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OPP III final exam > GI Clinical Case Presentation > Flashcards

GI Clinical Case Presentation Flashcards

1
Q

viscerosomatic reflexes: Sympathetic Spinal Level and Facilitation Level of the Esophagus

A

S: T2-8/10
F: T1-6

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2
Q

viscerosomatic reflexes: Sympathetic Spinal Level and Facilitation Level of the Gallbladder

A

S: T5-9
F: T5R

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3
Q

viscerosomatic reflexes: Sympathetic Spinal Level and Facilitation Level of the Stomach

A

S: T5-9
F: T5-9L

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4
Q

viscerosomatic reflexes: Sympathetic Spinal Level and Facilitation Level of the Liver

A

S: T6-9
F: T5R

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5
Q

viscerosomatic reflexes: Sympathetic Spinal Level and Facilitation Level of the Spleen

A

S: T6-8
F: T7L

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6
Q

viscerosomatic reflexes: Sympathetic Spinal Level and Facilitation Level of the Pancreas

A

S: T6-9
F: T7R

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7
Q

viscerosomatic reflexes: Sympathetic Spinal Level and Facilitation Level of the Small Intestine

A

S: T8/9-11/12
F: T10-11

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8
Q

viscerosomatic reflexes: Sympathetic Spinal Level and Facilitation Level of the Appendix

A

S: T10
F: T12

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9
Q

viscerosomatic reflexes: Sympathetic Spinal Level and Facilitation Level of the Ascending, Transverse Colon

A

S: T10/11-L1/2
F: T10-11

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10
Q

viscerosomatic reflexes: Sympathetic Spinal Level and Facilitation Level of the Descending, Sigmoid Colon, Rectum

A

S: L1-2
F: T12-L2

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11
Q

Associated Ganglia: Esophagus

A

Celiac

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12
Q

Associated Ganglia: Gallbladder

A

Celiac

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13
Q

Associated Ganglia: Stomach

A

Celiac

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14
Q

Associated Ganglia: Liver

A

Celiac

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15
Q

Associated Ganglia: Spleen

A

Celiac

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16
Q

Associated Ganglia: Pancreas

A

Celiac

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17
Q

Associated Ganglia: Small Intestine

A

Superior mesenteric

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18
Q

Associated Ganglia: Ascending, Transverse Colon

A

Superior mesenteric

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19
Q

Associated Ganglia: Appendix

A

Superior mesenteric

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20
Q

Associated Ganglia: Descending, Sigmoid Colon, Rectum

A

Inferior mesenteric

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21
Q

Visceral Referred Pain Patterns: Liver, Gall bladder, duodenum

A

R shoulder

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22
Q

Visceral Referred Pain Patterns: Stomach

A

Post: between scapula
Ant: zyphoid and LUQ

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23
Q

Visceral Referred Pain Patterns Spleen

A

LUQ closer to mid axillary line going around to the base of the scapula

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24
Q

Visceral Referred Pain Patterns: Small intestine

A

Umbilical region

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25
Q

Visceral Referred Pain Patterns Sigmoid colon

A

Suprapubic region lateral to midline

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26
Q

Visceral Referred Pain Patterns Cecum and ascending colon

A

Suprapubic region, midline

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27
Q

Visceral Referred Pain Patterns: kidney and ureter

A

lower flank pain - ant and post

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28
Q

Visceral Referred Pain Patterns: appendix

A

Umbilical and RLQ

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29
Q

Visceral Referred Pain Patterns Gall bladder

A

RUQ costal margin wrapping around to the back

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30
Q

Visceral Referred Pain Patterns Liver

A

RUQ flank pain wrapping around the back

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31
Q

Visceral Referred Pain Patterns: duodenum and head of pancreas

A

xiphoid region midline - ant and post

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32
Q

Pain Referral Patterns: Acute Cholecystitis

A

R shoulder

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33
Q

Pain Referral Patterns: Cholecystitis

A

between midline and R nipple

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34
Q

Pain Referral Patterns: angina

A

xiphoid region

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35
Q

Pain Referral Patterns: splenic infarct

A

LUQ below lower ribs

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36
Q

Pain Referral Patterns: pleuritic pain

A

RUQ, costal margin

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37
Q

Pain Referral Patterns: renal colic and appendicitis

A

Groin area/testes in male

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38
Q

Keep in mind that what may be presenting as abdominal pain may have its source in _____.

A

the rotatores and/or multifides muscles.

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39
Q

“Heartburn” may be a trigger point in the _____.

A

external oblique muscle.

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40
Q

Projectile vomiting and belching can be triggered by palpation of points in the _______.

A

posterior abdominal wall bilaterally

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41
Q

Diarrhea can result from trigger points in_____which can mimic symptoms of _____.

