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OS3 EX1 > OAT GI > Flashcards

OAT GI Flashcards

1
Q

What’s the most common GI disorder that adults seek medical help for?

A

irritable bowel syndrome

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2
Q

What is the general goal of OMT for GI complaints?

A

toward improving blood/lymph flow and balancing autonomics

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3
Q

What is the definition of a ventral technique?

A

Also called VISCERAL MANIPULATION
“a system of diagnosis and treatment directed to the viscera to improve physiologic function. Typically, the viscera are moved toward their fascial attachments to a point of fascial balance.”

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4
Q

What are the differences between acute, subacute, chronic abd pain?

A 
acute = less than a few days and has worsened progressively 
chronic = unchanged pain for months to years
subacute = somewhere in the middle.....
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5
Q

What are some causes of LUQ pain (and their presentations)?

A

splenomegaly - pain, L shoulder pain, early satiety
splenic infarct - severe pain
splenic abscess - F, tenderness
splenic rupture - also L chest wall/shoulder pain worse with inspiration

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6
Q

What would usually cause a splenic rupture?

A

trauma

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7
Q

What are some causes of epigastric pain (and their presentations)?

A

acute MI
acute pancreatitis - acute onset- radiates to back
chronic pancreatitis -pain radiates to back/alcoholics/panc insufficiency
PUD - pain/discomfort
GERD - heartburn/reflux
gastritis - abd discomfort/heartburn/N/V/hematemasis
functional dyspepsia - postprandial fullness, early satiety. no evidence of structural disease
gastroparesis - N/V/abd pain/early satiety/postprandial fullness/bloating. diabetic/postsx/idiopathic

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8
Q

What are some causes of RUQ pain (biliary related) (and their presentations)?

A

biliary colic - intense/dull discomfort/N/V/sweaty. lasts 30min-1hr.
acute cholecystitis - pain >4-6hrs/F/abd guarding/+Murphys
Acute cholangitis - F/jaundice/RUQ = Charcot’s triad. in old people and immcomp this may look atypical
sphincter of oddi dysfxn - looks same as biliary colic

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9
Q

What are some causes of RUQ pain (liver related) (and their presentations)?

A

acute hepatitis - pain + fatigue/N/V/anorexia/jaundice/dark pee/acholic stools. Hep A, alcohol.
Perihepatitis(Fitz-Hugh-Curtis syn) - pain refers to R shoulder. +/- elevated ALT/AST
Liver abscess - F/abd. risk factors: DM, hepatobiliarypanc dz, liver transplant
Budd-Chiari syn - F/pain/distension/ascites/pedal edema/jaundice/GI bleeding/hepatic encephalopathy
portal vein thrombosis - abd pain, dyspepsia, GI bleeds. amount depends extent of obstruction

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10
Q

What can cause RLQ pain?

A

appendicitis

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11
Q

What can cause LLQ pain?

A

diverticulitis

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12
Q

What does it mean a the SD persists after OMT?

A

it may be cause secondarily to a VSR

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13
Q

The severity of a palpated TTA =

A

the severity of the visceral problem

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14
Q

How can OMT be applied to a post-surgical patient?

A

to help recovery phase aka reduce the hospital stay

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15
Q

What are the retroperitoneal organs?

A

SAD PUCKER
suprarenal glands, aorta/IVC, 2nd and 3rd duodenum, pancreas, ureters, ascending/descending colon, kidneys, esophagus, up 2/3 rectum

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16
Q

infra-peritoneal organ?

A

lower 1/3 rectum

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17
Q

Where are the Pacinian corpuscles and free nerve endings located in the GI tract? And what do they sense?

A

Wall of GI viscera

highly sensitive to stretch, spasm, inflammation and ischemia

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18
Q

Describe true visceral pain

A

Poorly Localized

irritation/stretch/spasm/vague cramping/sweating/N/V/pallor

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19
Q

Describe true somatic pain

A

WELL LOCALIZED

asymmetric/sharp/worse with specific movements/has additive effect with visceral pain

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20
Q

Describe phrenic pain

A

when the hemidiaphragm or liver capsule is stimulated

will refer to ipsilateral shoulder

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21
Q

What is the pathology (pathway) of a viscerosomatic reflex?

A

some visceral pathology > increased stretch/irritation of the GI visceral nerves > increased afferent signals to dorsal horn of SC > prolonged afferent signals leads to Facilitation of neurons and corresponding spinal segment

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22
Q

What characterizes viscerosomatic pain?

