GI Flashcards
What is visceral manipulation
A system of diagnosis and treatment directed to the viscera to improve physiologic function. Typically the viscera are moved towards their fascial attachments to a point of fascial balance. Also called ventral techniques
Most common GI disorder
IBS
GERD too prevelance increases with age-worsened with food and lifestyle factors
How can OMT help with GI
Improving blood/lymphatic glow and balancing Autonomics
LUQ pain causes
Splenomegaly
Splenic infarct
Splenic abscess
Splenic rupture
Splenomegaly clinical
Pain/discomfort, left shoulder pain, and/or early satiety
Splenic infarct clinical
Severe pain
Splenic abscess clinical
Associated with fever and tenderness
Splenic rupture clinical
Left chest wall/shoulder pain worse with inspiration
Causes of epigastric pain
Acute MI Acute pancreatitis Chronic pancreatitis Peptic ulcer disease GERD Gastritis/gastropathy Functional dyspepsia Gastroparesis
RUQ pain causes biliary
Biliary colic
Acute cholecystitis
Acute cholangitis
Sphincter of Oddi dysfunction
RUQ pain causes hepatic
Acute hepatitis
Preihepatitis (fitz high Curtis syndrome)
Budd chiari
Portal vein thrombosis
LQ pain
Appendicitis-R
Diverticulitis-L
Ectopic preg
Neohrolithiasis Pyelonephritis Acute urinary retention Cystitis Infectious colitis
What are the 5 models
Biomechanical Neuro Respiratory/card Behavioursa Metabolic
For the biomechanical model you want to determine whether the SD is an MSK or viscerosomatic reflex problem. How?
Failure of SD to respond to OMT points to viscerosomatic
SD can be affected by MSK through direct myofascial relationships
Severity of palpated tissue texture abnormality=?
Severity of visceral problem
How sue OMT for surgery
Make a better surgical candidate
Help with recovery phase
What are the intraperitoneal organs
Stomach, SI, spleen, liver
*supeprior part of duodenum
Extra peritoneal
SAD PUCKER
Descending and horizontal duodenum
Pancreas, ascending and descending colon, cecum, pancreas, upper 2/3 rectum
Infreaperitoneal
Lower 1/3 rectum
Anterior abdominal wall muscles
Rectus abdominis, pyramidalis
Anterior lateral abdominal wall muscles
External, internal oblique, transversum abdominis
Posterior abdominal wall muscles
Psoas major, psoas minor, iliacus, quadratics lumborum
Borders of abdominal cavity
Diaphragm to pelvic diaphragm
In the GI tract, ___ ___ and __ __ ___ are found in the wall of the viscera
Panician corpuscles and free nerve endings
How are pancian corpuscles and free nerve endings activated
Stretch and spasm
Highly sensitive to stretch, spasm, inflammation, and ischemia
True visceral pain
Poorly localized
From. Irritation, stretch, spasm
True somatic pain
Well localized and sharp
Phrenic pain
Hemidiaphragm or liver capsule stimulated
Refer to ipsilateral shoulder
Visceral pathology
Increased stretch/irritation to GI nerves->increased afferent signals to CNS->afferent fibers synapse in the dorsal horn to the spinal cord
Prolonged afferent activity leads to ____ of the neurons and the orresponding spinal segments
Facilitation
Describe the facilitated segments of viscerosomatic pain
Abnormal sensory stimulus from overstretched visceral organ spindle sensitized two interneurons in spinal cord
- Exaggerated output to initiating site (increase muscle tension) as well as brain (increased pain awareness) and local cutaneous tissue (tissue texture change)
Visceral disturbances can cause activation of what
Somatic muscle activity
Visceral pathology results in somatic changes ___
Paraspinal lh
-paravertebral tissue/texture changes and increased tenderness (due to increased sensitivity of segment from spinal facilitation)
Pattern usually reflexes to soma on same side of organ
Somatic: percutaneous reflex of Morley
Direct transfer of inflammatory irritation
From viscera to peritoneum
Not reflecting through visceral afferent reflex
Example of percutaneous reflex of Morley
Appendicitis->peritonitis
Responsible for abdominal wall rigidity
Abdominal wall pain
Rebound tenderness
Direct organ to peritoneum inflammation
Sympathetic GI
Thoracic splanchnic n->celiacand superior mesenteric
Lumbar splanchnic n->inferior mesenteric ganglion
GI parasympathetic
Vagus Pelvic splanchnic (S2-4)
Celiac ganglion
Sympathetic
T5-t9
Distal esophagus, stomach, proximal duodenum, liver, gallbladder, spleen
Superior mesenteric ganglion
Sympathetic
T10-T11
Distal duodenum, portions of pancrea, jejunum, ascending colon, proximal 2.3 of transverse colon
Dinferior mesenteric ganglion sympathetic
T12-l2
