Review: ANS and Homeostatic Clinical Examples, Chapmans

Question 1

Define the ANS

Answer 1

Two-neuron chain connecting preganglionic neurons through ganglia to visceral target tissues

Question 2

Components of sympathetic ANS

Answer 2

Cervical ganglia (superior, middle, stellate)

Paravertebral ganglia (thoracolumbar)

Prevertebral ganglia (celiac, superior mesenteric, inferior mesenteric)

Question 3

Components of parasympathetic ANS

Answer 3

CN3 — eye

CN7 — lacrimal, palatine, and submandibular

CN9 — parotid

CN10 — cardiopulm, GI

Sacral (S2, S3, S4) — colon, rectum, GU

Question 4

What are paraganglia?

Answer 4

Extrasuprarenal aggregations of chromaffin tissue — abdominal, adrenal, and paraspinal

Synthesize and store catecholamines

[pheochromocytoma sxs = HA, sweating, and tachycardia]

Question 5

Distribution of sympathetic vs. parasympathetic in terms of vascular and visceral supplies

Answer 5

Sympathetic: vascular includes fascia, smooth muscle and sweat glands + trunk and extremities; visceral includes smooth muscle, cardiac, nodal and glandular tissue in thoracoabdominopelvic cavity

Parasympathetic: no extremities! Visceral — same as sympathetic but also in viscera of head and neck

Question 6

What is meant by “allostatic load”?

Answer 6

Frequent activation of allostatic systems — continuation of feedback pathways meant to reestablish normal homeostasis

Longterm exposure may cause atrophy of hippocampus affecting feedback, memory, and autonomic function

[allostasis = adaptation in the face of potentially stressful challenges involves activation of neural, neuroendocrine and neuroendocrine-immune mechanisms]

Question 7

A facilitated segment is also known as somatic dysfunction — what are 2 hallmarks of a facilitated segment?

Answer 7

Lowered neuronal threshold

Hypersensitivity of receptive fields

Question 8

Goals of OMT in reestablishing homeostasis

Answer 8

Reduce allostatic load by balancing ANS

Reduce postural strain

Improve biomechanics of gait

Remove obstructions to fluid flow and drainage, augment fluid flow

Improve biomechanics of respiration

Optimize tissue healing and homeostatic reserve

Question 9

Limbic system —> hypothalamus —> sympathetic nervous system —> ???

Answer 9

SNS —> lateral horn of the thoracolumbar spinal cord —> paravertebral and prevertebral ganglia —> end organ

Question 10

Limbic system —> hypothalamus —> parasympathetic nervous system —> ???

Answer 10

PNS —> brainstem nuclei and lateral horn of sacral SC —> organ ganglia —> end organ

Question 11

Thoacolumbar (T1-L2) system arising from the intermediolateral cell column of the lateral horn of the SC acting through chain ganglia and collateral ganglia

Answer 11

SNS

Question 12

Craniosacral system arising from brainstem nuclei associated with CNs III, VII, IX, and X and from the intermediate gray in the S2-S4 SC

Answer 12

PNS

Question 13

Sympathetic innervation of head/neck, heart/lungs, and upper GI

Answer 13

Head/Neck = T1-4
Heart lungs = T1-6
Upper GI = T5-9

Question 14

Sympathetic innervation of small intestine+right colon, appendix, and left colon+pelvis

Answer 14

Small intestine+right colon = T10-11

Appendix = T12

L colon/pelvis = T12-L2

Question 15

Sympathetic innervation of adrenals, GU tract, and upper/lower ureter

Answer 15

Adrenals = T10-T11

GU tract = T10-L2

Upper/lower ureter = T10-11/T12-L2

Question 16

Sympathetic innervation of bladder and upper/lower extremities

Answer 16

Bladder = T12-L2

Extremities upper/lower = T2-8, T11-L2

Question 17

Parasympathetic innervation of vagus n. (CN X) involves what structures?

Answer 17

Heart, lungs, thyroid, carotids

Upper/middle GI, liver

Kidney, upper ureter

Ovaries/testes

Question 18

S2-4 Pelvic splanchnic nn. of parasympathetic nervous system innervate what structures?

