Visceral Lectures Flashcards
List the anatomiccal layers from surface to organ through the abdominal wall.
Skin Superficial fascia Anterior rectus sheath/investing fascia Rectus abdominus Deep investing fascia Transveralis fascia Peritoneum Empty space (hand drops) Viscera
Describe indirect treatment of visceral organs.
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.
Describe direct treatment of visceral organs – release of colon for constipation.
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)
Viscerosomatic reflexes T6-9 Right
Liver (R)
Gallbladder (R)
Viscerosomatic reflexes T7 (2)
Spleen (L)
Pancreas (R)
Viscerosomatic reflexes T10-11
Right colon Adrenals Kidneys Ovaries Testes
Viscerosomatic reflexes T12-L2
Left colon
Viscerosomatic reflexes T12
Appendix
Sympathetic preganglionics
- spinal levels?
- divisions?
T5-L2 Greater (T5-9) Lesser (T10-11) Least Splanchnic (T12) Lumbar splanchnic (L1-L2)
Celiac Ganglion Post-Ganglionic to: (7)
FOREGUT: Distal esophagus Stomach Liver Gallbladder Spleen portions of pancreas proximal duodenum
Superior Mesenteric Ganglion Post-Ganglionic to: (10)
MIDGUT: Portions of pancreas Duodenum Jejunum Ileum Asc colon Prox 2/3 of transverse colon ALSO: Adrenals Gonads Kidneys Upper 1/2 ureter
Inferior Mesenteric Ganglion Post-Ganglionic to: (7)
HINDGUT: Distal 1/3 of transverse Desc colon Sigmoid Rectum ALSO: Lower 1/2 Ureter Bladder Genitals
Indications for visceral manipulation
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.
Absolute contraindications to visceral manipulation
acute abdomen appendicitis pancreatitis splenomegaly GI obstruction abdominal aortic aneurysm post-abdominal/pelvic surgery (NO direct) GI infection (colitis; duodenitis; ileitis) tumor.
Relative contraindications to visceral manipulation
Abdom hernia/diastasis
Pain of unknown origin
Viscerosomatic reflex T5-6 (R)
Upper esophagus
Viscerosomatic reflexes T5-9 (L)
Lower esophagus
Stomach
Viscerosomatic reflexes T8-9
Small intestine
Name 3 techniques to treat the sympathetics in the abdomen
Chapman reflexes
Rib raising
Ventral abdominal ganglion inhibition
Name 3 techniques to treat the parasympathetics to the abdomen
Cervical (OA, AA)
Soft tissue (suboccipital)
Cranial (occipitomastoid suture)
Describe true visceral pain
- where are the receptors?
- carried by what type of fibers?
- where is the pain and what does it feel like?
pacinian corpuscles; free nerve endings
activated by spasm or stretch
carried by visceral afferents
midline, poorly localized, vague, deep, diffuse, burning ache.
Describe viscerosomatic pain
-where are the receptors?
pain receptors in anterior and lateral parietal peritoneum, lesser omentum, mesentery, mesocolon
facilitated cord segments in somatic areas related to viscera sympathetic innervation.
Describe the percutaneous reflex of Morley.
NO pain receptors in visceral peritoneum (greater omentum; spleen)
Awareness of pain only if affecting adjacent pain-sensitive structure.
Where does cranial nerve X exit?
Describe its innervations (6).
Jugular foramen
Left: greater curvature of stomach; duodenum
Right: lesser curvature of stomach; small intestines; right colon; organs/glands up to mid-transverse colon.
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
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.
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
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.
Contraindications to visceral tx.
Acute infection (except bladder)
Foreign bodies
Calculi (relative)
Thrombosis
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.
Fulford diaphragm (shock) release is used primarily to:
Re-establish diaphragm motion
Can be used for pts with hx of MVA.
Sympathetics T10-11 innervate (2)
-which ganglion?
Right colon
1/2 transverse colon
Superior mesenteric ganglion
Sympathetics T12-L2 innervate (2)
-which ganglion? (2)
1/2 transverse
Left colon
Inferior mesenteric ganglion
Lumbar
Hyperactivity of the sympathetics in the lower GI tract can produce which symptoms:
Flatulence
Abdominal distension
Constipation
Ileus (inactivity)
Vagus innervates (2)
Right colon
1/2 transverse
Pelvic splanchnics innervae (4)
1/2 transverse (distal)
Left colon
Sigmoid
Rectum
