Myeloma (most common –peaks between age 50-60) –Lymphoma –Leukemia

Answer 86

–Osteosarcoma(most common –75% in age 20 or younger) –Chondrosarcoma(age 40 or older) –Ewing Sarcoma (80% 20 yrs or younger)

Answer 87

* Metastatic process * Primary tumor * Paraneoplasticsyndromes (intrathoracictumors)

Answer 88

clubbing of the fingers and toes and a polyarthritis that resembles rheumatoid arthritis – knees, ankles, and wrists are most commonly affected

Answer 89

* Tumors can metastasize to muscles and cause pain and decreased function due to muscle or nerve compression * These masses may be small and deep-seated * Dermatomyositisand polymyositishave a progressive proximal muscular weakness and is associated with lung and gastric cancer 50% of the time * Acanthosisnigricansis associated with gastric or abdominal malignancies

Answer 90

days or years – skin manifestations include a purplish erythema – dx via muscle bx, increased ESR and muscle enzymes, and abnormal EMG. Acanthosis nigricans – hyperpigmented, hyperkeratotic skin lesion in the flexor areas of axillary, neck, or anogenital areas is assoc with gastric or abd malignancies

Answer 91

``` •Leukemias(26.5%) –Acute lymphoblastic leukemia (19%) •CNS tumors (17.7%) •Lymphomas (14.6%) •Other (10.3%) –Thyroid (4%), melanoma (3.4%) •Soft tissue sarcoma (7%) •Germ cell (6.4%) •Bone tumor (5.3%) •Neuroblastomas(4.8%) •Renal tumor (3.9%) ```

Answer 92

may present with bone pain secondary to marrow hyperplasia as well as fatigue, pallor, ecchymoses, infection, fever, anorexia, weight loss Extremity lesions present with pain subsequent to trauma but the trauma may not be causing the pain CNS tumors often present with a headache in addition to ataxia and gait abnls, seizures or cranial nerve palsies – look for history of a headache while sleeping and absence of a family hx of migraines Sudden onset of back pain that worsens when supine – may need an MRI Neuroblastomas – most common extracranial solid tumor of childhood – paraspinal tumors may extend into the neural foramina and cause signs and symptoms of nerve root or spinal cord compression – bone mets very common esp skull

Answer 93

•Malignant musculoskeletal tumors account for approximately 12% of malignant neoplasms of childhood •Most common are: –Osteosarcoma–during puberty, around the knee –Ewing’s sarcoma –Rhabdomyosarcoma •Pain is the most common presenting symptom

Answer 94

* Neuroblastoma * Wilmstumor * Osteosarcoma * Ewing sarcoma * Rhabdomyosarcoma account for more than 60% of childhood cancers Leukemia, bone tumors, neuroblastomas can cause bone or muscle pain

Answer 95

* Previous cancer dxand tx * Dxevalfor cancer * Occupational and exposure history * Signs/symptoms specific to the 5 organs from which bone metscommonly arise

Answer 96

* Cancer causes less than 1% of back pain in the general population * 98% of known cancer patients who present with back pain have underlying metastases * Up to 1/3 of patients with cancer develop metastases to the spine

Answer 97

they could destabilize the axial skeleton and encroach upon the spinal cord or cauda equina

Answer 98

* Pain is the most common presenting symptom * Localized, constant bone pain is the hallmark * Often begins as dull and intermittent but worsens steadily, often over several days or weeks * Pain at night and at rest is common * Common sites are the vertebral column (espthorax), skull, humerus, ribs, pelvis,

Answer 99

Requires radiographic and laboratory evaluation | Bone scan may be needed to find occult lesions

Answer 100

* Unexplained musculoskeletal pain * Pain in spine or proximal extremities (hips, thighs, shoulders) that doesn’t correlate with a known injury * Night or rest pain

Answer 101

* High cervical spine mets–posterior headache * C7-T1 –interscapularpain * T12-L1 –flank, iliac crest, or sacroiliac joint * Sacral destruction –saddle distribution

Answer 102

* Differentiate between bone and joint pain * If passive motion of the adjacent joint isn’t painful then be more alert to a cancer possibility * Specific exam of the common neoplasticprimary sites

Answer 103

* Plain film radiography is the most specific for metastatic disease –will detect 70% of vertebral tumors * Obtain radiograph of the entire long bone for all painful sites * Multiple lesions are characteristic of metastatic disease * Lytic: lung, thyroid, kidney * Blastic: prostate * Mixed: breast, cervical, testicular, ovarian * Bone scan should be done if there is lesion on xrayor on a pt with a known primary cancer and negative xray * CT scan of the chest, abdomen, and pelvis to look for primary cancer

Answer 104

but most involve the axial skeleton (vertebral column, pelvis, ribs, skull, sternum), proximal femur, and humerus, in descending order of frequency. The red marrow in these areas with its rich capillary network, slow blood flow, and nutrient environment facilitates implantation and growth of the tumor cells. Metastases to the small bones of the hands and feet are uncommon and usually originate in cancers of the lung, kidney, or colon. (Kumar, Vinay. Robbins & Cotran Pathologic Basis of Disease, 7th Edition. Saunders Book Company, 082004. 26.1.2.6.3). Carefully inspect xrays for the type and extent of disease, presence of multiple lesions within the same bone, and the involvement of adjacent joints. Xray is limited because 40-50% of the trabecular bone must be destroyed before it becomes evident on imaging Bone scans can identify lesions as small as 2mm

Answer 105

–Immunoelectrophoresisfor multiple myeloma –Prostate-specific antigen (PSA) for prostate CA –CBC to evalanemia and thrombocytopenia –Serum alkaline phosphataseto evalbone turnover –Serum creatinine –Calcium

Answer 106

tumor cells displace hematopoietic cells Hypercalcemia common with bone mets – undetected it causes significant morbidity – can lead to sudden death secondary to cardiac arrhythmia

Answer 107

* Confirm or restage metastatic disease in a pt with a known primary tumor and no history of bone disease * Evaluate a lesion in a pt without a known primary tumor * Obtain tissue for hormonal and immunohistochemicaleval

Answer 108

history, PE, and imaging studies are more likely to identify it

Answer 109

periosteal elevation, cortical destruction with a “moth-eaten” appearance, and an apparent soft-tissue mass

Answer 110

* Pain management (opiates) * Assessment for impending fracture * Chemotherapy, radiation, systemic radionucleotides, hormone therapy, bisphosphonatetherapy * Surgery * Emotional/Spiritual support * Nutritional * OMT

Answer 111

endosteal nerve endings, microfracture through weakened bone, or periosteal stretching from tumor growth

Answer 112

* Why not? * Empowers patients to live until they die. * Comfort of touch * Emotional support –reduces tension and stress * Pain reduction * Optimization of function especially visceral

Answer 113

* Somatic dysfunction * Pain including post-surgical pain (ex: pt who is post-sternotomyor thoracotomyfor a lung CA) * Prevention or treatment of immobility-related complications in a bed-ridden patient (ex: atelectasisor constipation) * Treatment of extremity lymphedema(ex: UE after masectomy)

Answer 114

Primary indication is musculoskeletal pain associated with SD but not directly related to the tumor Foundations: “initiation of rib raising should be preceded by tx of significant vertebral and rib SD to prevent exacerbation of visceral facilitation” – do gentle rib raising and focus on releasing ribs at the same time!

Answer 115

* Treatment in the immediate vicinity of the cancer because of the risk of hematogenousspread * HVLA because of risk of pathologic fracture of weakened bones * Lymphatic pumps and effleurage due to risk of lymphogenousspread??

Answer 116

improved immune function | Passive lymphatic techniques are fine – MFR for the thoracic inlet and abd diaphragm as well as pectoral traction

Answer 117

a) Biomechanical perspective b) Neurological perspective c) Lymphatic (Respiratory-Circulatory) perspective

Answer 118

Check out ALL those beautiful anatomical connections from the upper extremity to: Cervical spine Thoracic spine Ribs Lumbar spine Sacrum Generally long restrictor muscles which will cause vertebral Type I dysfunctions Rib elevation or depression Sacral restriction that do not make sense with the model you have learned

Answer 119

Somato-somatic reflexes Upper extremity: SNS T1-4 PNS: NONE Breast: SNS T3-5 (2-6) PNS: NONE SO: look for Type II dysfunction in these areas

Answer 120

