GI cases techniques, LAB

Question 1

What tissue to you address osteopathically to affect the viscera

Answer 1

ligaments, peritoneum, pleura and mediastinum

Question 2

With inhalation how does the abdomen move

Answer 2

the viscera, diaphragm, thoracic inlet, pelvic floor descend while the rib cage raises

Question 3

with inhalation describe blood flow in superior vena cava and portal vein

Answer 3

blood inf superior vena cava increases

flow in portal vein decreases

Question 4

During respiration which way do the abdomoinal organs move

Answer 4

cephalocaudal (more so laterally and near midline than ant/post)

Question 5

An anterior pull of fascia can be from what

Answer 5

visceral restriction, anterior rib or sternal problem

Question 6

a posterior pull of fascia could be what

Answer 6

spinal or dural problem

Question 7

lateral fascial pull could be what

Answer 7

extremities or paired bilateral viscera

Question 8

when palpating the viscera which axis should your hand be on and how does it move with respiration

Answer 8

the longitudinal

moves away from midline in inspiration and toward midline in exhalation

Question 9

what is difference somatoviscleral reflex than viscerosomatic

Answer 9

visceral problem from somatic structure is somatovisceral

visceral or somatic problem from viscera is viscerosomatic

Question 10

goal of Tx of viscera

Answer 10

Balanced ligamentous tension, normal movement with respiration, balanced inherent motion and normalization of the nervous system, fluid, nurtrion and pressure exchange

Question 11

in cases of intestinal ptosis, stress urinary incontinence, abnormal stoold production, diverticulosis, UC, crohn disease, asthma and allergies what area of small intestine should be evaluated

Answer 11

jejunoileum

Question 12

describe Tx for root of mesentery small intestine

Answer 12

patient supine, knees bent
doctor to the R with fingers below root, thumbs above and palpating deep to the root
take tissue to tension then relax and see speed tissue comes back, use speed to rhythmically engage and disengage tension

Question 13

when to evaluate the colon osteopathically

Answer 13

constipaion, diarrhea, intestinal prolpase, ptosis, diverticulosis, Hx appendectomy, IBS, UC, CD, hemorrhoids, anorectal pain

Question 14

movement of colon with respiration

Answer 14

inspiration: counterclockwise inferior
expiration:
clockwise superior

Question 15

Tx colon OMT

Answer 15

take to direct barrier, relax and let tissues come back, assume that rhythm and repeat steps while encouraging the motion that is better

Question 16

motion of fascial pull over sigmoid colon

Answer 16

superior-medially

inferior-laterally

Question 17

Tx sigmoid colon

Answer 17

take tissues in direcition of ease then exaggerate direction until feel release
take tissues into barrier and maintain with respiratory assistance

Question 18

how to set up collateral ganglia inhibition

Answer 18

patient supine, operator faces abdomen, fingerpads along midline above umbilicus
assess for tenderness and tension in the subcut tissues
when feel tension patient breathes deeply and you maintain firm pressure toward spine
during exhale increase P on tissues

Question 19

what is the cecal release (how do you do it)

Answer 19

supine patient with knees flexed and feet flat on the table(or laying on L side with hips and knees flexed)
operator has tumbs inside R ilium below ASIS
gentle progressive painless P to treat organ

Question 20

describe placement of P for cecal release technique

Answer 20

lateral side of cecum superiomedially
medial side inferolaterally
inferior side superolaterally

Question 21

how does the sigmoid release work

Answer 21

patient supine with knees flexed and feet flat on table, lying on R side with hips and knees flexed
fingerpads inside L ilium below ASIS and press along interior aspect
gentle pressure as you draw sigmoid and mesocolon superiomedially in direction of umbilicus

Question 22

contraindications for mesenteric release of SI

Answer 22

abdominal incision, acute ischemic bowel disease, obstruction or similar condition

Question 23

patient position for mesenteric release SI

Answer 23

supine or on L lateral recumbent position

Question 24

Tx method for mesenteric release SI

Answer 24

hands on L border mesenteric region of SI with fingers curled, gently push toward patients back and then to R side until meet restriction
hold position until release then follow the fascial creep to the new barrier
repeat until no further barriers

Question 25

what part of respiration makes it easiest to release an organ

Answer 25

visceral expiration

Question 26

contraindicaitons to visceral manipulation

Answer 26

nausea and vomiting
sweating
tachycardia
syncope
dizziness
guarding and pain on rebound
acute infections, ruptured viscera, acute blunt force trauma, aortic aneurysm, ischemic bowel, lack of consent

Question 27

what are the relative contraindications to visceral manipulation

Answer 27

gallstones, cancer, bowel obstruction, pregnancy, IUD

Question 28

sequence of Tx of the colon

Answer 28

any structural pelvic SD
plexi
cecum
ileocecal valve
ascending colon
hepatic flexure
transverse colon
splenic flexure
descending colon
sigmoid colon

Question 29

how to Tx pre-aortic plexi

Answer 29

stand next to supine patient, fingers of both hands along linea alba above umbilicus until reach plexi
maintain P and await fascial release
can do gentle repeated rebounds

Question 30

how does hepatic flexure attach to diaphragm

Answer 30

R phrenicocolic ligament

Question 31

how does splenic curvature attach to diaphragm

Answer 31

L phrenicocolic ligament

Question 32

how to Tx ileocecal valve

Answer 32

thenar eminence over valve and apply P medially and then laterally until freer motion

Question 33

which direction do you push the lateral aspect of sigmoid during Tx

Answer 33

superomedially

Question 34

where does the root of mesentery run from

Answer 34

L L2 to R S3

Question 35

where is the central chain of fascia for mesentery

Answer 35

pretracheal fascia, mediastinum, central tendon diaphragm, midline abdominal cavity

Question 36

the direct technique of Tx of mesentery lift if best performed when

Answer 36

after mobilizing the cecum, ileoceal valve and sigmoid