GI cases CIS

Question 1

what organs are controlled by celiac ganglia sympathetically

Answer 1

esophagus, gallbladder, stomach, liver, spleen, and pancreas

Question 2

what organs are controlled by superior mesenteric ganglia

Answer 2

small intestine
ascending and transverse colon
appendix

Question 3

what organs are controlled by the inferior mesenteric ganglion

Answer 3

descending sigmoid colon, rectum

Question 4

what is the facilitation level of appendix? sympathetic level?

Answer 4

facilitation- T12

sympathetic- T10

Question 5

what commonly refers to the right neck trapezius area

Answer 5

liver, gallbladder, duodenum

from iritation of the diaphragm

Question 6

where are trigger points for heartburn

Answer 6

external oblique

Question 7

projectile vomiting and belching can be tirggerd how

Answer 7

palpation of points of the posterior abdominal wall bilaterally

Question 8

where are the trigger points for diarrhea

Answer 8

lower abdominal muscles

Question 9

where is chapmans for stomach hyperaciditiy and and post

Answer 9

Ant: 5th 6th intercostal space MCL to L of sternum
post: intertransverse space midway spinous and transveser processes between 5th and 6th on L

Question 10

chapmans for liver/gallbladder ant/post

Answer 10

ant: 6th and 7th ICS MCL sternum to R
post: intertransverese space 6th and 7th vertebrae on R

Question 11

chapmans point for appendix ant/post

Answer 11

ant: upper edge near tip 12th rib on R
post: 11th intertransverse space on R

Question 12

describe chapmans points for colon anterior

Answer 12

1-2 “ wide on trochanter femur down to patella
R: cecum is upper 1/5
next 3/3 is ascending colon
last 1/5 is for the first 2/5 transverse of colon
L: lower 1/5 last 3/5 transverse colon
middle 3/5 is descending colon
upper 1/5 sigmoid colon
very tip trochanter on L is recto-sigmoid junction

Question 13

colon TP on posterior side

Answer 13

TP of L2 and TP of L4 in triangular pattern reaching across iliac crest

Question 14

what is post-operative ileus

Answer 14

failure to pass flatus or stool for 3/6 days after surgery

transient impairment of f(x) and motility

Question 15

what is the arndt-schultz law

Answer 15

weak stimuli accelerate physiologic activity
medium stimuli inhibit physiologic activity
strong stimuli halt physiologic activity

Question 16

What are the pacemakers of the gut

Answer 16

interstitial cells of Cajal

Question 17

what is the concept visceral joint

Answer 17

held together by the suction between surfaces of peritoneum
the fold of peritoneum or pleura act like ligaments
the intracavity P holds viscera in place
the mesentery supports vessels
omental system join 2 elements of digestive tract together

Question 18

what is visceral somatic dysfunction

Answer 18

any restriction. fixation, adhesion limits mobility and motility
even a small amount of restriction can have big consequences

Question 19

causes of visceral somatic dysfunction

Answer 19

infection/inflammation
trauma
surgery
pregnancy
scoliosis/short leg syndrome
craniosacral dysfunction

Question 20

when palpating abdomen evaluate for what

Answer 20

painfulness
differences in tension
position of the organ
tone of the organ

Question 21

74 y.o M crampy abdominal pain crescendo decrescendo for past week and getting worse
no bowel movement for 3 days, small hard stool.
similar episodes before
fiber worsens Sx, denies vomiting or blood in stool
PMH + HTN +HLD +CABG 4 yr ago, appendectomy, + smoking Hx
mild AV nicking on exam, soft to palpation, tenderness in LLQ no organomegaly, LLQ absent BS, + occult blood
ddx?

Answer 21

bowel obstruction/ileus
IBD (crohn/UC)
tumor
ischemic bowel
adhesions
constipation
fecal impaction
diverticulitis
hypothyroidism

Question 22

What OMT for absent bowel movements

Answer 22

sympathetics T10-L2 (inferior mesenteric gangnion
PAN S2-4
sibsons, diaphragm and pelvic diaphragm

Question 23

chapmans for atonic constipation

Answer 23

ant: b/l in muscle tissues between ASIS and greater trochanter
post: b/l along 11th rib at costovertebral junction

Question 24

32 y.o F with diffuse abdominal pain during night and before meals. no spicy food and has food backup in throat, denies blood in stool. +smoking Hx, drinks lots of soda, DM2, HTN amenorrheic past 4-5 mo
obese - occult blood
ddx

Answer 24

GERD
gastric ulcer
duodenal ulcer
cholycystitis
cholylithiasis
pregnancy

Question 25

osteopathic considerations for GERD

Answer 25

SAN: T5-9 celiac ganglion
PAN: vagus
lymph: sibsons, respiratory diaphragm, pelvic diaphragm

Question 26

47 F upper abdominal pain during and after meals, feels gassy after fatty meals, no blood in stools, R shouldr aches on and off
+ hypothyroidism, + smoking, tenderness in RUQ, no rigidity or guarding, normal BS all 4quadrants, stool = occult blood
ddx?

Answer 26

cholycystitis
cholylithiasis
GERD
gastric ulcer
duodenal ulcer

Question 27

osteopathic considerations for cholycystitis

Answer 27

SAN: T6-8 on R, celiac ganglion
PAN: vagus
lymph: sibsons, respiratory diaphragm, pelvic diaphragm

Question 28

18 mo M vomiting diarrhea 36 hrs, slight temperature
26 Lb last visit
1st child, nonsmokers
tenderness throughout belly
hyperactive BS
ddx?

Answer 28

gastroenteritis: rotavirus, norwalk
intussusception
dehydration

Question 29

osteo considerations gastroenteritis in infant

Answer 29

T10-11
superior mesenteric ganglion
celiac gangion
PAN: Vagus S2-4
lymph: sibsons, respiratory diaphragm, pelvic diaphragm