GI CBL Flashcards
Differentiating pain
True visceral pain:
- early pain from irritation/stretching/contraction of exaggerated physiological motor activity
- midline pain is poorly localized and described as vague/deep/diffuse/burning ache
Viscerosomatic pain:
- usually in a dermatome area patter and is well localized and asymmetric
Paraspinal somatic dysfunction with respect to spinal regions
T5-T9 = stomach/liver/gallbladder/duodenum/pancreas
T10-11 = small intestine/ascending/transverse colon
T12-L2 = transverse/descending/sigmoid colon and rectum
Prolonged sympathetic innervation generally leads to what?
Vasoconstriction
- decreased oxygen and nutrients to the tissues
- increased acid secretion vs mucus secretion
Parasympathetic to the GI tract
Left vagus = greater curvature and pyloric sphincter
Right vagus = lesser curvature, right colon, gall bladder
Pelvic splanchnic nerves (S2-4)
- left colon and pelvis
effects are increased peristalsis (diarrhea), increased secretion rates of most GI glands, decreased LES tone (GERD) and increased contraction of gallbladder
Occipital headache with parasympathetic innervation
Caused by Vagal connections with two cervical somatic nerves being constantly stimulated
N/V with severe headache
Pretty rare though
Sympathetic dominant complaints
Constipation, ab pain, flatulence and distention
Psoas syndrome
In pancreatitis, ab muscles weaken severely, which causes the psoas to spasm results in:
- L1/2 F/E and rotated/sidebent towards spasming psoas
pelvis will shift opposite Lumbar side-bending and induce sciatic nerve irritation towards the side of pelvis shifting
Pain distribution in quadrants and possible organs affected
Sub sternal = esophagus
RUQ = duodenum, liver, gallbladder, hepatic flexure of colon
LUQ = splenic flexure Of colon
RLQ = appendix and cecum
LLQ = signmoid and rectum
Epigastric = stomach
Upper abdominal = pancreas (usually non specific)
Peri-umbilical = small intestine
How to differentiate true visceral pain from visceral somatic pain?
True visceral pain
- early pain that is poorly localized and is described as vague/deep/diffuse/burning
- comes from irritation/stretching/contraction of exaggerate physiologic motor activity and dysfunction
Viscerosomatic pain
- pain is later and well localized/asymmetric along dermatome patterns
- is aggregated by jarring motions
- may be added to visceral pain and mask it**
What is the percutaneous reflex of Morley?
Direct transfer of inflammatory irritation from the viscera to the parietal peritoneum and abdominal wall without reflexes through visceral afferent nerves on a somatic afferent near the mesentery
always procedures abdominal wall rigidity/pain and rebound tenderness
What are the levels that innervate the esophagus?
T2-8
What are splanchnic nerves?
GI related sympathetics that synapse at their respective ganglia and then go to the target organs
1) greater splanchnic nerves (T5-9)
- synapses at celiac ganglion and supplies foregut organs
- functions = vasoconstriction, alteration of bicarbonate and mucous secretion, decreases mucosal defense
- *over stimulation = gastritis and Peptic ulcers
2) lesser splanchnic nerves (T10-11)
- synapses at the superior mesenteric ganglion And supplies the small intestines and right colon
- functions = vasoconstriction and decreased peristalsis
- *overstimulation = ileus, constipation, distention, flatulence, abdominal pain
3) least splanchnic (T12) and lumbar splanchnic nerves (L1-2)
- synapses at the inferior mesenteric ganglia
And innervates the left colon and pelvic organs
- functions = vasoconstriction and decreased peristalsis
- *overstimulation = ileus, constipation, distention, flatulence, abdominal pain
Important GI chapman reflex points
5th and 6th left intercostal space
- stomach (acidity and peristalsis respectively)
- *also 5th and 6th vertebrae spinous process on left side
5th and 6th right intercostal space
- liver (both) and gallbladder (only 6th)
- also 5th and 6th vertebrae spinous process on the right
7th right intercostal (anterior) 7th vertebrae spinous process on the right (posterior)
- pancreas
7th left intercostal (anterior) 7th vertebrae spinous process on the left (posterior)
- spleen
8th-10th intercostal spaces on both sides (anterior) and T8-10 on both sides of spinous process (posterior)
- small intestines
Tip of 12th right rib (anterior) and T11 right side of spinous process (Posterior)
- appendix
Right lateral knee = hepatic flexure
Left lateral knee = splenic flexure and sigmoid colon
Medial-lateral thigh (both sides) = colon
Near inguinal ligament (both sides) = rectum
Upper GI reflex dysfunction shows what combination of vertebrae somatic dysfunctions?
C2 and T5 are rotated left
- may also show chapman points as well here
T3 and T7 is rotated right
- may also show chapman points here as well
What vertebral dysfunctions can be present during GI sympathetic reflex dysfunction?
Esophagus = T3 rotated right
Stomach = T5-8 rotated left
Duodenum = T7-8 rotated right