Distal 1/3 of the transverse colon, descending colon, sigmoid colon, rectum
Upper GGI and 1/3 lower GI
Vagus n
Right vagus
Lesser curvature of stomach, liver/gallbladder, small bowel, right colon to mid transverse colon
Left vagus
Greater curve of stomach, ends at duodenum
Lower 1/3 GI parasympathetics
Pelvic splanchnic
Descending colon, sigmoid colon, rectum
Autonomic neuropathy
Gastroparesis, GERD, achlasia, cyclic vomiting syndrome, IBS, reflux esophagitis
Symtpethetic GI issue
Ileus
Constipation/flatulence
Abdominal distention
Parasympathetic problem GI
Increased secretion rate of all GI glands
Diarrhea . Incontinence
Decreased water absorption
Sympathetic and para of upper GI (liver gallbladder, spleen, pancreas, duodenum
T5-T9, grater splanchnic and celiac ganglion
Vagus, occiput, C1 C2
Symp and para of lower GI
Pancreas, duodenum, jejunum, ascending colon, proximal 2.3 of transverse colon
T10-t11, lesser splanchnic, superior mesenteric ganglion
Vagus, occiput, C1, C2
Lower GI para and symp
Distal 1/3 of transverse colon, descending/sigmoid colon, rectum
T12-L2, least splanchnic and inferior mesenteric
Pelvic splanchnic
S2-4
How does diaphragm move with inspiration
Inferior and contracts as the thoracic and pelvic
How does diaphragm move during exhalation
Thoracic and pelvic diaphram expand and move superior
Diaphragm as a pump
Stimulates movement of the vasculature and lymphatic fluids
SD pelvic diaphragm
Fluid stasis within the pelvic (fascia torsion, diaphragm hypertonicity)
Pelvic congestion, VISCEROSOMATIC PAIN, inability to clear infections
The GI is __ linked to the vascular system
Holistically
Major portal of nutrients and processing of harmful substances
Obstruction in venous and lymphatic drainage
Tissue congestion, causing arterial obstruction and ischemia
What can acute abdominal pains lead to
Surgery-appendicitis, cholecystisis, diverticulitis, SBO
Leads to an obstruction in venous and lymphatic drainage->organ wall edema->arterial obstruction and ischemia
Vasculature and lymphatic stastis causing bacterial overgrowth
Can lead to systemic sepsis
Inflammation and infection increase metabolic process
Increase release of interleukins+other cytokines->generate fever->SIRS
What does lymph congestion lead to
Accumulation of waste products
Decreased medicine distribution
Decreased absorption and nutrition to cells
Increased likelihood of fibrosis or scarring
Worsened prognosis of UC and C
Bloating, cramps, increased symptomatic pain in IBS
Reduced oxygenation
Lymphatics drain to the __ __ (L1-L2 area-lies righ of the abdominal aorta)->thoracic duct->left subclavian vein
Cisterns chili
Celiac node
Stomach duodenum spleen liver
Superior mesenteric node
Jejunum, ileum, ascending.transverse colon
Inferior mesenteric node
Descending/sigmoid colon, rectum
GI metabolic
Internal organs, endocrine organs
What disorders influence the metabolic energetic Odell
CD, celiac, food sensitivities, OSA, thyroid disorders, other inflammatory disorders, malabsorption, inability to eliminate wastes
Hyperparathyroidism
Diarrhea
Hypopatathyroidism
Constipation
Hypercalcemia and hypokalemia
Constipation
Hyperkalemia
Diarrhea
Diarrhea and acid base
Metabolic acidosis loss of bicarbonate
Vomiting acid base
Metabolis alkalosis with hypokalemic loss of hydrochloride acid
Behavior GI
Anxiety.stress.diet.laxative abuse.probiotics.fear of poop pain
Inflammatory foods
Fried, white bread, red meat, fats, gluten, casein, MSG-Asian foods
Anti-inflammatory foods
Olive oil, tomatoes, nute, spinach and kale, salmon a, blueberries and oranges
Visceral dysfunction
Impaired or altered motility of the visceral system and related fascial, neurological, vascular, skeletal, and lymphatic elements
How can OMT used to treat SD affect underlying visceral functions t
Somatovisceral network
When stop omm
Relaxation of sot tissues in treated area
Altered autonomic tone
Peripheral vasodilation
Increased HR and or RR
Urgency in using restroom
Biomechanical model
Postural msucles, spine, extremities, myofascial relationships to organs
Respiratory circulatory
Diaphragm: thoracic inlet, thoracotomy-abdominal, pelvic
Venous and lymphatic drainage
Neurological
ANS
Treat sympathetic ganglion, parasympathetic vagus, and parasympathetic pelvic splanchnic n
Metabolic model
Treating the other models first can treat this by taking into consideration the relationship to the internal organs and endocrine glands
Homeostasis, energy balance, regulatory processes, inflammation and repair, absorption of nutrients, and removal of waste are all targeted goals