Answer 18

Lower GI, uterus/cervix, penis/clitoris

Lower ureter, bladder

Question 19

Assessment of sympathetics

Answer 19

Appropriate spinal levels

Paraspinal muscle spasms

Rib restrictions

Distant ganglia — cervical, celiac, mesenteric

Question 20

Parasympathetic assessment

Answer 20

Vagus — look for condylar compression, OM suture restrictions, OA/AA SDs

Sacrum (S2-4) — sacral somatic dysfunction

Question 21

Define somatic dysfunction

Answer 21

Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, myofascial structures, and their related vascular, lymphatic, and neural elements

Important people = J.S. Denslow, DO, and Irvin Korr, PhD

Question 22

Define spinal facilitation

Answer 22

The maintenance of a pool of neurons in a state of partial or subthreshold excitation; in this state, less afferent stim is required to trigger discharge of impulses

Facilitation may be d/t sustained increase in afferent input, aberrant patterns of afferent input, or changes within affected neurons themselves or their chemical environment — once established, facilitation can be sustained by normal CNS activity

Question 23

General technique for balancing the ANS

Answer 23

CV4 OCMM

Question 24

Regional techniques for balancing the ANS

Answer 24

Rib raising
Paraspinal muscle inhibition
Abdominal collateral ganglia techniques
Target type II SDs if present
Suboccipital inhibition
Sphenopalatine ganglia release
Sacral inhibition and rocking
SI joint gapping

Question 25

OMT used to decrease sympathetic activity

Answer 25

``` Rib raising Paraspinal muscle inhibition Cervical ganglia inhibition Abdominal collateral ganglia technique Target non-neutral (type II) SD if present ```

Question 26

OMT to normalize parasympathetic tone

Answer 26

``` Suboccipital inhibition Sphenopalatine ganglion release Sacral inhibition and rocking SI joint gapping BLT Gentle muscle energy ```

Question 27

Who performed the prospective controlled study with rabbits in which SD was induced weekly at atlas, C6, and T3 with subsequent measurement of pulse, response to exercise, EKG, and tissue sample?

Answer 27

Louisa Burns, DO

Question 28

What were the results of Dr. Burns’ research in terms of functional changes as a result of T3 SD?

Answer 28

Immediate: rapid, weak, and somewhat irregular pulse 10 minutes later: slightly stronger, slower an dmore regular, but did not return to normal as long as SD persisted 2 months later: gradually weaker with staccato quality similar to that found in elderly [this was not present in rabbits without T3 SD]

Question 29

What were the results of Dr. Burns’ research in terms of functional changes as a result of atlas SD?

Answer 29

Immediate: stronger and irregular pulse 10 minutes later: closer to normal as long as SD persisted 2 months later: developed arrhythmias [theorized to be d/t vagal n. facilitation]

Question 30

Cardiac cross section findings in rabbits after atlas and T3 induced SD

Answer 30

Abnormalities in muscle patterns — abnormal color, cross striations, abundant fibrils, variable nuclear relations Edema Hemorrhagic areas Overgrowth of CT [neurotrophic findings]

Question 31

What type of reflex? Localized somatic stimuli producing patterns of reflex response in segmentally related somatic structures

Answer 31

Somatosomatic reflex

Question 32

What type of reflex? Localized somatic stimulation producing patterns of reflex response in segmentally related visceral structures

Answer 32

Somatovisceral reflex

Question 33

What type of reflex? Localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures

Answer 33

Viscerosomatic reflex

Question 34

What type of reflex? Localized visceral stimuli producing patterns of reflex response in segmentally related visceral structures

Answer 34

Viscerovisceral reflex

Question 35

A 35 y/o female d/c yesterday s/p smoke inhalation presents with cough and mild SOB. She has a hx of asthma x20 years. Where might she have dysfunction and what are some OMT options?

Answer 35

Lungs are T2-4 and CN X OMT with indirect tx of cervical, thoracic, rib, and lumbar SD — quiet the aberrant neural input from pre-existing SDs OMT to open the lymphatic system — No pumps!! Be careful bc she is only 1 day out of the hospital

Question 36

72 y/o male hospitalized s/p abdominal surgery resecting malignant tumors from his large and small bowel now c/o ileus and cramping abdominal pain 5d s/p surgery...what are some possible areas of ANS findings?

Answer 36

SI = T9-10, CN X Ascending and transverse: T11-L1, CN X Descending, sigmoid: L1-2, S2-4

Question 37

67 y/o male 7d hospitalized with complaints of inability to urinate s/p TURP twice and has LBP. What are some possible areas of ANS findings?

Answer 37

Kidneys: T10-L1, CNX Ureters: T11-L2, CN X Bladder: T10-L1, S2-4

Question 38

40 y/o female with c/o carpal tunnel syndrome, scleroderma, Raynaud’s disease. After your OSE you find significant TART findings (edematous, boggy, tender) in bilateral lower cervical and upper thoracic spine...why is that?

Answer 38

UE sympathetic supply to vascular is via upper thoracics Hand dermatomal and myotomal nerve supply via C6-C8

Question 39

What are the 5 models of the osteopathic approach to tx?

