OAT GI Flashcards
What’s the most common GI disorder that adults seek medical help for?
irritable bowel syndrome
What is the general goal of OMT for GI complaints?
toward improving blood/lymph flow and balancing autonomics
What is the definition of a ventral technique?
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.”
What are the differences between acute, subacute, chronic abd pain?
acute = less than a few days and has worsened progressively chronic = unchanged pain for months to years subacute = somewhere in the middle.....
What are some causes of LUQ pain (and their presentations)?
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
What would usually cause a splenic rupture?
trauma
What are some causes of epigastric pain (and their presentations)?
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
What are some causes of RUQ pain (biliary related) (and their presentations)?
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
What are some causes of RUQ pain (liver related) (and their presentations)?
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
What can cause RLQ pain?
appendicitis
What can cause LLQ pain?
diverticulitis
What does it mean a the SD persists after OMT?
it may be cause secondarily to a VSR
The severity of a palpated TTA =
the severity of the visceral problem
How can OMT be applied to a post-surgical patient?
to help recovery phase aka reduce the hospital stay
What are the retroperitoneal organs?
SAD PUCKER
suprarenal glands, aorta/IVC, 2nd and 3rd duodenum, pancreas, ureters, ascending/descending colon, kidneys, esophagus, up 2/3 rectum
infra-peritoneal organ?
lower 1/3 rectum
Where are the Pacinian corpuscles and free nerve endings located in the GI tract? And what do they sense?
Wall of GI viscera
highly sensitive to stretch, spasm, inflammation and ischemia
Describe true visceral pain
Poorly Localized
irritation/stretch/spasm/vague cramping/sweating/N/V/pallor
Describe true somatic pain
WELL LOCALIZED
asymmetric/sharp/worse with specific movements/has additive effect with visceral pain
Describe phrenic pain
when the hemidiaphragm or liver capsule is stimulated
will refer to ipsilateral shoulder
What is the pathology (pathway) of a viscerosomatic reflex?
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
What characterizes viscerosomatic pain?
increased muscle tension, increased pain awareness, local TTA
Where would the somatic changes occur with visceral disturbances?
paravertebral TTA and increased tenderness on side of the organ that has disturbance
What os the percutaneous reflex of morley?
a direct transfer of inflammatory irritation from the viscera to the peritoneum that does not reflex through the visceral afferent reflex.
Where is the pain located in percutaneous reflex of morley?
usually directly over the inflamed organ
What is the percutaneous reflex of morley responsible for?
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)
What nerves make up the sympathetic part of the GI autonomic NS?
thoracic splanchnic n = celiac and sup mesenteric ganglion
lumbar splanchnic n = inferior mesenteric ganglion
What nerves make up the parasympathetic part of the GI autonomic NS?
Vagus pelvic splanchnic (s2-4)
What spinal levels feed into the celiac ganglion?
T5-T9
What spinal levels feed into the sup mesenteric ganglion?
T10-T11
What spinal levels feed into the inf mesenteric ganglion?
T12-L2
What organs are supplied by the celiac ganglion?
distal esophagus through prox duodenum
liver, gall bladder, spleen, pancreas
What organs are supplied by the sup mesenteric ganglion?
distal duodenum through prox 2/3 of transverse colon
What organs are supplied by the inf mesenteric ganglion?
distal 1/3 transverse colon (splenic flexure) through rectum
What organs are supplied by the Vagus nerve?
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
What organs are supplied by the pelvic splanchnic n?
the lower 1/2 GI
descending colon, sigmoid colon, rectum
What can increased sympathetic tone in the GI tract cause?
ileus, constipation/flatulence, increased water absorption, abd distention
What can increased parasympathetic tone in the GI tract cause?
increased sec rate of all GI glands, diarrhea, fecal incontinence, decreased water absorption
If a pt is complaining of bloody diarrhea and it is UC where would the TTA be located?