Behaviors
Physchologocal and social
Diet, habits, restroom, exercise
How evaluate biomechanical model
T1-T4
Sacral TART
Lumbosacral spring and sacral rock
Suboccipital, cervical
Lumbosacral spring test
Push lumbosacral junction in anterior direction several times
Negative-east of springing-either normal motion or a preference for anterior sacral base motion unilaterally or bilaterally
Positive-resistance to springing
-preference for posterior sacral base motion unilaterally or bilateral
Sacral rock oblique axis
Docs thumb is over the posterior aspect of the left ILA and left thumb over the right sacral base
Doc applies anteriorly directed pressure alternately between the two thumb pads to assess motion
Right oblique ACEI-switch
Axis is determined by the test that demonstrates the greatest motion
Neurological model
Paraspinal inhibition t10-l2
AA ME
OA ME
SI gap
Sacral rock-increases parasympathetic tone
Sacral inhibition -decreases parasympathetic tone
Treatments to normalize sympathetic activity
Treat facilitates segments associated with organ
T5-T9
T10-T11
T12-L2
ME, ST< MFR, STills, Chapman, HVLA< rib raising, paraspinal inhibition
How evaluate cranial cervical jucntion
Fingerpads under suboccipital area
Rotation
How evaluate cervical thoracic jucntion
Palms on the scapula and fingers rest with pads infraclavicularly
How evaluate thoracolumnar junction
Place palms on lateral aspects of the lower most ribs to introduce rotation
Evaluate lumbopelvic jucntion
Pads of jabs on posterolateral aspects of the innominate to introduce rotation
Anterior Chapman points are __
Posterior points are ___
Diagnostic
Treatment
Where are Chapman points
At free nerve endings
Develop secondary to irritation/inflammation relative to specific organs
How treat chapman point
Direct circular pressure for 10-30 seconds
How long after treat chapman point do we see change in organ function
24 hours
Pylorus chapman point
Sternal
R R10 at costotransver joint
Stomach chapman
L 6th intercostal
L bw T5 T 6
Liver chapman
R 5th ICS
R bw T5 T6
Spleen
L 7th ICSL bw T7 T8
L bw T7 T8
Pancreas
R 7th ICS
R bw T7 and T8
R bw T7 T8
SI
Bl 8-10 ICS
Upper bw t8 t9
Middle bw t9 t10
Lower bw t11 t12
Appendix
R tip of 12th rib
Upper IT band
Right cecum left sigmoid colon
Lower IT band
Right proximal transverse colon
Left distal transverse colon
Contraindication to soft tissue
Fracture or dislocation
Neurological entrapment syndromes
Serious vascular compromise
Local malignancy
Local infection
Contraindication to lymphatic tratment
Malignancy of lymphatic
Contraindication to ME
Fracture, allusion, dislocation
Infection, hematoma, teat of muscle
Severe osteoporosis
Metastatic disease of bone or muscle
Cervical spine instability
Rib raising contraindications
Spinal or rib fracture
Recent spinal surgery
Mesenteric release contraindication
Aortic aneurysm
Open surgical wound
Contraindications sacral treatment
Local infection
Incision in area
Decubitus ulcer
Indication for large intestine OMT
Constipation
IBS
Viscerosomatic reflex findings
Contraindication for large intestine visceral OMT
Peritonitis
Colon obstruction
Recent abdominal surgery
In healthy people colon tapers from _ to )
Proximal to distal
What is anterior to kidney
Ascending colon or descending colon
Fascia is attached to the ___ ___
Parietal peritoneum on posterior abdominal wall
Collateral ganglia diagnosis
After abdominal quadrant exam
TART changes within the deeper myofascial of the abdomen but may affec ttissue
Celiac
Midway between xiphoid and superior mesenteric
Superior mesenteric
Midway between xiphoid and umbilicus
Inferior mesenteric
Midway between superior mesenteric and umbilicus
Colon chapmen
A triangle from L2-L4 TP to crest of ilium
Direct fascial relationship between the descending or ascending colon, depending upon side, and the quadratic lumborum muscle
Collateral ganglia release
Patient supine with knees bent
Physician on right side and transfer to left after treating mid transverse area
Force is posterior and engages the feathers adage of RB of tissues demonstrating a myofascial RB
Activation force-maintain a gentle force until softening
Reassess-TART
Colon release
Patient supine with knees bent; physician stands on right side of patient and transfers to left after treating the mid transverse colon ares
Activating force -maintain a gentle force on the outer margin of the colon tissues until a softening occurs
Reassess-TART
Sigmoid
On anteromedial of the left pelvic brim with a force direcected medial
