Osteopathic approach to the GI patient Flashcards
What is the difference between visceral and somatic pain?
Visceral is more generalized and poorly localized while somatic pain is well localized and asymmetric… aggravated by specific motions
Where does phrenic pain refer to?
from the hemidiaphragm or liver capsule to the ipsilateral shoulder
Where do visceral afferent fibers synapse from GI nerves?
the DORSAL horn of the spinal cord
What does prolonged afferent activity lead to?
Facilitation
What is facilitation?
maintenance of a pool of neurons at partial or subthreshold excitiation…. less afferent stimulation is needed to trigger the idscharge of impulses
What was that thing in red she put in about viscerosomatic pain?
- Visceral disturbances can cause activation of somatic muscle activity
- Visceral pathology results in somatic changes paraspinally
What is the percutaneous reflex of Morely?
- direct tranfer of inflammatory irritation
- from visceral to pertioneum
- not reflexing through visceral afferent reflex
- direct organ to peritoneum inflammation
What are the Sympathetic components of the GI system?
Thoracic splanchnic n.
Lumbar splanchnic n.
What are the parasympathetic components of the GI system?
Vagus n.
Pelvic Splanchnic n.
What are the three ganglia in the GI area?
Celiac, superior mesenteric, inferior mesenteric
What spinal segments do viscerosomatic reflexes cover?
T5-L2
What is upper GI sympathetics?
T5-T9 from distal esoph to proximal duodenum
What is lower GI sympathetics?
Distal duodeum to transverses colon is T10-11
the rest is T12-L2
What spinal segement do sympathetics end at?
L2!!!!!!!
What contributes to the celiac ganglion?
T5-9… greater splanchnic n.
Sup. mesenteric Ganglion?
T10-11… lesser splanchnic n.
Inf. mesenteric Ganglion?
T12-L2… least splanchnic n.
What did Korr note about all disease processes?
the common factor was Hypersympathetic activity
What is the parasympathetic innervation of the GI tract?
Right vagus gets more than left… goesfrom lesser curvature of stomach to mid transverse colon
-the rest is innervated by the pelvic splanchnic nervese…. goes to the rectum
where does lymph from the abdominal viscera drain into?
the cisterna chyli (L1-2 area) to the thoracic duct… to the left subclavian vein
What is important about lymphatics?
congestion in the bowel channels will interfere in medical treatment of disease processes
What are the 3 treatment areas for lymphatics?
- thoracic duct (duh)
- Thoracolumbar diaphragm
- Pelvic diaphragm
How do you tell if a patient’s pain is from the msk system or from the underlying visceral organs?
good history and phyiscal exam stuff
-abdominal distension test: have pt. lift feet up and push on their belly, if it hurts, somatic, if it gets better, visceral pain…. because that rectus abdominis is effectively sheliding the viscera from the stretch
What treatments can we use to normalize sympathetic activity?
treat the facilitated segments associate with organ involved
- T5-9, T10-11, or T12-L2
- ME, Soft tissue, MFR, HVLA, rib raising, paraspinal inhibition
What treatments could we use to normalize parasympathetic activity?
- vagus n. (address AA/OA)
- sacral treatment… for pelvic splanchnic n.
What are some lymphatic treatments we could use?
- open thoracic inlet
- dome the thoracolumbar diaphragm
- rib raising
- visceral techniques
- release fascial restrictions around the diaphrgagms
chapman’s points for the appendix
appendix: tip of rib 12 anteriorly, costovertebral joint posteriorly (Treat)
Chapmans points for the colon
just flip it over onto your lap
- right leg from top to bottom: cecum to proximal transverse colon
- left leg same way: sigmoid colon to distal transverse colon