S2-S4
If a pt is complaining of constipation for a week what part of the ANS is most likely overactive?
Sympathetic NS T10-L2
What model would delivery of O2 and nutrients and draining waste products fit into?
The respiratory circulatory
What model would removal of SD and restoration of posture/balance fit into?
Biomechanical
What model would somatic facilitated segment, ANS, nociception fit into?
Neurological
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?
visceral pain
What direction(s) do the abdominal and pelvic diaphragms move during inhalation?
both move inferior
Somatic dysfunctions of the pelvic diaphragm can lead to what?
fluid stasis within the pelvis, pelvic congestions, viscerosomatic pain, inability to clear infections properly
The GI tract is holistically linked to the lymphatic system through what?
the vascular system. the lymph and LN run alongside the BV
An obstruction in venous and lymphatic drainage in the abd can lead to what complications?
tissue congestions > arterial obstruction > ischemia
What can causes bacterial proliferation and systemic sepsis?
vascular and lymphatic stasis cause inflammation/infection and increased release of IL-1 IL-6 TNFa IFNg = fever»_space; SIRS (systemic inflammatory response syndrome)
What are the consequences of lymphatic congestion in the GI tract/abdomen?
build up waste products, decreased med distribution, decreased absorption of nuts, increased likelihood of fibrosis/scaring, bloating, cramps, worsening IBS and IBD
What are the drainage routes of lymph in abd?
- 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
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?
release the diaphragmatic restrictions
What model would maintaining homeostasis fit into?
all of them…..
but per stupid PP = metabolic-energetic
Using the energetic model why are old people predisposed to constipation?
the don’t move much
Per the metabolic model hypercalcemia and hypokalemia would cause what?
constipation
Per the metabolic model hyperkalemia would cause what?
diarrhea
Diarrhea causes what acid-base imbalance?
metabolic acidosis due to loss of bicarb
Vomiting causes what acid-base imbalance?
metabolic alkalosis with hypokalemia due to loss of HCl
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?
Metabolic = hypothyroidism
What is the goal of the behavioral model?
to optimize emotional state…
Opioid abuse leading to constipation would be classified under which of the 5 models?
behavioral (but also probably met/energetic……)
What is the definition of visceral dysfunction?
impaired or altered mobility or motility of the visceral system and related fascial, neurological, vascular, skeletal, and lymph
What are some signs that the OMT provided to a patient is enough aka when to stop?
- 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
OMT treatment of GI is focused on what?
focused on the metabolic/energetic model to conserve/maintain homeostasis. this can frequently be accomplished by treating the other models first?
Which Chapman’s point is primarily used for diagnosis? which for treatment?
anterior = diagnostic posterior = treatment
Where are the chapman’s points located along a nerve?
at the free nerve endings
What are soft tissue tx contradictionsf?
fx/dislocation/neuro entrapment syndromes/ serious vascular compromise/local malignancy/local infection/bleeding disorders
What are lymphatic tx contraindications?
potentially malignancy of lymph system (although no study has proven malignancy will spread via lymph treatment, more like a conceptual contraindication)
What are MET contraindications to treatment?
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
What are rib raising contraindications?
spinal or rib fx/recent spinal surgery
What are mesenteric release tx contraindications?
aortic aneurysm/open surgical wound
What are sacral tx contraindications?
local infection/incision in the area/decubitus ulcer (bed sore)
Where is the appendix chapman point?
Right 12th rip tip (anterior)
How does sacral ROCKING affect parasympathetic tone?
it increases PNS tone
How does sacral INHIBITION affect parasympathetic tone?
it decreases PNS tone
What treatments can be used to normalize sympathetic tone in the GI?
MET, soft tissue, MFR, Still’s, Chapman’s pt, HVLA, rib raising, paraspinal inhibition
Techniques that can be used to evaluate the lymphatics of a patient?
- 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)
Treatments for opening lymph in abd?
Open thoracic inlet, doming the diaphragm, thoracic pump