Descending colon
On left posterolateral flank with a medial force
Transverse
Inferior to the costal margin with an inferior directed force
Ascending colon
On right posterolateral flank with a mediall directed force
MF seated thoracic SD
Ipsilateral hand to PTP clasped behind neck and hold elbow
Monitor TPusing thumb and index or 9 and middle for tp of 10
Left hand on patient bicep
Into barrier
Hold inhalation
Indications for small intestine
Indigestion
Delayed gastric empty
Cholestasis
Other functional disorders
Viscerosomatic reflex
Contraindication SI visceral OMT
Peritonitis, splenomegaly, recent abdominal surgery
Evaluate SI
T9(duodenum)
T10.11(SNS VS)
Suboccipital (PNS VS)
AA
OA
C2-C7
Chapman
Mesenteric colonic release
Patient supine with knees bent;physician stands on right side for SI mesenteric root release and then proceeds to the left side for cecum, switching back to right side at the mid transverse colon
Activating force-maintain a gentle force on the outer margin of the tissue until a softening occurs
Reassess-TART of colon and/or VS
SSI mesenteric root
1 inch inferior 1 inch lateral to the umbilicus
Cecum
Medial to the right ASIS
Ascending
On right posterolateral flank with a medially directed force
Transverse
Inferior to the costal margin with an inferior directed force
Descending
On left posterolateral flan with a medially directed force
Sigmoid
On anteromedial of the left pelvic brim with a force directed toward RUQ
Treat SI
Chapman
Superfine FPR: cervical superficial muscles from suboccipital hypertronicity
STills T5-12
Mesenteric colonic release
Supine FPR for cervical superficial msucles
Neutralize sagittal curveL monitor segment and flex spine to straighten lordotic curve at that level
Activating force: add compression of <1 lb localized to the segment
Indirect positioning is triplanar
Hold 3-5 seconded
Return to neutral and retest TART
Still lower thoracic T5-12
Extend to localize to T6 then add rotation into east while monitor TP for tissue texture normalization
Localizing force; compression through shoulders to the segment
Activating force; move T6 through restrictive barrier through shoulder contact while maintaining compression
Final position-at anatomical barrier
Return to neutral retest
Indications for liver visceral OMT
Passive congestion of liver ANS spleen
CHF
Inferior
Consider in patients with parenchymal disease of liver or spleen as it may affect the disease process by modulating blood and lymph fluid dynamics
Liver visceral dysfunction
Contraindications for liver visceral OMT
Fractures, dislocations in thorax
Lymphatic system malignancy
Traumatic disruption of liver, spleen, or adjacent organs
Acute hepatitis
Friable hepatomegaly or splenomegaly as in mononucleosis or sickle cell anemia
Liver chapman
Anterior R 5th ICS
R bw T5 T6
Gallbladder chapman
R 6th ICS
Blbw T6 T7
Evaluate liver
T7-T9 Tart
Suboccipital tart , AA, C2-C7
Upper, middle (c3-5
Lower C6-7
Liver pump
Patient supine with knees bent; physician stands or site on the right side of patient
Caudate hand is placed on the anteroinferior, right inferior ribs and costal margin and cephalic hand is placed on the posteroinferior ,right inferior ribs and costal margin
Activating force;use a gentle alternating compressive, pumping force through the rib cage to pump the liver tissues for 30-60 seconds
Reassess tart
Liver pump with recoil
Patient supine with knees bend physician stands of sits on right side
Caudate hand is placed on the anteroinferior, right inferior ribs and costal margin and cephalic hand is placed on the posteroinferior, right inferior ribs and costal margin
Force -apply compressive force to engage the liver tissues (sense of resistance while compressing through rubs), then evaluate f/e, sb, r,—stack indirect
Activating force-instruct patient to take a few deep breaths and follow tissues towards ease, then during an early inhalation release compression and other forces.
-inherent mechanism and recoiled release
Reassess tart of VS reflexes
OA BLT
One hand pincher grasp of the marina on either side of the midline for C1 to stabilize and monitor the OA through the atlas
Place other hand on patients head o induce position of greatest BLT
Test respiratory mechanism and airhunter
Repeat 1-3x until best motion obtained
Recheck
FPR thoracic
Monitor segment and instruct patient to extend spine to straighten kyphotic curve
Activating force-add compression lass than 1lb localized to the segment
Indirect position triplanar
Hold 2-5 seconds
Return and retest
