Lecture 10: Osteopathic Approach to GI Patient Flashcards
What are the 2 goals of Mesenteric/Colonic Release?
- Enhance lymphatic and venous drainage
- Alleviate congestion secondary to visceral ptosis/dysfunction
OMT for GI dysfunctions is directed toward improving what 2 things?
Blood/lymphatic flow and balancing autonomics
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?
Biliary colic
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?
Viscerosomatic
The severity of palpated tissue texture abnormality = ?
Severity of visceral problem
An organ that is intra-peritoneal means that it has what?
Mesentery and covered by peritoneum
What are the abdominal peritoneal organs?
- Stomach
- Small intestine (jejunum, ileum, superior duodenum)
- Spleen
- Liver
What is the span of the abdominal cavity?
Diaphragm (excluding esophagus) —> Pelvic Diaphragm
In the GI tract what is found in the wall of the viscera in regards to viscerosensory/visceromotor?
- Pacinian corpuscles
- Free nerve endings
How does the localization of true visceral pain vs. true somatic pain differ?
- True visceral pain = POORLY localized –> vague, cramping, achy
- True somatic pain = WELL localized –> Sharp, asymmetric
How does visceral pathology lead to viscerosomatic reflexes?
- 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
Visceral disturbances can cause activation of what leading to SD?
- Activation of somatic muscle activity
- Visceral pathology –> somatic changes paraspinally (TTC’s and increased tenderness)
What is the Percutaneous reflex of Morley?
Association with Appendicitis?
- 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
In the GI the sympathetic component involving the thoracic splanchnic n. and lumbar splanchnic n. synapse with what ganglion?
- Thoracic splanchnic n. –> Celiac and Superior Mesenteric Ganglion
- Lumbar splanchnic n. –> Inferior Mesenteric Ganglion
Which spinal levels is the Celiac Ganglion involved with?
Organs?
- T5-T9
- Distal esophagus, stomach, prox. duodenum, liver, GB, spleen and portions of pancreas
Which spinal levels is the Superior Mesenteric Ganglion involved with?
Organs?
- T10-T11
- Distal duodenum, portions of pancreas, jejunum, ascending colon, proximal 2/3 of transverse colon
Which spinal levels is the Inferior Mesenteric Ganglion involved with?
Organs?
- T12-L2
- Distal 1/3 of transverse colon, descending colon, sigmoid, and rectum
The Upper GI + Lower GI (1/2) tract suppled by what nerve for parasympathetics?
Vagus n. (CN X)
What does the Right Vagus N. vs. Left Vagus N. supply?
- Right = lesser curve stomach, liver/GB, small bowel, right colon to mid-transverse colon
- Left = greater curve stomach, ends at duodenum
What is the parasympathetic supply for the descending colon, sigmoid, and rectum?
Pelvic splanchnic N. (S2-S4)
What are the 3 large collecting interstitial lymph nodes for the GI?
- Celiac = stomach, duodenum, spleen and liver
- Superior mesenteric = jejunum, ileum, ascending/transverse colon
- Inferior mesenteric = descending/sigmoid colon, rectum
Which metabolic disturbances (hormones, electrolytes, and acid base) lead to/associated w/ diarrhea?
- Hyperthyroidism
- Hypocalcemia and Hyperkalemia
- Metabolic acidosis
Which OMM treatment modalities can be used to normalize sympathetic activity in the GI?
- ME
- Soft tissue/MFR
- Still’s
- Chapman’s points
- HVLA
- Rib raising
- Paraspinal inhibition
How do anterior vs. posterior Chapman’s points differ in their utility?
- Anterior are primarily diagnostic
- Posterior are focus of treatment
Increased sympathetic tone may cause what 3 GI problems?
- Ileus
- Constipation/flatulence –> Increased H2O absorption
- Abdominal distention
Increased parasympathetic tone may cause what GI disturbances?
- Increased secretion rate of all GI glands
- Diarrhea/fecal incontinence –> decreased H2O absorption
Proximal 2/3 of colon vs. distal 1/3 of colon spinal cord levels and SNS/PNS innervation?
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)
Any form of SD to the pelvic diaphragm can lead to fluid stasis within the pelvis, which then can cause what?
Pelvic congestion, viscerosomatic pain, and inability to clear infections
How do the pelvic and thoracic diaphragm work together?
- Both contract and expand during respiratory cycle; in unison
- Act as a pump, thereby stimulating movement of the vasculature and lymphatic fluids
In relation to the Posterior Chapman point for the colon there is a direct fascial relationship between the descending/ascending colon and which muscle?
Quadratus Lumborum