``` Breast Axillary nodes (3/4) Apical nodes Internal thoracic nodes May go to contralateral breast May go to rectus abdominusand the subperitonealand subhepaticplexi ```

Answer 121

* Continuous structure from the interstitial space, through terminal lymphatics, vessels, nodes and into central circulation * Baffles * Removal of part of the structure * Passive movement through interstitial space * Regeneration of vessels * Collateral circulation

Answer 122

Somatic dysfunction Pain associated with somatic dysfunction (not pain associated with tumor) ``` When to think about osteopathic evaluation and treatment Post-surgical Bed-ridden Lymphedema Constipation Atelectasis Pneumonia ``` In general indirect techniques (BLT, SCS, etc) or gentle direct or indirect soft tissue/myofascial

Answer 123

Risk of hematogenous spread is high  Vertebral cancers (as a result of Batson’s plexus): NO OMT in the vertebral spine Direct techniques directly over area of tumor Direct techniques in the presence of loss of boney integrity Risk of lymphatogenousspread is high Lymphatic techniques relatively contraindicated

Answer 124

However, consider that patients who do a moderate amount of exercise daily during treatment tend to do better overall than those who don’t. Lymphatic pumps do not move as much lymph as moderate exercise will… If you have concerns, use other techniques to passively affect lymphatic flow rather than actively Example: Myofascial release to the thoracic inlet rather than thoracic lymphatic pump

Answer 125

Evaluate rotation of thoracic inlet Posterior hand on spinous processes of T1-3 (ish)to encourage rotation into the barrier (DIRECT) Anterior hand along infraclaviculararea (manubrium/ribs/proximal clavicles) Both hands engage barrier firmly Patient takes several deep breaths while the physician continues to take up the slack and encourage rotation into the barrier

Answer 126

``` • One hand palpates the area worked on, other hand on top introduces a gentle vibratory motion • Areas to address: • Upper left thorax • Inferior and medial motion • Epigastric area • Superior and posterior motion (“lift”) • Inferior to umbilicus • Superior and posterior motion (“lift”) ```

Answer 127

nov 4th, just the box?

Answer 128

• 1. The human being is a dynamic unit of function • 2. The body possesses self-regulatory mechanisms that are self-healing in nature • 3. Structure and function are interrelated at all levels • 4. Rational treatment is based on these principles.

Answer 129

• Deep Venous Thrombosis (DVT)

Answer 130

• Work up for etiology • Decreased activity, LE elevation, Heat, Compression stockings • Anticoagulatnts: Coumadin, Heparin, LMWH, Apixaban, Rivaroxaban

Answer 131

* Fascial Pattern Compensation * Open Thoracic Inlet * Fascial restriction points of LE * Pelvic/Thoracic Diaphragm Redoming * Pedal/Thoracic Lymphatic Pump (anticoagulated) * SNS LE: T10-L3, PNS: None

Answer 132

``` • Acute fracture in area being treated, modify technique • Embolism • Theoretical risk metastasis in CA • No evidence of harm • Animal models show reduction in tumor formation ```

Answer 133

* Occipitoatlantal * Cervicothoracic * Thoracolumbar * Lumbosacral

Answer 134

* Thoracic Inlet (1st) * Posterior Axillary Fold * Antecubital Fossa * Carpal Tunnel * Inguinal Ligament * Popliteal Fossa * Achilles Tendon