Answer 39

``` Biomechanical Psych/behavioral Respiratory/circulatory Metabolic Neurologic ```

Question 40

Sympathetic findings and tx in acute bronchitis

Answer 40

Sympathetic innervation: T1-6 Paraspinal muscle inhibition, rib raising, OMT to appropriate region

Question 41

Parasympathetic findings and tx in acute bronchitis

Answer 41

OA, AA OMT: suboccipital inhibition

Question 42

Lymphatic and vascular drainage associations and tx with acute bronchitis

Answer 42

Diagnose both thoracic inlet and abdominal diaphragm Tx: Thoracic inlet release, abdominal diaphragm release, rib raising

Question 43

Purpose of OA tx in the ANS

Answer 43

Free parasympathetic response to structures innervated by cranial nn. IX and X by freeing passage through jugular foramen — balance parasympathetic influence to the viscera Condylar compression in newborns may cause suckling difficulties Manipulation of OA, AA, or C2 joints will influence parasympathetic tone via vagus n

Question 44

What are chapman’s reflexes?

Answer 44

Viscerosomatic reflex of both diagnostic and tx value Gangliform contraction that blocks lymphatic drainage and causes SNS dysfunction (neurolymphatic) A consistent reproducible series of points both anterior and posterior related to specific organs or conditions

Question 45

Anterior Chapman’s reflexes of bronchus, upper lung, and lower lung

Answer 45

Bronchus = 2nd ICS Upper lung = 3rd ICS Lower lung = 4th ICS

Question 46

Posterior Chapman’s reflexes for bronchus, upper lung, and lower lung

Answer 46

Bronchus = b/l TP2 Upper lung = b/l between TP3 and TP4 Lower lung = b/l between TP4 and TP5

Question 47

Sympathetic findings and tx associated with chronic constipation

Answer 47

Sympathetic innervation: T10-L2 Tx: paraspinal muscle inhibition, collateral ganglia inhibition

Question 48

Parasympathetic findings and tx associated with chronic constipation

Answer 48

Sacrum, OA, AA Tx: suboccipital inhibtion, sacral inhibition and/or rocking

Question 49

Lymphatic and vascular drainage findings and tx associated with chronic constipation

Answer 49

Diagnose thoracic inlet, abdominal diaphragm, pelvic diaphragm, and mesenteries Tx: TI release, abdominal diaphragm release, mesenteric lifts, pelvic diaphgram release

Question 50

What is the difference in terms of PNS with sacral rocking vs. sacral inhibition?

Answer 50

Sacral rocking increases parasympathetic tone Sacral inhibition decreases parasympathetic tone

Question 51

Anterior chapmans points for esophagus, liver, and GB

Answer 51

Esophagus: b/l 2nd ICS Liver: R 5th ICS GB: R 6th ICS

Question 52

Anterior chapman points for pancreas, small intestines, and appendix

Answer 52

Pancreas = R 7th ICS Small intestines = 8-10th ICS Appendix = tip of R 12th rib

Question 53

Anterior chapmans points for pylorus, stomach acidity, stomach, and spleen

Answer 53

Pylorus: sternal Stomach acidity: L 5th ICS Stomach: L 6th ICS Spleen: L 7th ICS

Question 54

List chapmans points on right and left thigh from superior to inferior

Answer 54

Right thigh: ileocecal valve, ascending colon, right 2/5 transverse colon Left thigh: sigmoid colon, descending colon, left 3/5 of transverse colon

Question 55

Posterior chapmans points for stomach acidity, GB, and spleen

Answer 55

Stomach acidity = L b/w T5 and T6 GB = b/l between T5 and T6 Spleen = L between T7 and T8

Question 56

Posterior chapmans points for small intestine

Answer 56

Bilateral Upper SI between T8 and T9 Middle between T9 and T10 Lower between T11 and T12

Question 57

Posterior chapmans points for esophagus, liver, pancreas, and pylorus

Answer 57

Esophagus = b/l T2 Liver = R between T5 and T6 Pancreas = R between T7 and T8 Pylorus = R T10 a costotransverse joint

Question 58

Sinuses Chapmans points

Answer 58

Anterior: Inferior to medial clavicles Posterior: C2, midway between SP and TP

Question 59

Middle Ear Chapmans points

Answer 59

Anterior: Superior anterior aspect of clavicles just lateral to where they cross first ribs Posterior: tips of C1 transverse process

Question 60

Pharynx Chapmans points

Answer 60

Anterior: 3-4 cm medial to where 1st ribs emerge from beneath clavicles Posterior: C2 midway between SP and TP

Question 61

Larynx Chapmans points

Answer 61

Anterior: 5-7 cm lateral to sternocostal junction upon 2nd ribs Posterior: C2 between SP and TP

Question 62

Tonsils Chapmans points

Answer 62

Anterior: Between 1st and 2nd ribs adjacent to sternum Posterior: C1 midway between SP and TP

Question 63

Eye Chapmans points

Answer 63

Anterior: anterior aspect of humerus at level of surgical neck Posterior: squamous portion of occipital bone below superior nuchal line