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OS IV Exam I SG > Review: ANS and Homeostatic Clinical Examples, Chapmans > Flashcards

Review: ANS and Homeostatic Clinical Examples, Chapmans Flashcards

1
Q

Define the ANS

A

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

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2
Q

Components of sympathetic ANS

A

Cervical ganglia (superior, middle, stellate)

Paravertebral ganglia (thoracolumbar)

Prevertebral ganglia (celiac, superior mesenteric, inferior mesenteric)

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3
Q

Components of parasympathetic ANS

A

CN3 — eye

CN7 — lacrimal, palatine, and submandibular

CN9 — parotid

CN10 — cardiopulm, GI

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

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4
Q

What are paraganglia?

A

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

Synthesize and store catecholamines

[pheochromocytoma sxs = HA, sweating, and tachycardia]

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5
Q

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

A

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

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6
Q

What is meant by “allostatic load”?

A

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]

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7
Q

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

A

Lowered neuronal threshold

Hypersensitivity of receptive fields

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8
Q

Goals of OMT in reestablishing homeostasis

A

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

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9
Q

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

A

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

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10
Q

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

A

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

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11
Q

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

A

SNS

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12
Q

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

A

PNS

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13
Q

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

A

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

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14
Q

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

A

Small intestine+right colon = T10-11

Appendix = T12

L colon/pelvis = T12-L2

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15
Q

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

A

Adrenals = T10-T11

GU tract = T10-L2

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

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16
Q

Sympathetic innervation of bladder and upper/lower extremities

A

Bladder = T12-L2

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

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17
Q

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

A

Heart, lungs, thyroid, carotids

Upper/middle GI, liver

Kidney, upper ureter

Ovaries/testes

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18
Q

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

A

Lower GI, uterus/cervix, penis/clitoris

Lower ureter, bladder

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19
Q

Assessment of sympathetics

A

Appropriate spinal levels

Paraspinal muscle spasms

Rib restrictions

Distant ganglia — cervical, celiac, mesenteric

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20
Q

Parasympathetic assessment

A

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

Sacrum (S2-4) — sacral somatic dysfunction

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21
Q

Define somatic dysfunction

A

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

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22
Q

Define spinal facilitation

A

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

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23
Q

General technique for balancing the ANS

A

CV4 OCMM

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24
Q

Regional techniques for balancing the ANS

A 
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
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25
Q

OMT used to decrease sympathetic activity

A 
Rib raising
Paraspinal muscle inhibition
Cervical ganglia inhibition
Abdominal collateral ganglia technique
Target non-neutral (type II) SD if present
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26
Q

OMT to normalize parasympathetic tone

A 
Suboccipital inhibition
Sphenopalatine ganglion release
Sacral inhibition and rocking
SI joint gapping
BLT
Gentle muscle energy
27
Q

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?

A

Louisa Burns, DO

28
Q

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

A

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]

29
Q

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

A

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]

30
Q

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

A

Abnormalities in muscle patterns — abnormal color, cross striations, abundant fibrils, variable nuclear relations

Edema

Hemorrhagic areas

Overgrowth of CT

[neurotrophic findings]

31
Q

What type of reflex?

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

A

Somatosomatic reflex

32
Q

What type of reflex?

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

A

Somatovisceral reflex

33
Q

What type of reflex?

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

A

Viscerosomatic reflex

34
Q

What type of reflex?

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

A

Viscerovisceral reflex

35
Q

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?

A

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

36
Q

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?

A

SI = T9-10, CN X

Ascending and transverse: T11-L1, CN X

Descending, sigmoid: L1-2, S2-4

37
Q

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?

A

Kidneys: T10-L1, CNX

Ureters: T11-L2, CN X

Bladder: T10-L1, S2-4

38
Q

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?