Answer 135

• Provide increasing compression to area of restriction • As fluid drains and area releases, compress further

Answer 136

``` • Ensure Restrictions Open 1st, Proximal to Distal • Effleurage: Continuous moving compression to move fluid distal to proximal ```

Answer 137

pages 307-310

Answer 138

Requires precise recall of anatomy and 3-D spatial organization This is essentially a myofascial technique that applies stretch to the restricted/constricted “ligament” Can hold an organ and stretch the patient so that a ligament or duct is stretched (gallbladder, hiatal hernia, hepatic and splenic flexures) Can hold one point/organ with one hand while the other hand stretches another point/organ May need to treat with a “rebound” technique to remind the ligament of its initial length (liver)

Answer 139

Nausea Gastroesophageal reflux Constipation Liver congestion Gall bladder dysfunction High sympathetic tone in the viscera Malabsorption from the intestines Congestion of the intestines Adhesions, scars Mechanical small bowel obstruction

Answer 140

Nausea and vomiting* Sweating Tachycardia Syncope Dizziness Guarding and pain on rebound

Answer 141

Acute infection: appendicitis, peritonitis, diverticulitis, cholecystitis, gastroenteritis, etc. Ruptured viscera Acute blunt-force trauma Aortic aneurysm Ischemic bowel Gallstones (relative) Cancer (relative) Bowel obstruction (relative) Pregnancy (relative) IUD (relative) Lack of consent

Answer 142

Start by correcting any structural pelvic somatic dysfunctions Then release the plexi Then release the cecum The ileocecalvalve Ascending colon Hepatic flexure Transverse colon Splenicflexure Descending colon Sigmoid colon

Answer 143

celiac ganglion superior mesenteric gaglion inferior mesenteric ganglion

Answer 144

Stand next to the supine patient. Place fingers of both hands (one re-inforcingthe other) along linea alba above the umbilicus. Gently let your fingers sink into the tissues until you reach the plexi. Maintain pressure and await a fascialrelease. There may be a few that occur on your way toward the plexi. To stimulate the plexi, one can perform gentle, repeated rebounds.

Answer 145

``` S = Suprarenal glands (aka the adrenal glands) A = Aorta/IVC D = Duodenum (second and third segments [some also include the fourth segment] ) P = Pancreas (only head, neck, and body are retroperitoneal. The tail is intraperitoneal) U = Ureters C = Colon (only the ascending and descending colons, as transverse and sigmoid retain mesocolon) K = Kidneys E = Esophagus (not including the part inside the abdominal cavity) R = Rectum ```

Answer 146

Treatment is performed when there is restricted mobility/motility. Patient is supine on the table with knees flexed With gentle fingers (don’t lock the PIP and DIP joints), or both thumbs or the lateral curve of your fingers, slid along the iliac fossa until you palpate the cecum. Push the lateral aspect of the cecum anteromedially. Push the medial aspect of the cecum inferolaterally. Push the inferior aspect of the cecum superolaterally. Once this has been released, treat the iliocecal valve by placing the thenar eminence over the valve and applying pressure medially and then laterally until there is freer motion.

Answer 147

Treatment is performed when there is restricted mobility/motility. Patient is supine on the table with knees flexed. With gentle fingers (don’t lock the PIP and DIP joints), or both thumbs or the lateral curve of your fingers, slid along the iliac fossa until you palpate the sigmoid colon. Push the lateral aspect of the sigmoid superomedially toward the umbilicus. Then place your fingers just above the pubic symphysis and push the sigmoid and small intestine superiorly toward the umbilicus. There should be the perception of a fascial release.

Answer 148

Displace toward medial | Displace toward lateral

Answer 149

The root runs from the left side of L2 to the right sacroiliac joint. The sigmoid mesocolonic attachment arises on the medial aspect of the left psoas muscle, curves over the iliac vessels and ends lying over the 3rdsacral segment.

Answer 150

This technique can relieve venous congestion and edema in the intestines, improve immune function and absorption of nutrition Technique also addresses part of the “central chain” or “central tendon” which refer to the fascial connection from the base of the sphenobasilar symphysis to the perineal body via the pre-tracheal fascia, mediastinum, the central tendon of the diaphragm, the midline of the abdominal cavity from which all of the organs arose via invagination of the gut cavity during embryology to the pre-sacral fascia.

Answer 151

This direct technique is best performed after mobilizing the cecum, ileocecalvalve and sigmoid. Do not perform this technique if there is a recent abdominal incision, acute ischemic bowel disease, bowel obstruction, etc. Patient is supine or in the left lateral recumbent position. Physician stands on the patient’s right side or behind them. Place your finger tips at the left border of the mesenteric region and curl the fingertips. Then push them gently toward the patient’s spine and toward their right side until a restrictive barrier is engaged. Maintain this position, taking up slack as releases occur, and hold until no further improvement is detected.

Answer 152

Anterior: 2nd intercostal space bilaterally close to sternum Posterior: Midway between the spinous process and tip of the transverse process of T2 bilaterally. (same as bronchus)

Answer 153

Anterior: In the left 5th intercostal space between the mid-clavicular line and sternum Posterior: Midway between the spinous process and tip of the transverse process on the Left 5th and 6th thoracic vertebrae

Answer 154

Anterior: In the right 5th and 6th intercostal space between the mid-clavicular line and sternum Posterior: Midway between the spinous process and tip of the transverse process on the Right 5th, 6th and 7th thoracic vertebrae

Answer 155

Anterior: In the right 6th intercostal space between the mid-clavicular line and sternum Posterior: Midway between the spinous process and tip of the transverse process on the Right 6th and 7th thoracic vertebrae

Answer 156

Anterior: Right 7th intercostal space close to the costochondral junction Posterior: Midway between the spinous process and tip of the transverse process on the Right 7th and 8th thoracic vertebrae