A

increased muscle tension, increased pain awareness, local TTA

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23
Q

Where would the somatic changes occur with visceral disturbances?

A

paravertebral TTA and increased tenderness on side of the organ that has disturbance

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24
Q

What os the percutaneous reflex of morley?

A

a direct transfer of inflammatory irritation from the viscera to the peritoneum that does not reflex through the visceral afferent reflex.

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25
Q

Where is the pain located in percutaneous reflex of morley?

A

usually directly over the inflamed organ

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26
Q

What is the percutaneous reflex of morley responsible for?

A

rebound tenderness and abd guarding associated with more severe abd pain
eg (in appendicitis that causes peritonitis: this reflex is responsible for abd wall rigidity, abd wall pain, rebound tenderness, direct organ to peritoneum inflammation)

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27
Q

What nerves make up the sympathetic part of the GI autonomic NS?

A

thoracic splanchnic n = celiac and sup mesenteric ganglion

lumbar splanchnic n = inferior mesenteric ganglion

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28
Q

What nerves make up the parasympathetic part of the GI autonomic NS?

A 
Vagus
pelvic splanchnic (s2-4)
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29
Q

What spinal levels feed into the celiac ganglion?

A

T5-T9

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30
Q

What spinal levels feed into the sup mesenteric ganglion?

A

T10-T11

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31
Q

What spinal levels feed into the inf mesenteric ganglion?

A

T12-L2

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32
Q

What organs are supplied by the celiac ganglion?

A

distal esophagus through prox duodenum

liver, gall bladder, spleen, pancreas

33
Q

What organs are supplied by the sup mesenteric ganglion?

A

distal duodenum through prox 2/3 of transverse colon

34
Q

What organs are supplied by the inf mesenteric ganglion?

A

distal 1/3 transverse colon (splenic flexure) through rectum

35
Q

What organs are supplied by the Vagus nerve?

A

upper GI through lower 1/2 GI
RIGHT vagus = lesser curve of stomach/liver/GB/SI/right colon/midtransverse colon
LEFT vagus = greater curve of stomach/stops at duoden

36
Q

What organs are supplied by the pelvic splanchnic n?

A

the lower 1/2 GI

descending colon, sigmoid colon, rectum

37
Q

What can increased sympathetic tone in the GI tract cause?

A

ileus, constipation/flatulence, increased water absorption, abd distention

38
Q

What can increased parasympathetic tone in the GI tract cause?

A

increased sec rate of all GI glands, diarrhea, fecal incontinence, decreased water absorption

39
Q

If a pt is complaining of bloody diarrhea and it is UC where would the TTA be located?

A

S2-S4

40
Q

If a pt is complaining of constipation for a week what part of the ANS is most likely overactive?

A

Sympathetic NS T10-L2

41
Q

What model would delivery of O2 and nutrients and draining waste products fit into?

A

The respiratory circulatory

42
Q

What model would removal of SD and restoration of posture/balance fit into?

A

Biomechanical

43
Q

What model would somatic facilitated segment, ANS, nociception fit into?

A

Neurological

44
Q

A pt complains of crampy, achy, abd pain, but can’t point to a specific area of tenderness. She has been nauseous. What type of pain is she experiencing?

A

visceral pain

45
Q

What direction(s) do the abdominal and pelvic diaphragms move during inhalation?

A

both move inferior

46
Q

Somatic dysfunctions of the pelvic diaphragm can lead to what?

A

fluid stasis within the pelvis, pelvic congestions, viscerosomatic pain, inability to clear infections properly

47
Q

The GI tract is holistically linked to the lymphatic system through what?

A

the vascular system. the lymph and LN run alongside the BV

48
Q

An obstruction in venous and lymphatic drainage in the abd can lead to what complications?

A

tissue congestions > arterial obstruction > ischemia

49
Q

What can causes bacterial proliferation and systemic sepsis?

A

vascular and lymphatic stasis cause inflammation/infection and increased release of IL-1 IL-6 TNFa IFNg = fever&raquo_space; SIRS (systemic inflammatory response syndrome)

50
Q

What are the consequences of lymphatic congestion in the GI tract/abdomen?

A

build up waste products, decreased med distribution, decreased absorption of nuts, increased likelihood of fibrosis/scaring, bloating, cramps, worsening IBS and IBD

51
Q

What are the drainage routes of lymph in abd?