A

UE sympathetic supply to vascular is via upper thoracics

Hand dermatomal and myotomal nerve supply via C6-C8

39
Q

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

A 
Biomechanical
Psych/behavioral
Respiratory/circulatory
Metabolic
Neurologic
40
Q

Sympathetic findings and tx in acute bronchitis

A

Sympathetic innervation: T1-6

Paraspinal muscle inhibition, rib raising, OMT to appropriate region

41
Q

Parasympathetic findings and tx in acute bronchitis

A

OA, AA

OMT: suboccipital inhibition

42
Q

Lymphatic and vascular drainage associations and tx with acute bronchitis

A

Diagnose both thoracic inlet and abdominal diaphragm

Tx: Thoracic inlet release, abdominal diaphragm release, rib raising

43
Q

Purpose of OA tx in the ANS

A

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

44
Q

What are chapman’s reflexes?

A

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

45
Q

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

A

Bronchus = 2nd ICS

Upper lung = 3rd ICS

Lower lung = 4th ICS

46
Q

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

A

Bronchus = b/l TP2

Upper lung = b/l between TP3 and TP4

Lower lung = b/l between TP4 and TP5

47
Q

Sympathetic findings and tx associated with chronic constipation

A

Sympathetic innervation: T10-L2

Tx: paraspinal muscle inhibition, collateral ganglia inhibition

48
Q

Parasympathetic findings and tx associated with chronic constipation

A

Sacrum, OA, AA

Tx: suboccipital inhibtion, sacral inhibition and/or rocking

49
Q

Lymphatic and vascular drainage findings and tx associated with chronic constipation

A

Diagnose thoracic inlet, abdominal diaphragm, pelvic diaphragm, and mesenteries

Tx: TI release, abdominal diaphragm release, mesenteric lifts, pelvic diaphgram release

50
Q

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

A

Sacral rocking increases parasympathetic tone

Sacral inhibition decreases parasympathetic tone

51
Q

Anterior chapmans points for esophagus, liver, and GB

A

Esophagus: b/l 2nd ICS

Liver: R 5th ICS

GB: R 6th ICS

52
Q

Anterior chapman points for pancreas, small intestines, and appendix

A

Pancreas = R 7th ICS

Small intestines = 8-10th ICS

Appendix = tip of R 12th rib

53
Q

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

A

Pylorus: sternal

Stomach acidity: L 5th ICS

Stomach: L 6th ICS

Spleen: L 7th ICS

54
Q

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

A

Right thigh: ileocecal valve, ascending colon, right 2/5 transverse colon

Left thigh: sigmoid colon, descending colon, left 3/5 of transverse colon

55
Q

Posterior chapmans points for stomach acidity, GB, and spleen

A

Stomach acidity = L b/w T5 and T6

GB = b/l between T5 and T6

Spleen = L between T7 and T8

56
Q

Posterior chapmans points for small intestine

A

Bilateral

Upper SI between T8 and T9

Middle between T9 and T10

Lower between T11 and T12

57
Q

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

A

Esophagus = b/l T2

Liver = R between T5 and T6

Pancreas = R between T7 and T8

Pylorus = R T10 a costotransverse joint

58
Q

Sinuses Chapmans points

A

Anterior: Inferior to medial clavicles

Posterior: C2, midway between SP and TP

59
Q

Middle Ear Chapmans points

A

Anterior: Superior anterior aspect of clavicles just lateral to where they cross first ribs

Posterior: tips of C1 transverse process

60
Q

Pharynx Chapmans points

A

Anterior: 3-4 cm medial to where 1st ribs emerge from beneath clavicles

Posterior: C2 midway between SP and TP

61
Q

Larynx Chapmans points

A

Anterior: 5-7 cm lateral to sternocostal junction upon 2nd ribs

Posterior: C2 between SP and TP

62
Q

Tonsils Chapmans points

A

Anterior: Between 1st and 2nd ribs adjacent to sternum

Posterior: C1 midway between SP and TP

63
Q

Eye Chapmans points

A

Anterior: anterior aspect of humerus at level of surgical neck

Posterior: squamous portion of occipital bone below superior nuchal line

OS IV Exam I SG (20 decks)

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