Answer 157

Anterior: Intercostal spaces between 8-9, 9-10, 10-11 near cartilaginous attachments bilaterally Posterior: Midway between the spinous process and tip of the transverse process on the Left 8-9, 9-10, 10-11 thoracic vertebrae

Answer 158

Anterior: 1-2’’ area extending from greater trochanter to an inch above patella on anterolateral aspect of femur bilaterally Posterior: Bilateral transverse process of L2 to L4 creating a triangular area reaching across the iliac crest

Answer 159

Anterior: Bilaterally in the muscle tissues between the ASIS and the Greater Trochanter Posterior: Costovertebral junction of the 11th rib on the Right

Answer 160

Anterior: Anterior Midline of the Sternum (angle of Louis to xiphoid) Posterior: Right costovertebral junction of the 10th rib

Answer 161

Anterior: Tip of the right 12th rib, upper edge Posterior: Inter-transverse space between 11th and 12th thoracic vertebrae on the Right

Answer 162

Anterior: In the left 6th intercostal space between the mid-clavicular line and sternum Posterior: Midway between the spinous process and tip of the transverse process on the Left 6th and 7th thoracic vertebrae

Answer 163

stomach, duodenum,

Answer 164

(T7 on the right)

Answer 165

(T6-8 on the right)

Answer 166

(may encompass T8-12)

Answer 167

``` stomach, duodenum, pancreas (T7 on the right) gall bladder (T6-8 on the right) ```

Answer 168

(may encompass T8-12)

Answer 169

``` small intestine (may encompass T8-12) proximal 2/3 of the large intestine ```

Answer 170

Cord segments T12-L2 receiving innervation via the inferior mesenteric ganglion

Answer 171

(especially extended segment T5-9) can facilitate increased sympathetic tone to the stomach and pylorus leading to decreased mucous secretion in the stomach and delayed pyloric sphincter relaxation (increased contraction of the sphincter)

Answer 172

``` Vagus nerves (cranial nerve 10) serve the organs from the esophagus through the proximal 2/3’s of the large intestine The pelvic splanchnics (S2-4) serve the distal 1/3 of the large intestine ```

Answer 173

vagal function and the organs it serves, particularly decreasing acid production In the stomach

Answer 174

affecting the anterior cervical fascia and esophagus, vagus, phrenic nerves

Answer 175

(along with cervical spine 3-5/phrenic nerve)

Answer 176

thoracic dysfunctions

Answer 177

anterior cervical fascia and esophagus

Answer 178

(Sibson’s fascia bilaterally, thoracic inlet, upper ribs, thoracic outlet, diaphragm, T-L junction and lower ribs)

Answer 179

respiratory diaphragm and root of the mesentery

Answer 180

GI function

Answer 181

its pumping effect on the abdominal viscera, plus oxygenation as well as lymphatics

Answer 182

via the lymphatics

Answer 183

Sympathetic Spinal Level: T2-8/10 Facilitation Level:T1-6 Ganglia Celiac

Answer 184

Sympathetic Spinal Level:T5-9 Facilitation Level:T5R Ganglia Celiac

Answer 185

Sympathetic Spinal Level:T5-9 Facilitation Level:T5-9L Ganglia Celiac

Answer 186

Sympathetic Spinal Level:T6-9 Facilitation Level:T5R Ganglia Celiac

Answer 187

Sympathetic Spinal Level:T6-8 Facilitation Level:T7L Ganglia Celiac

Answer 188

Sympathetic Spinal Level:T6-9 Facilitation Level:T7R Ganglia Celiac

Answer 189

Sympathetic Spinal Level:T8/9-11/12 Facilitation Level:T10-11 Ganglia Superior mesenteric

Answer 190

Sympathetic Spinal Level:T10/11-L1/2 Facilitation Level:T10-11 Ganglia Superior mesenteric

Answer 191

Sympathetic Spinal Level:T10 Facilitation Level:T12 Ganglia Superior mesenteric

Answer 192

Sympathetic Spinal Level:L1-2 Facilitation Level:T12-L2 Ganglia inferior mesenteric

Answer 193

the rotatores and/or multifides muscles.

Answer 194

external oblique muscle

Answer 195

posterior abdominal wall bilaterally.

Answer 196

lower abdominal muscles

Answer 197

left 5th rib space

Answer 198

right 6th intercostal space t6 right

Answer 199

tip of 12 left rib t11 right

Answer 200

middle of sternum t7 right

Answer 201

right 5th intercostal space t 5 right

Answer 202

right 7th rib t7 right

Answer 203

ribs 8 9 and 10 bilateral 9 10 11 t spine left side

Answer 204

left 7 or 8 rib t 7 left

Answer 205

left 6th intercostal space

Answer 206

t 9 or 10 right asis bilateral

Answer 207

intertransverse space, midway between the spinous and transverse processes, between 5th and 6th vertebrae on the left

Answer 208

medial femur below ischial tuberosity bialteral

Answer 209

anterior femur bilateral tips of lumbar tps bilateral

Answer 210

si joing bilateral

Answer 211

ischial tuberosity bilateral

Answer 212

TP of L2 – TP of L4 a triangular area reaching across to the iliac crest

Answer 213

between ASIS and greater trocanter

Answer 214

manubrial-sternal junction down the front of the sternum

Answer 215

intertransverse space, midway between the spinous and transverse processes, between 5th and 6th vertebrae on the left

Answer 216

lateral femur

Answer 217

Sympathetic innervation is supplied by cell bodies in the spinal cord and fibers that terminate in the prevertebral ganglia(celiac, superior, and inferior mesenteric ganglia); these are the preganglionic neurons. These nerve fibers synapse with postganglionic neurons in the ganglia, and the fibers leave the ganglia and reach the end organ along the major blood vessels and their branches. Rarely, there is a synapse in the paravertebral(chain) ganglia, as seen with sympathetic innervation of other organ systems.

Answer 218

esophagus, stomach, gallbladder, pancreas, first part of the intestine, cecum, and the proximal part of the colon.

Answer 219

via the jugular foramen (along with the accessory and glossopharyngeal nerves).

Answer 220

distal part of the colon and the anorectal region.

Answer 221

lie in the brainstem (vagus) or the sacral spinal cord (pelvic). Axons from these neurons run in the nerves to the gut (vagus and pelvic nerves, respectively), where they synapse with postganglionicneurons in the wall of the organ, which in this case are enteric neurons in the gut wall.

Answer 222

