Lecture 10: Osteopathic Approach to GI Patient

Question 1

What are the 2 goals of Mesenteric/Colonic Release?

Answer 1

1. Enhance lymphatic and venous drainage
2. Alleviate congestion secondary to visceral ptosis/dysfunction

Question 2

OMT for GI dysfunctions is directed toward improving what 2 things?

Answer 2

Blood/lymphatic flow and balancing autonomics

Question 3

Intense, dull discomfort in the RUQ w/ associated N/V and diaphoresis, which lasts 30 mins. to 1 hour and generally has a benign PE is characteristic of?

Answer 3

Biliary colic

Question 4

When addressing the biomechanical component of GI pain, if there is failure of a SD to respond to OMT this point to what type of problem?

Answer 4

Viscerosomatic

Question 5

The severity of palpated tissue texture abnormality = ?

Answer 5

Severity of visceral problem

Question 6

An organ that is intra-peritoneal means that it has what?

Answer 6

Mesentery and covered by peritoneum

Question 7

What are the abdominal peritoneal organs?

Answer 7

• Stomach
• Small intestine (jejunum, ileum, superior duodenum)
• Spleen
• Liver

Question 8

What is the span of the abdominal cavity?

Answer 8

Diaphragm (excluding esophagus) —> Pelvic Diaphragm

Question 9

In the GI tract what is found in the wall of the viscera in regards to viscerosensory/visceromotor?

Answer 9

• Pacinian corpuscles
• Free nerve endings

Question 10

How does the localization of true visceral pain vs. true somatic pain differ?

Answer 10

• True visceral pain = POORLY localized –> vague, cramping, achy
• True somatic pain = WELL localized –> Sharp, asymmetric

Question 11

How does visceral pathology lead to viscerosomatic reflexes?

Answer 11

• Increased stretch/irritation to GI nerves –> increased afferent signals to CNS –> afferent fibers synapse in the dorsal horn of spinal cord
• Prolonged afferent activity leads to FACILITATION of the neurons and the corresponding spinal segments

Question 12

Visceral disturbances can cause activation of what leading to SD?

Answer 12

• Activation of somatic muscle activity
• Visceral pathology –> somatic changes paraspinally (TTC’s and increased tenderness)

Question 13

What is the Percutaneous reflex of Morley?

Association with Appendicitis?

Answer 13

• Direct transfer of inflammatory irritation from viscera –> peritoneum
• Not reflexing thru visceral afferent reflex
• Appendicitis –> Peritonitis = direct organ to peritoneum inflammation = abd. wall rigidity, pain, and rebound tenderness

Question 14

In the GI the sympathetic component involving the thoracic splanchnic n. and lumbar splanchnic n. synapse with what ganglion?

Answer 14

• Thoracic splanchnic n. –> Celiac and Superior Mesenteric Ganglion
• Lumbar splanchnic n. –> Inferior Mesenteric Ganglion

Question 15

Which spinal levels is the Celiac Ganglion involved with?

Organs?

Answer 15

• T5-T9
• Distal esophagus, stomach, prox. duodenum, liver, GB, spleen and portions of pancreas

Question 16

Which spinal levels is the Superior Mesenteric Ganglion involved with?

Organs?

Answer 16

• T10-T11
• Distal duodenum, portions of pancreas, jejunum, ascending colon, proximal 2/3 of transverse colon

Question 17

Which spinal levels is the Inferior Mesenteric Ganglion involved with?

Organs?

Answer 17

• T12-L2
• Distal 1/3 of transverse colon, descending colon, sigmoid, and rectum

Question 18

The Upper GI + Lower GI (1/2) tract suppled by what nerve for parasympathetics?

Answer 18

Vagus n. (CN X)

Question 19

What does the Right Vagus N. vs. Left Vagus N. supply?

Answer 19

• Right = lesser curve stomach, liver/GB, small bowel, right colon to mid-transverse colon
• Left = greater curve stomach, ends at duodenum

Question 20

What is the parasympathetic supply for the descending colon, sigmoid, and rectum?

Answer 20

Pelvic splanchnic N. (S2-S4)

Question 21

What are the 3 large collecting interstitial lymph nodes for the GI?

Answer 21

1. Celiac = stomach, duodenum, spleen and liver
2. Superior mesenteric = jejunum, ileum, ascending/transverse colon
3. Inferior mesenteric = descending/sigmoid colon, rectum

Question 22

Which metabolic disturbances (hormones, electrolytes, and acid base) lead to/associated w/ diarrhea?

Answer 22

• Hyperthyroidism
• Hypocalcemia and Hyperkalemia
• Metabolic acidosis

Question 23

Which OMM treatment modalities can be used to normalize sympathetic activity in the GI?

Answer 23

• ME
• Soft tissue/MFR
• Still’s
• Chapman’s points
• HVLA
• Rib raising
• Paraspinal inhibition

Question 24

How do anterior vs. posterior Chapman’s points differ in their utility?

Answer 24

• Anterior are primarily diagnostic
• Posterior are focus of treatment

Question 25

Increased sympathetic tone may cause what 3 GI problems?

Answer 25

1. Ileus
2. Constipation/flatulence –> Increased H₂O absorption
3. Abdominal distention

Question 26

Increased parasympathetic tone may cause what GI disturbances?

Answer 26

• Increased secretion rate of all GI glands
• Diarrhea/fecal incontinence –> decreased H₂O absorption

Question 27

Proximal 2/3 of colon vs. distal 1/3 of colon spinal cord levels and SNS/PNS innervation?

Answer 27

Prox. 2/3 = T10-T11

- SNS = lesser splanchnic n. + superior mesenteric ganglion

- PNS = Vagus n.

Distal 1/3 = T12-L2

- SNS = least splanchnic n. + inferior mesenteric ganglion

• PNS = sacral (pelvic) splanchnic (S2-S4)

Question 28

Any form of SD to the pelvic diaphragm can lead to fluid stasis within the pelvis, which then can cause what?

Answer 28

Pelvic congestion, viscerosomatic pain, and inability to clear infections

Question 29

How do the pelvic and thoracic diaphragm work together?

Answer 29

• Both contract and expand during respiratory cycle; in unison
• Act as a pump, thereby stimulating movement of the vasculature and lymphatic fluids

Question 30

In relation to the Posterior Chapman point for the colon there is a direct fascial relationship between the descending/ascending colon and which muscle?

Answer 30

Quadratus Lumborum