Visceral Lectures Flashcards

1
Q

List the anatomiccal layers from surface to organ through the abdominal wall.

A
Skin 
Superficial fascia
Anterior rectus sheath/investing fascia
Rectus abdominus
Deep investing fascia
Transveralis fascia
Peritoneum
Empty space (hand drops)
Viscera
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2
Q

Describe indirect treatment of visceral organs.

A
Layer palpation to level of organ.
Fascial (local) listening.
Motion testing in various planes.
BLT: stack in directio nof EASE and wait for release (~30 seconds)
Re-assess.
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3
Q

Describe direct treatment of visceral organs – release of colon for constipation.

A

Start at distal portion (sigmoid colon) and insert fingers gently on lateral wall of colon.
Pull gently/firmly toward umbilicus.
Wait for release.
Repeat moving proximally along colon (descending; ascending; cecum)

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4
Q

Viscerosomatic reflexes T6-9 Right

A

Liver (R)

Gallbladder (R)

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5
Q

Viscerosomatic reflexes T7 (2)

A

Spleen (L)

Pancreas (R)

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6
Q

Viscerosomatic reflexes T10-11

A
Right colon
Adrenals
Kidneys
Ovaries
Testes
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7
Q

Viscerosomatic reflexes T12-L2

A

Left colon

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8
Q

Viscerosomatic reflexes T12

A

Appendix

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9
Q

Sympathetic preganglionics

  • spinal levels?
  • divisions?
A
T5-L2
Greater (T5-9)
Lesser (T10-11)
Least Splanchnic (T12)
Lumbar splanchnic (L1-L2)
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10
Q

Celiac Ganglion Post-Ganglionic to: (7)

A
FOREGUT:
Distal esophagus
Stomach
Liver
Gallbladder
Spleen
portions of pancreas
proximal duodenum
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11
Q

Superior Mesenteric Ganglion Post-Ganglionic to: (10)

A
MIDGUT:
Portions of pancreas
Duodenum
Jejunum
Ileum
Asc colon
Prox 2/3 of transverse colon
ALSO:
Adrenals
Gonads
Kidneys
Upper 1/2 ureter
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12
Q

Inferior Mesenteric Ganglion Post-Ganglionic to: (7)

A
HINDGUT:
Distal 1/3 of transverse 
Desc colon
Sigmoid
Rectum
ALSO: 
Lower 1/2 Ureter
Bladder
Genitals
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13
Q

Indications for visceral manipulation

A
liver dysfunction
gallbladder dysfunction
stomach (GERD; hypomotility)
small intestinal mobility/motility
colon (constipation; IBS; iliocecal valve)
pain of non-surgical nature
lymphatic congestion
immune dysfunction (spleen)
vascular supply problems.
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14
Q

Absolute contraindications to visceral manipulation

A
acute abdomen
appendicitis
pancreatitis
splenomegaly
GI obstruction
abdominal aortic aneurysm
post-abdominal/pelvic surgery (NO direct)
GI infection (colitis; duodenitis; ileitis)
tumor.
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15
Q

Relative contraindications to visceral manipulation

A

Abdom hernia/diastasis

Pain of unknown origin

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16
Q

Viscerosomatic reflex T5-6 (R)

A

Upper esophagus

17
Q

Viscerosomatic reflexes T5-9 (L)

A

Lower esophagus

Stomach

18
Q

Viscerosomatic reflexes T8-9

A

Small intestine

19
Q

Name 3 techniques to treat the sympathetics in the abdomen

A

Chapman reflexes
Rib raising
Ventral abdominal ganglion inhibition

20
Q

Name 3 techniques to treat the parasympathetics to the abdomen

A

Cervical (OA, AA)
Soft tissue (suboccipital)
Cranial (occipitomastoid suture)

21
Q

Describe true visceral pain

  • where are the receptors?
  • carried by what type of fibers?
  • where is the pain and what does it feel like?
A

pacinian corpuscles; free nerve endings
activated by spasm or stretch
carried by visceral afferents
midline, poorly localized, vague, deep, diffuse, burning ache.

22
Q

Describe viscerosomatic pain

-where are the receptors?

A

pain receptors in anterior and lateral parietal peritoneum, lesser omentum, mesentery, mesocolon
facilitated cord segments in somatic areas related to viscera sympathetic innervation.

23
Q

Describe the percutaneous reflex of Morley.

A

NO pain receptors in visceral peritoneum (greater omentum; spleen)
Awareness of pain only if affecting adjacent pain-sensitive structure.

24
Q

Where does cranial nerve X exit?

Describe its innervations (6).

A

Jugular foramen
Left: greater curvature of stomach; duodenum
Right: lesser curvature of stomach; small intestines; right colon; organs/glands up to mid-transverse colon.

25
Discuss visceral manipulation and who it was defined by.
Jean-Pierre Barral Organ/viscera in good health has physiologic motion Restriction implies functional impairment Motion repeated thousands of times daily
26
Mobility vs. motility in terms of visceral manipulation and testing
Mobility: voluntary or diaphragmatic; skeletal muscle effects --direct movement of organ via PALPATION Motility: inherent motion --listening Paired organs test together! Pressure on suspected organ while monitoring will inhibit the influence on the monitored organ.
27
Visceral rhythm: - how many cycles/min? - motion is ...?
7-8 cycles/min Motion is toward and away from midline Inspiration: cranial FLEXION; swelling of organ EXpiration: cranial EXtension; organ gets smaller
28
How many cycles before results should be expected in visceral treatment? -how long should you wait between treatmnets?
15 cycles | Wait 3-4 weeks b/t treatments.
29
Contraindications to visceral tx.
Acute infection (except bladder) Foreign bodies Calculi (relative) Thrombosis
30
Describe the liver flip technique. | -is it direct or indirect?
Physician standing behind seated patient. Reach under ribcage with PADS of fingers (2-3) Lift fingers enough to move liver Move up and down ribcage.
31
Fulford diaphragm (shock) release is used primarily to:
Re-establish diaphragm motion | Can be used for pts with hx of MVA.
32
Sympathetics T10-11 innervate (2) | -which ganglion?
Right colon 1/2 transverse colon Superior mesenteric ganglion
33
Sympathetics T12-L2 innervate (2) | -which ganglion? (2)
1/2 transverse Left colon Inferior mesenteric ganglion Lumbar
34
Hyperactivity of the sympathetics in the lower GI tract can produce which symptoms:
Flatulence Abdominal distension Constipation Ileus (inactivity)
35
Vagus innervates (2)
Right colon | 1/2 transverse
36
Pelvic splanchnics innervae (4)
1/2 transverse (distal) Left colon Sigmoid Rectum