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GI Flashcards

1
Q

What is visceral manipulation

A

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

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2
Q

Most common GI disorder

A

IBS

GERD too prevelance increases with age-worsened with food and lifestyle factors

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3
Q

How can OMT help with GI

A

Improving blood/lymphatic glow and balancing Autonomics

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4
Q

LUQ pain causes

A

Splenomegaly
Splenic infarct
Splenic abscess
Splenic rupture

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5
Q

Splenomegaly clinical

A

Pain/discomfort, left shoulder pain, and/or early satiety

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6
Q

Splenic infarct clinical

A

Severe pain

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7
Q

Splenic abscess clinical

A

Associated with fever and tenderness

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8
Q

Splenic rupture clinical

A

Left chest wall/shoulder pain worse with inspiration

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9
Q

Causes of epigastric pain

A 
Acute MI
Acute pancreatitis
Chronic pancreatitis
Peptic ulcer disease
GERD
Gastritis/gastropathy
Functional dyspepsia
Gastroparesis
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10
Q

RUQ pain causes biliary

A

Biliary colic
Acute cholecystitis
Acute cholangitis
Sphincter of Oddi dysfunction

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11
Q

RUQ pain causes hepatic

A

Acute hepatitis
Preihepatitis (fitz high Curtis syndrome)
Budd chiari
Portal vein thrombosis

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12
Q

LQ pain

A

Appendicitis-R
Diverticulitis-L

Ectopic preg

Neohrolithiasis
Pyelonephritis
Acute urinary retention
Cystitis
Infectious colitis
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13
Q

What are the 5 models

A 
Biomechanical
Neuro
Respiratory/card
Behavioursa
Metabolic
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14
Q

For the biomechanical model you want to determine whether the SD is an MSK or viscerosomatic reflex problem. How?

A

Failure of SD to respond to OMT points to viscerosomatic

SD can be affected by MSK through direct myofascial relationships

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15
Q

Severity of palpated tissue texture abnormality=?

A

Severity of visceral problem

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16
Q

How sue OMT for surgery

A

Make a better surgical candidate

Help with recovery phase

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17
Q

What are the intraperitoneal organs

A

Stomach, SI, spleen, liver

*supeprior part of duodenum

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18
Q

Extra peritoneal

SAD PUCKER

A

Descending and horizontal duodenum

Pancreas, ascending and descending colon, cecum, pancreas, upper 2/3 rectum

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19
Q

Infreaperitoneal

A

Lower 1/3 rectum

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20
Q

Anterior abdominal wall muscles

A

Rectus abdominis, pyramidalis

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21
Q

Anterior lateral abdominal wall muscles

A

External, internal oblique, transversum abdominis

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22
Q

Posterior abdominal wall muscles

A

Psoas major, psoas minor, iliacus, quadratics lumborum

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23
Q

Borders of abdominal cavity

A

Diaphragm to pelvic diaphragm

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24
Q

In the GI tract, ___ ___ and __ __ ___ are found in the wall of the viscera

A

Panician corpuscles and free nerve endings

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25
Q

How are pancian corpuscles and free nerve endings activated

A

Stretch and spasm

Highly sensitive to stretch, spasm, inflammation, and ischemia

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26
Q

True visceral pain

A

Poorly localized

From. Irritation, stretch, spasm

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27
Q

True somatic pain

A

Well localized and sharp

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28
Q

Phrenic pain

A

Hemidiaphragm or liver capsule stimulated

Refer to ipsilateral shoulder

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29
Q

Visceral pathology

A

Increased stretch/irritation to GI nerves->increased afferent signals to CNS->afferent fibers synapse in the dorsal horn to the spinal cord

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30
Q

Prolonged afferent activity leads to ____ of the neurons and the orresponding spinal segments

A

Facilitation

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31
Q

Describe the facilitated segments of viscerosomatic pain

A

Abnormal sensory stimulus from overstretched visceral organ spindle sensitized two interneurons in spinal cord

  1. Exaggerated output to initiating site (increase muscle tension) as well as brain (increased pain awareness) and local cutaneous tissue (tissue texture change)
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32
Q

