GI Cases (DSA and CIS and Lab) Flashcards
what are the contraindications to visceral manipulation
The following symptoms on palpation: Nausea and vomiting* Sweating Tachycardia Syncope Dizziness Guarding and pain on rebound
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
what is the sequence of treatment of the colon
Start by correcting any structural pelvic somatic dysfunctions Then release the plexi Then release the cecum The ileocecal valve Ascending colon Hepatic flexure Transverse colon Splenic flexure Descending colon Sigmoid colon
where is the celiac ganglion
just below the xiphoid at midline
where is the superior mesenteric ganglion
between the celiac ganglion and the inferior mesenteric ganglion which is just above the umbilicus
how do you treat the pre-aortic plexi
Stand next to the supine patient.
Place fingers of both hands (one re-inforcing the 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 fascial release. There may be a few that occur on your way toward the plexi.
To stimulate the plexi, one can perform gentle, repeated rebounds.
which structures in the abdomen are retroperitoneal
adrenal gland
duodenum (2nd and 3rd parts)
pancreas
ureter
colon
kidneys
rectum
when treating the cecum, which direction do you push the inferior aspect
superolaterally
when treating the cecum, which direction do you push the medial aspect
inferolaterally
when treating the cecum, which direction do you push the lateral aspect
anteromedially
where does the mesenteric root attach
root runs from the left side of L2 to the right sacroiliac joint
where does the hepatic flexure attach
to the diaphragm by the right phrenicocolic ligament, lies b/w the right kidney (posterior) and liver (anterior)
what does the splenic flexure contact and how does it attach to the diaphragm
contacts the greater curvature of the stomach , attaches to the diaphragm by the left phrenicocolic ligament (spleen is superior)
how do you treat the sigmoid colon
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.
where is the sigmoid mesocolonic attachment ?
arises on the medial aspect of the left psoas muscle , curves over the iliac vessels and end lying over the 3rd sacral segment
how do you treat the mesentery
This direct technique is best performed after mobilizing the cecum, ileocecal valve 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.
what is the central tendon
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.
esophagus sympathetic spinal level
T2-8/10
gallbladder sympathetic spinal level
T5-9
stomach sympathetic spinal level
T5-9
liver sympathetic spinal level
T6-9
Spleen sympathetic spinal level
T6-8
Pancreas
sympathetic spinal level
T6-9
small intestine sympathetic spinal level
T8/9 - 11/12
Ascending, transverse colon sympathetic spinal level
T10/11- L1/L2
Appendix sympathetic spinal level
T10
Descending, sigmoid colon, rectum
L1-2
what is infantile colic
Wessel criteria: 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
what are the big 5 foods that should be restricted in mothers with colicky babies
gluten dairy egg citrus soy
fennel, sucrose/glucose have what effect in colicky babies
analgesic effect
where are 5 high yield areas to evaluate and treat in colicky baby
OA
Suboccipital inhibition/soft tissue
-addresses parasympathetic input
Mid thoracic
Rib raising, sympathetics
Thoracolumbar junction
Myofascial release
-help with fluid exchange of the abdomen
Lumbar spine
Myofascial, especially upper lumbars
-constipation
Pelvic diaphragm
Myofascial release
-addressing the parasympathetic innervation to the gut
what 6 organs in the abdomen are associated with the celiac ganglion
Esophagus Gallbladder Stomach Liver Spleen Pancreas
what portions of the abdominal viscera are associated with the superior mesenteric ganglia
small intestine
ascedning, transverse colon
appendix
what organs in the abdomen are associated with the inferior mesenteric ganglia
descending, sigmoid colon, rectum
heart burn may be a trigger point in what area
external oblique muscle
projectile vomiting and belching can be triggered by palpation of what
can be triggered by palpation of points in the posterior abdominal wall bilaterally.
