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