Visceral disturbances can cause activation of what

A

Somatic muscle activity

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33
Q

Visceral pathology results in somatic changes ___

A

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

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34
Q

Somatic: percutaneous reflex of Morley

A

Direct transfer of inflammatory irritation

From viscera to peritoneum

Not reflecting through visceral afferent reflex

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35
Q

Example of percutaneous reflex of Morley

A

Appendicitis->peritonitis

Responsible for abdominal wall rigidity
Abdominal wall pain
Rebound tenderness
Direct organ to peritoneum inflammation

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36
Q

Sympathetic GI

A

Thoracic splanchnic n->celiacand superior mesenteric

Lumbar splanchnic n->inferior mesenteric ganglion

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37
Q

GI parasympathetic

A 
Vagus
Pelvic splanchnic (S2-4)
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38
Q

Celiac ganglion

Sympathetic

A

T5-t9

Distal esophagus, stomach, proximal duodenum, liver, gallbladder, spleen

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39
Q

Superior mesenteric ganglion

Sympathetic

A

T10-T11

Distal duodenum, portions of pancrea, jejunum, ascending colon, proximal 2.3 of transverse colon

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40
Q

Dinferior mesenteric ganglion sympathetic

A

T12-l2

Distal 1/3 of the transverse colon, descending colon, sigmoid colon, rectum

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41
Q

Upper GGI and 1/3 lower GI

A

Vagus n

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42
Q

Right vagus

A

Lesser curvature of stomach, liver/gallbladder, small bowel, right colon to mid transverse colon

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43
Q

Left vagus

A

Greater curve of stomach, ends at duodenum

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44
Q

Lower 1/3 GI parasympathetics

A

Pelvic splanchnic

Descending colon, sigmoid colon, rectum

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45
Q

Autonomic neuropathy

A

Gastroparesis, GERD, achlasia, cyclic vomiting syndrome, IBS, reflux esophagitis

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46
Q

Symtpethetic GI issue

A

Ileus

Constipation/flatulence

Abdominal distention

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47
Q

Parasympathetic problem GI

A

Increased secretion rate of all GI glands

Diarrhea . Incontinence

Decreased water absorption

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48
Q

Sympathetic and para of upper GI (liver gallbladder, spleen, pancreas, duodenum

A

T5-T9, grater splanchnic and celiac ganglion

Vagus, occiput, C1 C2

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49
Q

Symp and para of lower GI

Pancreas, duodenum, jejunum, ascending colon, proximal 2.3 of transverse colon

A

T10-t11, lesser splanchnic, superior mesenteric ganglion

Vagus, occiput, C1, C2

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50
Q

Lower GI para and symp

Distal 1/3 of transverse colon, descending/sigmoid colon, rectum

A

T12-L2, least splanchnic and inferior mesenteric

Pelvic splanchnic
S2-4

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51
Q

How does diaphragm move with inspiration

A

Inferior and contracts as the thoracic and pelvic

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52
Q

How does diaphragm move during exhalation

A

Thoracic and pelvic diaphram expand and move superior

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53
Q

Diaphragm as a pump

A

Stimulates movement of the vasculature and lymphatic fluids

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54
Q

SD pelvic diaphragm

A

Fluid stasis within the pelvic (fascia torsion, diaphragm hypertonicity)

Pelvic congestion, VISCEROSOMATIC PAIN, inability to clear infections

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55
Q

The GI is __ linked to the vascular system

A

Holistically

Major portal of nutrients and processing of harmful substances

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56
Q

Obstruction in venous and lymphatic drainage

A

Tissue congestion, causing arterial obstruction and ischemia

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57
Q

What can acute abdominal pains lead to

A

Surgery-appendicitis, cholecystisis, diverticulitis, SBO

Leads to an obstruction in venous and lymphatic drainage->organ wall edema->arterial obstruction and ischemia

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58
Q

Vasculature and lymphatic stastis causing bacterial overgrowth

A

Can lead to systemic sepsis

Inflammation and infection increase metabolic process
Increase release of interleukins+other cytokines->generate fever->SIRS

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59
Q

What does lymph congestion lead to

A

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

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60
Q

Lymphatics drain to the __ __ (L1-L2 area-lies righ of the abdominal aorta)->thoracic duct->left subclavian vein