A

the lower abdominal muscles …. renal pathology

42
Q

Chapman’s Reflex Points: *Liver

A

A: R 5th and 6th intercostal space - midclavicular line to sternum
P: R Intertransverse space between T5, T6, and T7

43
Q

Chapman’s Reflex Points: *Gall bladder

A

A: R 6th intercostal space - midclavicular line to sternum
P: R T6 - T7 intertransverse space

44
Q

Chapman’s Reflex Points: Pancreas

A

A: R 7th intercostal space, at the costochondral junction
P: T7-T8 intertransverse space

45
Q

Chapman’s Reflex Points: Small intestines

A

A: 8th, 9th and 10th intercostal space near cartilaginous B/L
P: L intertransverse spaces between T8-T11

46
Q

Chapman’s Reflex Points: *Appendix:

A

A: R upper edge of rib 12 at tip
P: R intertransverse space T11-12

47
Q

Chapman’s Reflex Points: Pyloric stenosis

A

A: Sternal body: angle of louis to xiphoid process
P: R costovertebral junction of Rib 10

48
Q

Chapman’s Reflex Points: *Stomach hyperacidity

A

A: L 5th intercostal space: midclavicular line to sternum
P: L intertransverse space T5-6

49
Q

Chapman’s Reflex Points: Stomach decreased peristalsis

A

A: L 6th intercostal space: midclavicular line to sternum
P: L intertransverse space T6-7

50
Q

Chapman’s Reflex Points: Spleen

A

A: L 7th intercostal space: costochondral junction
P: L intertransverse space T7-8

51
Q

*Chapman’s Reflex Points: Colon (spastic constipation or colitis)

A

A: B/L an area 1-2” wide, extending from the trocanter to within an inch of the patella on the front, outer aspect of the femur
P: TP of L2 – TP of L4 a triangular area reaching across to the iliac crest

52
Q

*Chapman’s Reflex Points: Ant Colon (spastic constipation or colitis) R upper 1/5 indicates problem with ____.

A

cecum

53
Q

*Chapman’s Reflex Points: Ant Colon (spastic constipation or colitis) R lower 1/5 indicates problem with the ______.

A

first 2/5 of transverse colon

54
Q

*Chapman’s Reflex Points: Ant Colon (spastic constipation or colitis) R middle 3/5 indicates problem with _____.

A

ascending colon

55
Q

*Chapman’s Reflex Points: Ant Colon (spastic constipation or colitis) L first 1/5 indicates problem with ______

A

sigmoid colon

56
Q

*Chapman’s Reflex Points: Ant Colon (spastic constipation or colitis) L last 1/5 indicates problem with ______

A

to the last 3/5 of transverse colon

57
Q

*Chapman’s Reflex Points: Ant Colon (spastic constipation or colitis) L Middle 3/5 indicates problem with ______

A

descending colon

58
Q

*Chapman’s Reflex Points: Ant Colon (spastic constipation or colitis) L upper extreme end of the trocanter correlates with ______

A

recto-sigmoid junction

59
Q

Chapman’s Reflex Points: Intestinal peristalsis (constipation)

A

A: B/L between ASIS and greater trocanter

60
Q

Chapman’s Reflex Points: Rectum

A

A: B/L around the lesser trocanter

61
Q

Chapman’s Reflex Points: Hemorrhoids, Rectum

A

P: B/L on the sacrum close to the ilium at the lower end of the SI jt

62
Q

Chapman’s Reflex Points: Hemorrhoids

A

B/L just above the ischial tuberosity (anterior points)

63
Q

Broad ligament and prostate Chapman points are along _____.

A

the lateral femur.

64
Q

Sympathetic innervation is supplied by cell bodies in the ____ and fibers that terminate in the ______; these are the _____ neurons.

A

spinal cord …. prevertebral ganglia (celiac, superior, and inferior mesenteric ganglia)……preganglionic

65
Q

Sympathetic preganglionic nerve fibers synapse with postganglionic neurons in the ganglia, and the fibers leave the ganglia and reach the end organ along ______. Rarely, there is a synapse in the ______, as seen with sympathetic innervation of other organ systems.

A

the major blood vessels and their branches…..paravertebral (chain) ganglia

66
Q

Parasympathetic Innervation:

The vagus nerve, (CN 10th), innervates the ____(7)___.

A
  • esophagus
  • stomach
  • gallbladder
  • pancreas
  • first part of the intestine
  • cecum
  • the proximal part of the colon
67
Q

Parasympathetic Innervation:

The vagus exits the cranium via the ____ (along with the accessory and glossopharyngeal nerves).

A

jugular foramen

68
Q

Parasympathetic Innervation:

The pelvic nerves innervate the ___(2)___

A

colon and the anorectal region

69
Q

Parasympathetic Innervation:
Consistent with the typical organization of the parasympathetic nervous system, the preganglionic nerve cell bodies lie in the ____ or_____. Axons from these neurons run in the nerves to the gut (vagus and pelvic nerves, respectively), where they synapse with postganglionic neurons in ______which in this case are______.

A

brainstem (vagus) or the sacral spinal cord (pelvic)……..the wall of the organ, ….. enteric neurons in the gut wall.