``` Tends to inhibit GI function Frequently activated in pathological situations Inhibits smooth muscle Induces contraction of sphincters Regulates blood flow in the GI tract ```

Answer 223

Activates physiological processes in the gut wall Allows filling of the stomach to occur without an increase in intraluminal pressure Generally involved in relaxation of sphincters Contraction of smooth muscle layers in the colon Controls the caliber of the internal anal sphincter

Answer 224

distention of the stomach results in relaxation of the smooth muscle in the stomach;

Answer 225

``` Constipation Bloating Pain Contraction of sphincters Increased vasomotor tone (may lead to decreased mucus production in stomach and intestines) ```

Answer 226

``` Nausea Vomiting Diarrhea Hypermotility Relaxation of sphincters Increased mucus secretion Increased acid production in the stomach ```

Answer 227

Gastritis, Ulcers (peptic and duodenal), GERD Antacids, H2-blockers, PPIs, antibiotics

Answer 228

Elimination of wastes | Maintain homeostasis

Answer 229

Failure to pass flatus or stool for 3/6 days after surgery | Transient impairment of function and motility

Answer 230

Mechanical irritation Edema of tissues –mesentery and intestine Inflammatory molecules which cause the Activation of inhibitory neural reflexes Medications, particularly opiates

Answer 231

are sensitive to capsaicin. If you treat neonatal animals w/ capsaicin, it ablates the the sensory nerves from the gut. If you take the animals to surgery later, they have decreased ileus. Studies have shown increased sympathetic activity and increased catecholamines in the post-op period. Blocking the impulses has mixed response. Opioids don’t inhibit bowel motility, they increase it, but also increase uncoordinated contractions so there is an increase in tone, but a decrease in transit.

Answer 232

``` Nasogastricsuctioning Rectal stimulation Ambulation Medications -laxatives -erythromycin -metoclopromide -cisapride -alvimopan -methylnaltrexone Gum chewing –stimulates the gastrocolicreflex? NSAIDs Thoracic epidural analgesia with lidocaineor bupivacaine ```

Answer 233

NG around for > 100 years, no beneficial effect on POI Mobilization (rectal stimulation), no beneficial effect on POI\ Laxatives – no randomized studies E-mycin – no effect on POI, effective for neuropathic ileus Metoclopromide – no effect on POI Cisapride – off market d/t cardiac dysrhythmias Alvimopan – in trials, risk of bone fx, abn tissue growth, ? MI Methylnaltrexone – failed late-stage trial in US Gum chewing stimulating gastrocolic reflex?

Answer 234

``` Electrolyte imbalance Dehydration Gastric perforation Nasal irritation or erosion of mucosa Infection Rectal perforation Impaired nutrition Delayed healing Increased pain from withholding of opiate pain reliever Increased bleeding due to anti-platelet activity from NSAID Gastric mucosal erosions from NSAID Other adverse effects of NSAIDs Meningitis/spinal headache from epidural analgesia Cost ```

Answer 235

Increased vascular tone –decreased O2 and nutrients to the tissues Decreased peristalsis

Answer 236

Impaired flow increases tissue congestion Impaired nutrient absorption from the intestines Congestion increases the likelihood of fibrosis, and susceptibility to infection

Answer 237

317 surgical cases treated with OMT, 1/317 developed ileus (0.3%) 92 surgical cases without OMT, 7/92 developed ileus (7.6%)

Answer 238

Length of stay in patients given OMT = 11.8 days | Length of stay in patients not given OMT = 14.6 days

Answer 239

Length of stay in patients given OMT = 6.1 days | Length of stay in patients not given OMT = 11.5 days

Answer 240

Weak stimuli accelerate physiologic activity Medium stimuli inhibit physiologic activity Strong stimuli halt physiologic activity

Answer 241

system of the autonomic plexiwithin the wall of the intestine. Synapses between visceral afferents, the parasympathetic and sympathetic occur here. Pleximodify autonomic activity according to the local needs of that region of the intestine to move bolus, digest, etc

Answer 242

both fibroblasts and smooth muscle cells.

Answer 243

stimuli>sensors mechanical and chemical>brain and spinal cord and enteric nercous system>effectors ( motilitys secretion and blood flow)

Answer 244

between stimuli and sensors between sensors and enteric nervous system

Answer 245

(EEC) by chemical and mechanical stimuli

Answer 246

Arterial, venous and lymphatic circulation Vertebral segmental function to allow proper nerve flow to the viscera Chapman’s reflexes for proper function of the viscera. Visceral techniques to address restriction of mobility and motility of the viscera (ala Dr. Barral)

Answer 247

◦Peritoneum ◦Pericardium ◦Pleura ◦Meninges

Answer 248

serous fluid creates suction between surfaces of the peritoneum, etc. serous membranes and serous fluid is analogous to cartilaginous surfaces and synovial fluid.

Answer 249

folds of peritoneum or pleura binding an organ to the wall of the cavity or to another organ Not present for structural stability like skeletal ligaments

Answer 250

hold the viscera in place, remain constant in mass, yet stick together

Answer 251

folds of peritoneum that support the nerves, arteries, veins and lymphatics of the small and large intestines

Answer 252

folds of peritoneum that join 2 elements of the digestive tract together and has a neurovascular role

Answer 253

Any restriction, fixation or adhesion limits mobility and motility, along with viscerospasm and tethering (ptosis). Diaphragm moves about 20,000 times per day. Heart beats about 100,000 times per day Approximately 30-50 cc’s of blood is ejected from the left ventricle per beat causing a wave propagation through the arteries.