A

Cisterns chili

61
Q

Celiac node

A

Stomach duodenum spleen liver

62
Q

Superior mesenteric node

A

Jejunum, ileum, ascending.transverse colon

63
Q

Inferior mesenteric node

A

Descending/sigmoid colon, rectum

64
Q

GI metabolic

A

Internal organs, endocrine organs

65
Q

What disorders influence the metabolic energetic Odell

A

CD, celiac, food sensitivities, OSA, thyroid disorders, other inflammatory disorders, malabsorption, inability to eliminate wastes

66
Q

Hyperparathyroidism

A

Diarrhea

67
Q

Hypopatathyroidism

A

Constipation

68
Q

Hypercalcemia and hypokalemia

A

Constipation

69
Q

Hyperkalemia

A

Diarrhea

70
Q

Diarrhea and acid base

A

Metabolic acidosis loss of bicarbonate

71
Q

Vomiting acid base

A

Metabolis alkalosis with hypokalemic loss of hydrochloride acid

72
Q

Behavior GI

A

Anxiety.stress.diet.laxative abuse.probiotics.fear of poop pain

73
Q

Inflammatory foods

A

Fried, white bread, red meat, fats, gluten, casein, MSG-Asian foods

74
Q

Anti-inflammatory foods

A

Olive oil, tomatoes, nute, spinach and kale, salmon a, blueberries and oranges

75
Q

Visceral dysfunction

A

Impaired or altered motility of the visceral system and related fascial, neurological, vascular, skeletal, and lymphatic elements

76
Q

How can OMT used to treat SD affect underlying visceral functions t

A

Somatovisceral network

77
Q

When stop omm

A

Relaxation of sot tissues in treated area

Altered autonomic tone

Peripheral vasodilation

Increased HR and or RR

Urgency in using restroom

78
Q

Biomechanical model

A

Postural msucles, spine, extremities, myofascial relationships to organs

79
Q

Respiratory circulatory

A

Diaphragm: thoracic inlet, thoracotomy-abdominal, pelvic

Venous and lymphatic drainage

80
Q

Neurological

A

ANS

Treat sympathetic ganglion, parasympathetic vagus, and parasympathetic pelvic splanchnic n

81
Q

Metabolic model

A

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

82
Q

Behaviors

A

Physchologocal and social

Diet, habits, restroom, exercise

83
Q

How evaluate biomechanical model

A

T1-T4

Sacral TART

Lumbosacral spring and sacral rock

Suboccipital, cervical

84
Q

Lumbosacral spring test

A

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

85
Q

Sacral rock oblique axis

A

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

86
Q

Neurological model

A

Paraspinal inhibition t10-l2

AA ME

OA ME

SI gap

Sacral rock-increases parasympathetic tone
Sacral inhibition -decreases parasympathetic tone

