GI Management Flashcards
5 Models of Osteopathy
- Biomechanical
- Respiratory-circulatory
- Neurological
- Metabolic
- Behavioral
GIT Preganglionic Sympathetic Fibers
- Arise in the lateral horn of spinal segments T1-L2
- Exit out the ventral horn
- Pass thru series of splanchnic nerves to reach end organs
- Ganglia are dist. around 3 abdominal arteries (celiac, superior and inferior mesenteric)
- Stimulation of sympathetic fibers inhibit cholinergic activity of parasympathetics
- slowing peristalsis and motility
Celiac Ganglia
- Receives afferent fibers from the thoracic splanchnic nerves (T5-9)
- Supplies postganglionic sympathetic axons to foregut
- distal esophagus and stomach
- proximal duodenum
- liver
- gall bladder
- spleen
- pancrease
- Pain from these structures will be perceived as occurring in the EPIGASTRIC
Superior Mesenteric Ganglia
- Receives preganglionic axons from thoracic splanchnic nerves (T10-11)
- Supplies postganglionic sympathetic axons to midgut
- distal duodenum
- part of pancreas
- jejunum
- ileum
- ascending colon
- proximal 2/3 of transverse colon
- Pain is perceived as UMBILICAL
Inferior Mesenteric Ganglia
- Receives preganglionic from the thoracolumbar splanchnic nerves (T11-L2)
- Supplies postganglionic sympathetic axons to hindgut
- distal third of transverse colon
- descending colon
- sigmoid colon
- rectum
- Pain is perceived as HYPOGASTRIC
GIT Parasympathetic Nerves
- Vagus
- transmits fibers via celiac and superior mesenteric ganglia to foregut and midgut
- Pelvic splanchnic nerves
- supply the hindgut, including the area innervated by the inferior mesenteric ganglia
Visceral afferent neurons carry sensory information to the CNS along the pathways of the vagus and pelvic splanchnic nerves
*includes sensory and nociceptive input
Esophageal Innervation
- Lower esophagus innervation is diff. than the stomach/ UGI tract
- Sympathetic
- thoracic esophagus T3-5/6
- abdominal T5-8
- Think of viscera above the diaphragm T-5
- Below the diaphragm T5 and below
- Parasympathetic- Vagus nerve
GERD, Esophageal Spasm OMM Treatment
- Viscerosomatic
- sympathetic T3-6
- especially right side
- Parasympathetic
- vagus-occiput/ c1/ c2
- Mechanical
- diaphragm/ LES
Hiccups OMM Treatment
- Somatovisceral component
- Proximal clavicle pressure to inhibit phrenic nerve
Gastric Viscerosomatics
- T5-10, especially left sided (sympathetics)
- C1 and C2 (parasympathetic)
- “UGI Pattern” classically seen as
- C2 left
- T3-6 right
- T5-10 left
- T6-8 right
- “T3T, T5L, T7R”
Cholecystitis Referred Pain
- Involvement of central portion of diaphragmatic parietal peritoneum, innervated by phrenic nerve (C3, 4, 5), —> pain over the right shoulder
- this area is innervated by supraclavicular nerves (C3, 4)
- may be morecommon w/ ruptured viscous, such as peptic ulcer
Viscerosomatic findings for Gall Bladder Disease
- T5-10 on the right, transmitted via the celiac ganglia
- Parasympathetic reflexes via vagal nerve at occiput, C1 and C2
- Phrenic nerve mediated reflexes = C3-5
Viscerosomatic findings for Appendicitis
- Vagus-Occiput, C1-2
- T9-12 right side
- Localized findings appear as peritoneal involvement increases, based on location of appendix
- Anterior Chapman’s = tip of right 12th rib
Effect of OMT on post-op ileus study findings
- Time to bowel mvmt and clear liquid diet did not differ
- Mean time to flatus was significantly shortened w/ OMT
- Mean postoperative LOS significantly shortened w/ OMT
Post-op Ileus somatic findings
- Increased rigidity of the paraspinal area
- T5-11 stomach and small intestine viscerosomatic reflexes
- Vagus assoc. upper cervical (C2)
- Lower rib/diaphragm dysfunctions
IBS Viscerosomatic findings
- Large itestinal involvement
- T11-L3
- Small intestinal involvement (bacterial overgrowth?)
- T8-10
- Vagus-upper cervical
- Pelvic splanchnics-sacral findings
Esophagus GI Reflexes
- T3-6, often right sided
Stomach GI Reflexes
- T5-10, often left sided
Duodenum GI Reflexes
- T6-8, often right sided
Pancreas GI Reflexes
- T5-9, B/L, especially extended
Liver GI Reflexes
- T5-10, right sided
Gallbladder GI Reflexes
- T5-10, right sided, some sources state T7-9 right
Small Intestines GI Reflexes
- T8-10, B/L (R>L)
Appendix GI Reflexes
- T9-12 right side
- Chapman’s point = tip of 12th rib
Ascending and transverse colon GI Reflexes
- T11-L1 (right for ascending, B/L for transverse)
Descending colon GI Reflexes
- L1-3 left side
Esophagus Anterior Chapman’s Points
- B/w ribs 2 and 3
Stomach Anterior Chapman’s Points
- B/w ribs 5 and 6 and 6 and 7
Liver and gallbladder Anterior Chapman’s Points
- B/w ribs 6 and 7
Colon Anterior Chapman’s Points
- Iliotibial band
Esophagus Posterior Chapman’s Point
- Dorsal T2 b/w spinous and transverse processes
Stomach Posterior Chapman’s Point
- B/w T5-6 and T6-7, b/w spinous and transverse processes
Liver and Gallbladder Posterior Chapman’s Points
- T5-6, T6-7; same as stomach
Colon Posterior Chapman’s Points
- L2-4, transverse processes to iliac crest
GERD and PUD OMT Treatment
- Thoracic spine and rib eval and treatment
- Rib raising
- Suboccipital release
- Additional treatment
- dome the diaphragm
- mesenteric release
- chapman’s points
Constipation OMT Treatment
- Thoracic spine and rib eval and treatment
- Sacral eval and treatment
- Addition treatment
- rib raising
- pelvic diaphragm release
- thoracolumbar inhibition
- colonic stimulation-ventral technique
- OCMM eval and treatment
Post-op Ileus OMT Treatment
- Thoracolumbar spine and rib eval and treatment
- Rib raising
- Deep inhibition of thoracolumbar junction
- Additional treatment components
- sacral eval and treatment (even just sacral/innominate rocking)
- suboccipital release
- pelvic diaphragm release
- colonic stimulation (avoid incision)
IBD OMT Treatment
- Thoracic spine/costal eval and treatment
- Rib raising
- Suboccipital release
- Sacral eval and treatment
- Additional treatment
- linea alba release/mesenteric ganglia
- mesenteric release
- chapman’s points
- pedal pump