Answer 254

``` Infection/inflammation Trauma Surgery Pregnancy Scoliosis/short leg syndrome Craniosacral dysfunction ```

Answer 255

``` Evaluate for: ◦Painfulness ◦Differences in tension ◦Position of the organ ◦Tone of the organ ```

Answer 256

``` Bowel obstruction/Ileus Inflammatory bowel disease (Crohns/UC) Tumor Ischemic bowel Adhesions Constipation Fecal impaction Diverticulitis Hypothyroidism ```

Answer 257

``` Sympathetics? ◦T10/11-L2, Inferior mesenteric ganglion Parasympathetics? ◦S2-4 Lymphatics? ◦Sibson’s, respiratory diaphragm, pelvic diaphragm ```

Answer 258

Anterior: Bilateral 8-9th, 9-10th, and 10-11th intercostal spaces close to the costochondral junctions Posterior: Bilateral 8-9th, 9-10th, and 10-11th intertransverse spaces midway between the spinous process and the tip of the transverse process

Answer 259

an area 1-2" anterolateral aspect of the thighs along the femure starting at the greater trochanter and extending to within an inch of the knees Upper fifth corresponds with the cecum Middle 3/5’s corresponds with ascending colon Last 1/5 represents hepatic flexure and first 2/5’s of transverse colon

Answer 260

an area 1-2" anterolateral aspect of the thighs along the femure starting at the greater trochanter and extending to within an inch of the knees Upper fifth corresponds with the sigmoid Middle 3/5’s corresponds with descending colon Last 1/5 represents splenic flexure and last 3/5’s of transverse colon

Answer 261

Bilaterally, from the transverse process of L2 to L4, a triangular area reaching across to the crest of the ilium

Answer 262

Anterior: Bilaterally in the muscle tissues between the ASIS and the Greater Trochanter Posterior: Bilaterally along the 11th rib at the costovertebral junction.

Answer 263

``` ◦Pelvis ◦Sacrum ◦Lumbar ◦Thoracic/Rib raising ◦Abdomen: cecum, sigmoid, mesentery ◦Thoracic inlet ◦Diaphragm ◦OA/ OM suture/CV4 ```

Answer 264

``` GERD Gastric ulcer Duodenal ulcer Cholycystitits Cholylithiasis Pregnancy ```

Answer 265

``` Sympathetics? ◦T5-9, Celiac ganglion Parasympathetics? ◦Vagus Lymphatics? ◦Sibson’s, respiratory diaphragm, pelvic diaphragm ```

Answer 266

Chapman’s points for stomach -hyperacidity Chapman’s points for stomach –peristalsis Chapman’s points for esophagus

Answer 267

``` ◦Thoracic ◦Arcuateligament ◦Abdomen ◦Diaphragm ◦Thoracic inlet ◦Hyoid ◦OA/OM suture/CV4 ```

Answer 268

``` Cholycystitis Cholylithiasis GERD Gastric ulcer Duodenal ulcer ```

Answer 269

``` Sympathetics? ◦T6-8 on the right, Celiac ganglion Parasympathetics? ◦Vagus Lymphatics? Sibson’s, respiratory diaphragm, pelvic diaphragm Chapman’s points for liver/gallbladder ```

Answer 270

``` ◦Thoracic ◦Abdomen, organs, transversusabdominis ◦Diaphragm ◦Lumbar region, psoas ◦Thoracic inlet ◦OA/ OM suture/CV4 ```

Answer 271

``` Gastroenteritis ◦Rotavirus ◦Norwalk-like viruses Intussusception (What would likely be found in the diaper?) Dehydration ```

Answer 272

``` Sympathetics? ◦T10-11 (May encompass from T8-T12) ◦Superior mesenteric ganglion (primary) ◦Celiac ganglion (secondary) Parasympathetics? ◦Vagus, S2-4 Lymphatics? ◦Sibson’s, respiratory diaphragm, pelvic diaphragm Chapman’s points for Small Intestines Chapman’s points for Stomach/Peristalsis ```

Answer 273

``` ◦Pelvis ◦Sacrum ◦Lumbar ◦Thoracic/Rib raising ◦Thoracic inlet ◦Respiratory and Pelvic Diaphragms ◦OA/OM suture/CV4 ```

Answer 274

Mother’s pregnancy history: G2P2002 Unremarkable, high stress job and a move at about 6 months gestation No trauma, no prescription or illicit drug use, no tobacco use Birth history 41 wkgestation 9 hour labor, 2 hours hard labor Mother delivered on her left side No instrumentation or augmentation APGARS 6/10 at one minute, 10/10 at 10 minutes; no interventions needed Very quiet the first 24 hours, then started crying more Social history Lives at home with mom, dad and 2 year old brother No tobacco exposure No family history of food allergy No pets No childcare at this point Sleeps 2 hours at a stretch and breastfeeds in between No bottles No pacifier (he spits it out) ~8-10 wet/soiled diapers per day Mother returning to work in 3 weeks, is stressed about childcare Cries inconsolably every night from 6-9:30