A
  • stomach/duod/spleen/liver > CELIAC LN > cisterna chyli (L1-L2 area) > thoracic duct > L subclavian V
  • jej/ileum/ascending/transverse colon > SUP MESENTERIC LN > cisterna chyli (L1-L2 area) > thoracic duct > L subclavian V
  • descending/sigmoid colon/rectum > INF MESENTERIC LN > LEFT LUMBAR LN > LEFT LUMBAR TRUNK > cisterna chyli (L1-L2 area) > thoracic duct > L subclavian V
52
Q

When treating a pt with abd pain with the circ/resp what lymphatic treatment is would be appropriate to do after opening the thoracic duct?

A

release the diaphragmatic restrictions

53
Q

What model would maintaining homeostasis fit into?

A

all of them…..

but per stupid PP = metabolic-energetic

54
Q

Using the energetic model why are old people predisposed to constipation?

A

the don’t move much

55
Q

Per the metabolic model hypercalcemia and hypokalemia would cause what?

A

constipation

56
Q

Per the metabolic model hyperkalemia would cause what?

A

diarrhea

57
Q

Diarrhea causes what acid-base imbalance?

A

metabolic acidosis due to loss of bicarb

58
Q

Vomiting causes what acid-base imbalance?

A

metabolic alkalosis with hypokalemia due to loss of HCl

59
Q

A 31yo female complains of lethargy, trouble concentrating, constipation, gained 10lbs in the last 3wks, has noticed neck fullness. How would you categorize her illness via 5 Models?

A

Metabolic = hypothyroidism

60
Q

What is the goal of the behavioral model?

A

to optimize emotional state…

61
Q

Opioid abuse leading to constipation would be classified under which of the 5 models?

A

behavioral (but also probably met/energetic……)

62
Q

What is the definition of visceral dysfunction?

A

impaired or altered mobility or motility of the visceral system and related fascial, neurological, vascular, skeletal, and lymph

63
Q

What are some signs that the OMT provided to a patient is enough aka when to stop?

A
  • relaxation of soft tissue in treated area
  • altered autonomic tone (based on symptom changes)
  • peripheral vasodilation (increased skin temp, redness, swelling)
  • increased HR and or RR
  • urgency to use bathroom
64
Q

OMT treatment of GI is focused on what?

A

focused on the metabolic/energetic model to conserve/maintain homeostasis. this can frequently be accomplished by treating the other models first?

65
Q

Which Chapman’s point is primarily used for diagnosis? which for treatment?

A 
anterior = diagnostic
posterior = treatment
66
Q

Where are the chapman’s points located along a nerve?

A

at the free nerve endings

67
Q

What are soft tissue tx contradictionsf?

A

fx/dislocation/neuro entrapment syndromes/ serious vascular compromise/local malignancy/local infection/bleeding disorders

68
Q

What are lymphatic tx contraindications?

A

potentially malignancy of lymph system (although no study has proven malignancy will spread via lymph treatment, more like a conceptual contraindication)

69
Q

What are MET contraindications to treatment?

A

fx/avulsion/dislocation of involved joint/infection/hematoma/tear of involved muscle/severe osteoporosis/ metastatic dz of bone or muscle/ cervical spin instability = rheumatologic conditions

70
Q

What are rib raising contraindications?

A

spinal or rib fx/recent spinal surgery

71
Q

What are mesenteric release tx contraindications?

A

aortic aneurysm/open surgical wound

72
Q

What are sacral tx contraindications?

A

local infection/incision in the area/decubitus ulcer (bed sore)

73
Q

Where is the appendix chapman point?

A

Right 12th rip tip (anterior)

74
Q

How does sacral ROCKING affect parasympathetic tone?

A

it increases PNS tone

75
Q

How does sacral INHIBITION affect parasympathetic tone?

A

it decreases PNS tone

76
Q

What treatments can be used to normalize sympathetic tone in the GI?

A

MET, soft tissue, MFR, Still’s, Chapman’s pt, HVLA, rib raising, paraspinal inhibition

77
Q

Techniques that can be used to evaluate the lymphatics of a patient?

A
  • cranial-cervical junction (suboccipital) and find rotation restrictions
  • cervical-thoracic junction (drive the shoulders)
  • thoracocolumnar junction (move the diaphragm around)
  • lumbopelvic junction (rotation/press on pelvis)
78
Q

Treatments for opening lymph in abd?

A

Open thoracic inlet, doming the diaphragm, thoracic pump

OS3 EX1 (11 decks)

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