70
Q

Sympathetic or Parasympathetic?

Tends to inhibit GI function

A

Sympathetic

71
Q

Sympathetic or Parasympathetic?

Frequently activated in pathological situations

A

Sympathetic

72
Q

Sympathetic or Parasympathetic?

Inhibits smooth muscle

A

Sympathetic

73
Q

Sympathetic or Parasympathetic?

Induces contraction of sphincters

A

Sympathetic

74
Q

Sympathetic or Parasympathetic?

Regulates blood flow in the GI tract

A

Sympathetic

75
Q

Sympathetic or Parasympathetic?

Activates physiological processes in the gut wall

A

Parasympathetic

76
Q

Sympathetic or Parasympathetic?

Allows filling of the stomach to occur without an increase in intraluminal pressure

A

Parasympathetic

77
Q

Sympathetic or Parasympathetic?

Generally involved in relaxation of sphincters

A

Parasympathetic

78
Q

Sympathetic or Parasympathetic?

Contraction of smooth muscle layers in the colon

A

Parasympathetic

79
Q

Sympathetic or Parasympathetic?

Controls the caliber of the internal anal sphincter

A

Parasympathetic

80
Q

Sympathetically Driven Symptoms (5)

A
  • Constipation
  • Bloating
  • Pain
  • Contraction of sphincters
  • Increased vasomotor tone (may lead to decreased mucus production in stomach and intestines)
81
Q

Parasympathetically Driven Symptoms

A
  • Nausea
  • Vomiting
  • Diarrhea
  • Hypermotility
  • Relaxation of sphincters
  • Increased mucus secretion
  • Increased acid production in the stomach
82
Q

If increased vasomotor (sympathetic) tone leads to decreased mucus production in stomach (and/or parasympathetic activity causes increased acid production in the stomach), what is the end result?

A

Gastritis, Ulcers (peptic and duodenal), GERD

83
Q

What is the medical treatment approach for Gastritis, Ulcers (peptic and duodenal), GERD?

A

Antacids, H2-blockers, PPIs, antibiotics

84
Q

Why is bowel function important?

A
  • Elimination of wastes

- Maintain homeostasis

85
Q

What is Post-Operative Ileus?

A
  • Failure to pass flatus or stool for 3/6 days after surgery

- Transient impairment of function and motility

86
Q

Etiology of Post-Op Ileus (POI)

A
  • Mechanical irritation
  • Edema of tissues – mesentery and intestine
  • Inflammatory molecules which cause the
  • Activation of inhibitory neural reflexes
  • Medications, particularly opiates
87
Q

PathoPhysiology of Post-Op Ileus (POI) - Sympathetics

A

Sympathetic: Increased Tone

  • Increased vascular tone – decreased O2 and nutrients to the tissues
  • Decreased peristalsis
88
Q

PathoPhysiology of Post-Op Ileus (POI) - Lymphatics

A
  • Impaired flow increases tissue congestion
  • Impaired nutrient absorption from the intestines
  • Congestion increases the likelihood of fibrosis, and susceptibility to infection
89
Q

The Arndt-Schultz Law

A
  • Weak stimuli accelerate physiologic activity
  • Medium stimuli inhibit physiologic activity
  • Strong stimuli halt physiologic activity
90
Q

What cells are considered the pacemaker cells of the gut?

A

Interstitial Cajal Cells (ICC)

91
Q

How does visceral manipulation work?

A

Gut stimuli evoke digestive responses via the enteric and the central nervous systems

92
Q

Cajal interstitial cells have properties of both ______.

A

fibroblasts and smooth muscle cells.

93
Q

Visceral Sliding surfaces:

A
  • Peritoneum
  • Pericardium
  • Pleura
  • Meninges
94
Q

Double layer system of Visceral Joints

A

serous fluid creates suction between surfaces of the peritoneum, etc.

95
Q

Ligamentous System of the Visceral Joints

A
  • 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
96
Q

Turgor and Intracavitary pressure of Visceral Joints

A

hold the viscera in place, remain constant in mass, yet stick together

97
Q

Mesenteric system of Visceral Joints

A

folds of peritoneum that support the nerves, arteries, veins and lymphatics of the small and large intestines

98
Q

Omental system of Visceral Joints

A

folds of peritoneum that join 2 elements of the digestive tract together and has a neurovascular role

99
Q

What is a visceral somatic dysfunction?

A

Any restriction, fixation or adhesion limits mobility and motility, along with viscerospasm and tethering (ptosis).

100
Q

What causes visceral somatic dysfunctions? (6)

A
  • Infection/inflammation
  • Trauma
  • Surgery
  • Pregnancy
  • Scoliosis/short leg syndrome
  • Craniosacral dysfunction
101
Q

In palpation of the abdomen, Evaluate for (4)

A
  • Painfulness
  • Differences in tension
  • Position of the organ
  • Tone of the organ

OPP III final exam (14 decks)

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