Answer 275

``` Scientific-defined for research efforts Wessel criteria (1954) Crying and fussing more than 3 hours per day 3 days a week For more than 3 weeks ``` Inconsolable, excessive crying associated with hypertonicity, perceived pain, borborygmus, wakefulness Cyclic Onset 2-6 weeks old and lasts typically 3 months

Answer 276

For research and medical communication purposes, Wessel’s Criteria are still used today as a benchmark for defining infantile colic.

Answer 277

Infection –meningitis, encephalitis, sepsis, pneumonia, UTI, osteomyelitis, septic, toxic synovitis, AOM, herpes stomatitis, oral thrush, gastroenteritis, herpangina, insect bites, cellulitis, infectious arthritis Trauma –non-accidental trauma (skull fracture, intracranial bleed, rib fracture, pneumothorax, long bone fracture, intra-abdominal blunt trauma), accidental trauma (falls), corneal abrasion, hair tourniquets (digits, penis, clitoris) Metabolic –inborn error of metabolism, electrolyte abnormality, acid/base derangement, hypoglycemia Foreign body –oral, nasal, ear, pharynx, eye GI –intussusception dehydration constipation, GERD, hernia CV –SVT, congenital heart disease Environmental: neglect, hunger

Answer 278

``` Dietary Psychological Gastrointestinal Hormonal Neurological immaturity ```

Answer 279

Prospective cohort study of 856 mother infant dyads Maternal questionnaires at 1 and 6 weeks regarding feeding sources, presence of colicky behavior, maternal anxiety and alcohol consumption Breastfeeding did not have a protective effect on the development of colic Maternal anxiety was positively correlated with colic

Answer 280

RCT conducted among exclusively breastfed infants with colic (90 completed the trial) Average cry-fuss time over 48 hours was 630-690 minutes Active arm: mother’s excluded cow's milk, eggs, peanuts, tree nuts, wheat, soy, and fish. Control arm: mothers continued to consume these foods Outcomes assessed after 7 days as the duration of cry-fuss behavior over 48 hours using charts End point 25% reduction in cry-fuss behavior over 48 hour period after 7 days of dietary intervention Result: objective 21% of babies in the low allergen diet group had less cry-fuss time

Answer 281

The relationship between maternal post-partum depression and colic Ante-partum stress and depression and colic Association is clear—what is not clear is if there is an etiological relationship Maternal/familial stress and depression anxiety causes colic? Colic causes maternal/familial stress, depression and anxiety? Or they just exist together?

Answer 282

Gut motility and neurological immaturity | Intestinal flora imbalance

Answer 283

HPA axis and adrenergic system feedback loops activated as a result of perceived danger or discomfort (on the part of the infant) Epigenetic modulation in the limbic system may explain correlations between regulatory problems in the first months of life and behavioral/feeding problems later in life

Answer 284

Case control study (Saudi Arabia) Used H. Pylori stool antigen testing Case population 55 infants with colic per Wessel criteria 2-4 months age 45 (81.8%) tested positive for H. Pylori infection Control population 30 infants without colic Age, country of origin, gender and ethnicity matched 7 (23.3%) tested positive for H. Pylori infection

