Osteopathic Approach To The GI Patient

Question 1

What are the top 2 common GI disorders patients present with?

Answer 1

IBS and GERD

Question 2

OMT for the GI patient is directed towards improving what?

Answer 2

Lymph/Blood flow and balancing autonomics

Question 3

What do we need to determine for the biomechanical model for the GI patient?

Answer 3

Determine whether the SD is primarily MSK or secondary to viscerosomatic reflex. If SD doesn’t respond to OMT, it points to a viscerosomatic problem.

Question 4

How do you describe intra-peritoneal organs and what are those specific organs?

Answer 4

They have mesentery and peritoneum.

Stomach, jejunum, ileum, superior part of duodenum, liver, and spleen.

Question 5

How do you describe an extra peritoneal organ, what are the two types, and what specific organs fall in each category?

Answer 5

No mesentery. Retro and infra.
Cecum, ascending and descending colon, pancreas, other parts of duodenum, upper 2/3 rectum.
Lower rectum.

Question 6

What is the span of the abdominal cavity?

Answer 6

Diaphragm to pelvic diaphragm

Question 7

The viscera is highly sensitive to what 4 sensory signals?

Answer 7

Stretch, spasm, ischemia and inflammation

Question 8

2 characteristics of visceral pain and 2 characteristics of somatic pain?

Answer 8

Burning and poorly localized for visceral and sharp and well localized for somatic.

Question 9

Where does phrenic pain refer to?

Answer 9

Ipsilateral shoulder

Question 10

Visceral pathology results in somatic changes where?

Answer 10

Paraspinally

Question 11

What is the percutaneous reflex of Morley and give an example?

Answer 11

Transfer of inflammation from viscera to peritoneum. Appendicitis to peritonitis.

Question 12

Thoracic and Lumbar Splanchnic nerves lead to which ganglia?

Answer 12

Thoracic lead to celiac and superior mesenteric and lumbar leads to inferior mesenteric ganglia.

Question 13

What are we thinking with the respiratory circulatory model with a GI patient?

Answer 13

Pelvic Diaphragm and Lymphatics

Question 14

Any form of SD to the pelvic diaphragm leads to what which causes what 3 things?

Answer 14

Fluid stasis. Pelvic congestion, VS pain, and inability to clear infections efficiently.

Question 15

What are the three large collecting intestinal nodes for the gut and what organs drain to them? What is the pathway after the nodes back to the venous system?

Answer 15

1. Celiac: stomach, duodenum, liver and spleen.
2. Superior mesenteric: jejunum, ileum, ascending and proximal transverse
3. Inferior mesenteric: distal transverse, descending, sigmoid, and rectum.
   Cysterna chyli at L1-l2 right of abdominal aorta, thoracic duct, and subclavian vein.

Question 16

As far as the metabolic model, what does hyperthyroidism and hypothyroidism lead to in the GI patient?

Answer 16

Hyper is diarrhea and hypo is constipation

Question 17

What does hypercalcemia and hypokalemia lead to in the GI patient?

Answer 17

Constipation

Question 18

What does hyperkalemia lead to in the GI patient?

Answer 18

Diarrhea

Question 19

As far as acid base imbalance, what does diarrhea and vomiting lead to in the GI patient?

Answer 19

D: leads to metabolic acidosis
V: metabolic alkalosis with hypokalemia