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