Answer 285

``` Rule out organic disease Reassurance, reassurance, reassurance Dietary interventions Supplements Medication Behavioral Manual treatment/therapy ```

Answer 286

Maternal diet restriction (big 5: gluten, dairy, egg, citrus, soy) Formula changes Herbal teas Sugar water

Answer 287

High fat diet per mother or fats added to infant diet | Pro-and pre-biotics

Answer 288

Simethicone Dicyclomine Methylscopalamine

Answer 289

Quiet area/decreased stimulation Vibration (car ride, sitting on the dryer, etc) Intensive parental training 

Answer 290

OMT Chiropractic Massage

Answer 291

Fennel extract tea Chamomile, vervain, licorice, fennel, balm mint Fennel has analgesic effect Sucrose/glucose solutions Sweetness may induce analgesic effect Manipulation (of any sort) Several showed benefit, but lack of blinding, small ‘n’ limited usefulness of the studies Studies not well funded or of good trial design Need better studies Probiotics L reuterihas been found to be helpful in several studies

Answer 292

Somatic dysfunction | Organic disease ruled out and “functional” cause is suspected

Answer 293

?? Rule out organic disease Follow contraindications for modalities

Answer 294

Lies within the concept of facilitation and the long term effects it has on the nervous system

Answer 295

It is an anatomical and physiological process that helps us to explain how things that seem unrelated actually may be affecting one another. This is the core concept behind the viscero-somatic, viscero-viscero, somato-visceral and viscero-somatic reflexes. There is a lot of research going on in this area right now.

Answer 296

* Nociceptive information comes in from a peripheral source (outside the CNS). This could be from viscera, muscle, bones, peripheral nervous tissue….anything outside the CNS. * This information bombards the CNS and decreases the firing threshold of those neurons (side dynamic range neurons). In effects, these neurons are facilitated—they are activated more quickly than neurons that have not been exposed to excessive nociceptive information. * These irritated (facilitated) neurons activate and facilitate neighboring neurons. * These neighboring neurons serve other tissues in the body and will then volley signals to the tissues they serve and cause issues distal to the original site of nociceptive information.

Answer 297

A person has problems with chronic gastritis. That nociceptive information from the chronic inflammation of the stomach lining sends a volley along afferent fibers to the area of the spinal cord that serves the stomach with sensation, T5-7. Those fibers then synapse with wide dynamic range (WDR) fibers that synapse with many other neurons at that level. When the nociceptive information is chronic enough, or strong enough, those fibers get facilitated and their threshold for firing decreases. They also then facilitate the neurons next to them, or those connected by the WDR’s (these connections can be as far as 5-7 segments away from the original input level). This nociceptive input causes a reflexive protective volley to go out to all the tissues that that level serves. So all of the muscles, viscera, etc, that is served by the T5-7 spinal cord will then show signs of irritation—pain and muscle spasm in the mid back, type 2 somatic dysfunctions as a result of the muscle spasm of the rotatores at that level, sensory changes in the skin supplied by T5-6 (along the midline at that level), and even core control problems as a result of motor input to the transversus and other core muscles. It can even affect the function of the lungs (chronic cough) and esophagus (spasm). So this is how a person with persistent stomach pain also presents with mid-back pain, cough and a weak core musculature

Answer 298

The gut sends nociceptive information to the central nervous system via the visceral afferents (CN VII, IX and X) whose nucleus resides in the brainstem. This area gets facilitated. Notice that the nuclei for the visceral efferents (CN X) and motor efferents of CN IX and X are right next to the visceral afferents. Now these get facilitated and send protective information to those areas. We get reflex irritation as well as spasm in those areas. The stomach pain causes more stomach pain. Note also that the dorsal rootlets of C1 and C2, which carry motor efferents to the upper cervical spine, are right there and they also get facilitated causing muscular hypertonicity. Stiff neck. Note also that the nucleus of the trigeminal nerve is also right there. The trigeminal nerve is the primary sensory nerve to the cranium—it is the mediator of headache. When this nucleus gets facilitated, headache is the result.

Answer 299

When babies are born, a lot of force is placed through the system. The uterus generates up to 80 psi during the birth process. To absorb those forces properly, the baby’s body must be aligned well. It must be a vertex presentation with the head and neck aligned in such a way so that the forces are absorbed and dispersed through the cervical spine axially. When the head is turned or the body is in any other position, those forces get absorbed and dispersed into tissues not designed to tolerate those kinds of forces. Most commonly, these forces are taken up in the upper cervical spine and cranial base. What would the facilitation picture look like then? Muscular tensions and pain from the upper cervical spine sends nociceptive information to the upper cord via C1 and C2 rootlets. The upper cord area gets facilitated, irritating the nuclei of the motor and visceral efferents which then send a volley to the gut causing increased gastric secretions, increased or decreased peristalsis and pain. The trigeminal nucleus also gets facilitated and causes headache. This facilitation is why stiff necks cause headache (a clinical entity known as cervicogenic headache). It is also part of why people with migraines also have nausea and vomiting. It is the close physical relationship and interconnectedness of the central nervous system that makes it so that symptoms that appear to be unrelated may, in fact, be related.

Answer 300

Prospective study comparing infants with and without severe colic during infancy and 10 years later. Significantly increased incidence of  Recurrent abdominal pain (abdominal migraine)  Allergic diseases (asthmatic bronchitis, rhinitis, conjunctivitis, atopic eczema, food allergy)  Psychological disorders (sleep disorders, aggressiveness, fussiness, ‘supremacy’)

Answer 301

208 kids aged 6-18 with headache history; 471 without 72.6% of children with migraine also had infantile colic 26.5% of children without headache had infantile colic

Answer 302

Maternal migraine was associated with a more than 2-fold increase in prevalence of infantile colic

Answer 303

Vitals RR40 HR130 Wt8# 6oz (increase of 1# over birth weight) General: WDWN CM looks stated age, alert, active and interactive. Parental interaction appropriate. Skin: PWD, no rashes, no bruising HEENT: Anterior fontanelleis open and flat. Red-orange reflexes are positive in both eyes. Nose is clear. Mouth is clear. Strong and coordinated suck Pulm: lungs CTA bilaterally CV: regular rate and rhythm, no murmurs noted GU: Normal male. Both testes are descended. His circumcised penis has healed MSK: Negortolani/Barlow, spine straight. No sacral dimple. What would you look for on osteopathic structural exam?

Answer 304

OA Suboccipitalinhibition/soft tissue Mid thoracic Rib raising Thoracolumbar junction Myofascial release Lumbar spine Myofascial, especially upper lumbars Pelvic diaphragm Myofascial release

Answer 305

cervical spine and head for reasons we already talked about (facilitation). This is just one treatment approach that includes treatment modalities and technique concepts taught in all US colleges and schools of osteopathic medicine. It is stuff you already know! All you need to do to be successful in treating babies is to learn to modify what you know to your patient.

Answer 306

we are directly addressing the mechanical input of the diaphragm and its affect on gut function by increasing the lymphatic return of the pelvic cavity into central circulation. We are also addressing the parasympathetic innervation to the gut by way of the pelvic diaphragms biomechanical influence on the sacrum.

Answer 307

and releasing the myofascial connections of the gut to the posterior abdominal wall—the mesenteric root as well as the fascial connections of the colon. Releasing the mesenteric root influences the function of the neurovascular supply to the gut. This is an excellent technique for babies with constipation.

Answer 308

we are affecting the vertebral motion of the segment of the spinal cord that serves the gut, as well as augmenting function of the thoracic diaphragm which will help fluid exchange of the abdomen (aiding lymphatic return via the fenestrae of the diaphragm as well as the cisterna chyle).

Answer 309

The ribs of a young child are in a horizontal orientation, so the orientation of your hands and forces used will change as a result. It is also easier, and more effective, to treat both sides at once. This makes it easier to address vertebral dysfunctions at the same time as treating the rib dysfunctions.

Answer 310

the parasympathetic system and its affect on the upper GI system via the vagus nerve, as well as the upper cervical musculature and vertebral dysfunction that may be associated with central facilitation (see the above facilitation discussion).

Answer 311

Also addresses upper cervical spine

Answer 312

Depends-weekly is most often, usually Gauge how much help parents need Treat parents as well if necessary

Answer 313

Most likely etiology colic. Differential diagnosis includes: (whatever it is you think may be the differential)

Answer 314

Potential etiologies and course of colic explained to parents. They desire to try food elimination first; handout and instructions given. Parents understand red flags to look for and will call with any concerns. Will return in one week for re-evaluation.

Answer 315

There are no great answers, lots of questions, lots of interesting research going on Focus on helping parents cope

Answer 316

Augmenting GI circulation and respiratory motion | Treating viscero-somatic and/or somato-visceral reflexes

Answer 317

Look at diaphragms pelvic, thoracic diaphragm Upper lumbars/Mesenteric root (lymphatic and venous circulation) Mid-thoracic region (sympathetics/VSR) OA/upper cervicals(parasympathetics/VSR)