87
Q

Treatments to normalize sympathetic activity

A

Treat facilitates segments associated with organ

T5-T9

T10-T11

T12-L2

ME, ST< MFR, STills, Chapman, HVLA< rib raising, paraspinal inhibition

88
Q

How evaluate cranial cervical jucntion

A

Fingerpads under suboccipital area

Rotation

89
Q

How evaluate cervical thoracic jucntion

A

Palms on the scapula and fingers rest with pads infraclavicularly

90
Q

How evaluate thoracolumnar junction

A

Place palms on lateral aspects of the lower most ribs to introduce rotation

91
Q

Evaluate lumbopelvic jucntion

A

Pads of jabs on posterolateral aspects of the innominate to introduce rotation

92
Q

Anterior Chapman points are __

Posterior points are ___

A

Diagnostic

Treatment

93
Q

Where are Chapman points

A

At free nerve endings

Develop secondary to irritation/inflammation relative to specific organs

94
Q

How treat chapman point

A

Direct circular pressure for 10-30 seconds

95
Q

How long after treat chapman point do we see change in organ function

A

24 hours

96
Q

Pylorus chapman point

A

Sternal

R R10 at costotransver joint

97
Q

Stomach chapman

A

L 6th intercostal

L bw T5 T 6

98
Q

Liver chapman

A

R 5th ICS

R bw T5 T6

99
Q

Spleen

A

L 7th ICSL bw T7 T8

L bw T7 T8

100
Q

Pancreas

A

R 7th ICS

R bw T7 and T8

R bw T7 T8

101
Q

SI

A

Bl 8-10 ICS

Upper bw t8 t9
Middle bw t9 t10

Lower bw t11 t12

102
Q

Appendix

A

R tip of 12th rib

103
Q

Upper IT band

A

Right cecum left sigmoid colon

104
Q

Lower IT band

A

Right proximal transverse colon

Left distal transverse colon

105
Q

Contraindication to soft tissue

A

Fracture or dislocation

Neurological entrapment syndromes

Serious vascular compromise

Local malignancy

Local infection

106
Q

Contraindication to lymphatic tratment

A

Malignancy of lymphatic

107
Q

Contraindication to ME

A

Fracture, allusion, dislocation

Infection, hematoma, teat of muscle

Severe osteoporosis

Metastatic disease of bone or muscle

Cervical spine instability

108
Q

Rib raising contraindications

A

Spinal or rib fracture

Recent spinal surgery

109
Q

Mesenteric release contraindication

A

Aortic aneurysm

Open surgical wound

110
Q

Contraindications sacral treatment

A

Local infection

Incision in area

Decubitus ulcer

111
Q

Indication for large intestine OMT

A

Constipation

IBS

Viscerosomatic reflex findings

112
Q

Contraindication for large intestine visceral OMT

A

Peritonitis

Colon obstruction

Recent abdominal surgery

113
Q

In healthy people colon tapers from _ to )

A

Proximal to distal

114
Q

What is anterior to kidney

A

Ascending colon or descending colon

115
Q

Fascia is attached to the ___ ___

A

Parietal peritoneum on posterior abdominal wall

116
Q

Collateral ganglia diagnosis

A

After abdominal quadrant exam

TART changes within the deeper myofascial of the abdomen but may affec ttissue

117
Q

Celiac

A

Midway between xiphoid and superior mesenteric

118
Q

Superior mesenteric

A

Midway between xiphoid and umbilicus

119
Q

Inferior mesenteric

A

Midway between superior mesenteric and umbilicus

120
Q

Colon chapmen

A

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

121
Q

Collateral ganglia release

A

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

122
Q

Colon release

A

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

123
Q

Sigmoid

A

On anteromedial of the left pelvic brim with a force direcected medial

124
Q

Descending colon

A

On left posterolateral flank with a medial force

125
Q

Transverse

A

Inferior to the costal margin with an inferior directed force

126
Q

Ascending colon

A

On right posterolateral flank with a mediall directed force

127
Q

MF seated thoracic SD

A

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

128
Q

Indications for small intestine

A

Indigestion

Delayed gastric empty
Cholestasis
Other functional disorders
Viscerosomatic reflex

129
Q

Contraindication SI visceral OMT

A

Peritonitis, splenomegaly, recent abdominal surgery

130
Q

Evaluate SI

A

T9(duodenum)

T10.11(SNS VS)

Suboccipital (PNS VS)
AA
OA

C2-C7

Chapman

131
Q

Mesenteric colonic release

A

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

132
Q

SSI mesenteric root

A

1 inch inferior 1 inch lateral to the umbilicus

133
Q

Cecum

A

Medial to the right ASIS

134
Q

Ascending

A

On right posterolateral flank with a medially directed force

135
Q

Transverse

A

Inferior to the costal margin with an inferior directed force

136
Q

Descending

A

On left posterolateral flan with a medially directed force

137
Q

Sigmoid

A

On anteromedial of the left pelvic brim with a force directed toward RUQ

138
Q

Treat SI

A

Chapman

Superfine FPR: cervical superficial muscles from suboccipital hypertronicity

STills T5-12

Mesenteric colonic release

139
Q

Supine FPR for cervical superficial msucles

A

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

140
Q

Still lower thoracic T5-12

A

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

141
Q

Indications for liver visceral OMT

A

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

142
Q

Contraindications for liver visceral OMT

A

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

143
Q

Liver chapman

A

Anterior R 5th ICS

R bw T5 T6

144
Q

Gallbladder chapman

A

R 6th ICS

Blbw T6 T7

145
Q

Evaluate liver

A

T7-T9 Tart

Suboccipital tart , AA, C2-C7

Upper, middle (c3-5
Lower C6-7

146
Q

Liver pump

A

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

147
Q

Liver pump with recoil

A

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

148
Q

OA BLT

A

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

149
Q

FPR thoracic

A

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

Other (17 decks)

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