diarrhea can result from what trigger points
lower abdominal muscles
can mimic renal pathology
what are sympathetic actions on GI
inhibit GI function
frequently activated in pathologic situations
inhibits smooth muscle
induces sphincter contraction
regulates blood flow in the GI tract (vasoconstriction)
chapmans pyloric stenosis
Pyloric stenosis – manubrial-sternal junction down the front of the sternum
Pyloric stenosis – face of 10th rib at its junction with tip of TP of 10th vertebrae on the right
stomach hyperacidity
Stomach hyperacidity –5th and 6th intercostal space from the mid-clavicular line to the sternum on the left
Stomach hyperacidity - intertransverse space, midway between the spinous and transverse processes, between 5th and 6th vertebrae on the left
liver chapman’s
Liver - – 5th and 6th intercostal space from mid-clavicular line to the sternum on the right
Liver - - intertransverse space, midway between the spinous and transverse processes, between 5th and 6th vertebrae on the right
liver AND gallbladder chapman
Liver/gallbladder – 6th and 7th intercostal space from mid-clavicular line to the sternum on the right
Liver, gallbladder - intertransverse space, midway between the spinous and transverse processes, between 6th and 7th vertebrae on the right
chapman’s for stomach decreased peristalsis
Stomach decreased peristalsis –6th and 7th intercostal space from the mid-clavicular line to the sternum on the left
Stomach decreased peristalsis – intertransverse space, midway between the spinous and transverse processes, between 6th and 7th vertebrae on the left
pancreas chapmans
Pancreas – 7th and 8th intercostal space on the right
Pancreas - – intertransverse space, midway between the spinous and transverse processes, between 7th and 8th vertebrae on the right
spleen chapman’s
Spleen - 7th and 8th intercostal space on the left
Spleen - intertransverse space, midway between the spinous and transverse processes, between 7th and 8th vertebrae on the left
small intestine chapman’s
Small intestine – intercostal spaces between the 8th and 9th, 9th and 10th, and 10th and 11th ribs near the cartileges bilaterally
Small intestine – intertransverse spaces, midway between the spinous and transverse processes, between 8th and 9th, 9th and 10th, 10th and 11th vertebrae on the left
intestinal peristalsis chapmans (constipation)
Intestinal peristalsis (constipation) - – face of 11th rib at its junction with tip of TP of 11th vertebrae on the right
between ASIS and greater trocanter
rectum chapman’s
Rectum – lesser trocanter downward
colon chapman’s points
Colon (spastic constipation or colitis) – an area 1-2” wide, extending from the trocanter to within an inch of the patella on the front, outer aspect of the femur
– on the right side = upper 1/5 indicates cecum, next 3/5 ascending colon, last 1/5 for the first 2/5 of transverse colon;
on the left side = first 1/5 just above the knee corresponds to the last 3/5 of transverse colon, middle 3/5 is the descending colon, last 1/5 is the sigmoid; extreme upper end of the trocanter on the left side is the recto-sigmoid junction
TP of L2
TP of L4 a triangular area reaching across to the iliac crest
colon anteriorly
hemorrhoids, rectum
chapman’s
on the sacrum close to the ilium at the lower end of the SI jt
hemorrhoids only chapman’s
Hemorrhoids – just above the ischial tuberosity (anterior points)
what chapmans are along the lateral femur shaft
broad ligament and prostate points
what does the vagus innervate in the GI system
The vagus nerve, (CN 10th), innervates the esophagus, stomach, gallbladder, pancreas, first part of the intestine, cecum, and the proximal part of the colon.
what is the effect of the parasympathetic NS on the GI
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
what are some sympathetically driven symptoms in the GI tract
Constipation Bloating Pain Contraction of sphincters Increased vasomotor tone (may lead to decreased mucus production in stomach and intestines)
Increased vascular tone – decreased O2 and nutrients to the tissues
Decreased peristalsis
what are some parasympathetically driven symptoms in the GI tract
Nausea Vomiting Diarrhea Hypermotility Relaxation of sphincters Increased mucus secretion Increased acid production in the stomach
what is the Arndt -Schultz law
Weak stimuli accelerate physiologic activity
Medium stimuli inhibit physiologic activity
Strong stimuli halt physiologic activity
what are the interstitial cells of cajal
pacemakers of the gut
have properties of both fibroblasts and smooth muscle cells
in terms of visceral joints, what is the difference b/w the double layer system, ligamentous system, mesenteric system, omental system?
Double layer system - serous fluid creates suction between surfaces of the peritoneum, etc.
Ligamentous system – 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
Mesenteric system- folds of peritoneum that support the nerves, arteries, veins and lymphatics of the small and large intestines
Omental system – folds of peritoneum that join 2 elements of the digestive tract together and has a neurovascular role
where is the chapman’s point for atonic constipation
Anterior: Bilaterally in the muscle tissues between the ASIS and the Greater Trochanter
Posterior: Bilaterally along the 11th rib at the costovertebral junction.
