Visceral OMT DSA Flashcards
True or False: most interneurons receive input from both visceral and somatic sources
True
List the order of OMT treatment using Biomechanical, Circulatory Lymphatics, and Neurologic.
1) Biomechanical first
2) Neurologic second
3) Circulatory Lymphatics third
What are the characteristics of treating the biomechanical aspects of viscera using OMT?
- remove associated mechanical stress
- -lower ribs, TL spine, psoas, QL, pelvic floor
- -visceral support (mesentery, ligaments)
What are the characteristics of treating the neurologic aspects of viscera using OMT?
-treat areas related to sympathetic/parasympathetic innervation to normalize autonomic tone
- Para: OA (vagus) and sacrum (pelvic splanchnic)
- Sympathetic: T1-L2 dorsal root ganglia
- Chapman’s Points
What are the characteristics of treating the circulatory lymphatics aspect of viscera using OMT?
- reduce impediments to flow (local, regional, global)
- pumping (thoracoabdominal and pelvic diaphragms)
What are indications and contraindications of Large Intestine Visceral OMT?
+constipation, IBS, post-injury, viscerosomatic reflex
–active infection, colon obstruction, surgery within the past 2-3 weeks, splenomegaly
Which parts of the colon are intraperitoneal and which parts are retroperitoneal?
Intraperitoneal: Transverse and Sigmoid
Retroperitoneal: Ascending and Descending
True or False: the colon tapers from proximal to distal
True
Which two major arteries supply the colon?
Superior and Inferior Mesenteric aa.
How does the mesentery run along the posterior abdominal wall?
from superior left to inferior right
What is the sympathetic innervation and parasympathetic innervation of the ascending and transverse colon?
Sympathetic: T10-T11 (lesser splanchnic n.)
(superior mesenteric ganglion)
Parasympathetic: Vagus (CN X)
What is the sympathetic and parasympathetic innervation of the descending colon?
Sympathetic: T12-L2 (least splanchnic n.)
(inferior mesenteric ganglion)
Parasympathetic: Pelvic Splanchnic (S2-S4)
Where would you palpate the superior mesenteric ganglion and what does it control?
- midway between the xiphoid and the umbilicus
- distal duodenum, pancreas, jejunum, ileum, ascending colon, proximal 2/3rds of transverse colon
Where would you palpate the celiac ganglion and what does it control?
- 1/4th of the way between the xiphoid and the umbilicus
- distal esophagus, stomach, proximal duodenum, liver, gallbladder, spleen, pancreas
Where would you palpate the inferior mesenteric ganglion and what does it control?
- 1/4th of the way b/w the umbilicus and the xiphoid
- distal 1/3rd of the transverse colon, descending colon, sigmoid colon, rectum
How do you conduct collateral ganglia release?
- direct force posteriorly and engage the feather’s edge of the restrictive barrier
- maintain gentle force until a softening occurs (inhibition)
Where is the posterior Chapman point for the colon?
-a triangular area from the transverse process of L2, transverse process of L4, and the crest of the ilium
True or False: there is a direct fascial relationship b/w the QL and the colon
True: ascending colon on the right side and descending colon on the left side
How do you treat Chapman’s Points?
–slow circular massage with medium/firm pressure for 10-30s
–clockwise and counterclockwise may be alternated, whichever works best
What are indications and contraindications for performing Small Intestine Visceral OMT?
+indigestion, delayed gastric emptying, cholestasis, viscerosomatic reflex findings
–splenomegaly, active infection, colon obstruction, surgery within the past 2-3wks
Which parts of the small intestine are intraperitoneal and which parts are retroperitoneal?
Retroperitoneal: duodenum
Intraperitoneal: jejunum and ileum
What is the sympathetic and parasympathetic innervation to the duodenum?
Sympathetic: T5-T9 (greater splanchnic n., celiac ganglion)
Parasympathetic: Vagus n. (CN X)
What is the sympathetic and parasympathetic innervation to the jejunum and ileum?
Sympathetic: T10-T11 (lesser splanchnic n., superior mesenteric ganglion)
Parasympathetic: Vagus n. (CN X)
Where are the anterior Chapman points for the small intestines?
-on the inferior aspect of the costochondral joints of ribs 8-10
Where is the Chapman Point for the appendix?
tip of Rib 12
Where is the anterior Chapman Point for the spleen?
-7th intercostal space (b/w 7 and 8) on the Left
What are the posterior Chapman Points for the small intestines?
-midway between the transverse process and spinous process between T8-T9, T9-T10, and T10-T11
Where is the posterior Chapman Point for the spleen?
-midway b/w the transverse process and spinous process b/w T7-T8 on the Left
Where is the posterior Chapman Point for the pancreas?
-midway b/w the transverse process and spinous process b/w T7-T8 on the Right
True or False: if there’s no Chapman Point reflex, there’s no disease process
False, lack of Chapman Reflex does NOT indicate lack of disease
Conversely, presence of a Chapman Reflex doesn’t always indicate disease, could be a somatic dysfxn
What are indications for Liver Visceral OMT?
- passive congestion of liver and spleen
- parenchymal disease of liver or spleen
- pt’s w/ infectious processes (improve host immunity)
- liver visceral capsule or suspension dysfxn
What are contraindications for Liver Visceral OMT?
- fractures, dislocations in thorax
- lymphatic system malignancy
- trauma to liver, spleen, or adjacent organs
- acute hepatitis
- friable hepatomegaly or splenomegaly (mono, sickle)
True or False: blood supply passes through fascia
True; thus, tight fascia can cause blood flow issues
What is the sympathetic and parasympathetic innervation to the liver?
Sympathetic: T7-T9 (greater splanchnic n., celiac ganglion)
Parasympathetic: Vagus n. (CN X)
Describe the Liver Pump.
Set-up: caudad hand on front right ribs at bottom costal margin and cephalad hand on back right ribs at bottom costal margin
–alternate compress/release for 30-60s (15-20x/min)
Where is the anterior and posterior Liver Chapman Point?
Anterior: 5th intercostal space on the Right
Posterior: halfway b/w spinous process and transverse process b/w T5-T6 on the Right
Where is the anterior and posterior Gallbladder Chapman Point?
Anterior: 6th intercostal space on the Right
Posterior: halfway b/w the spinous process and the transverse process b/w T6-T7 on the Right
What are indications for Renal Visceral OMT?
- renal failure
- nephrolithiasis
- cystitis, interstitial cystitis
- incontinence, pelvic floor symptoms
- prostate or uterine disease
True or False: treating constipation may improve bladder function
True; constipation can cause reflexive bladder spasms, and the pressure of the stool on the urethra can prevent complete emptying.
Are the kidneys intraperitoneal or retroperitoneal?
Retroperitoneal
K of SAD PUCKER
What is the sympathetic and parasympathetic innervation of the ureters, bladder, and pelvic organs?
Sympathetic: T12-L2 (least splanchnic n., inferior mesenteric ganglion)
Parasympathetic: Pelvic splanchnic n. (S2-S4)
What happens when there’s dysfxn of the sympathetic innervation to the urinary system?
- vasoconstriction
- ureteral constriction
- constriction of internal urethral sphincter
What is parasympathetic innervation of the urinary system responsible for?
- helps w/ peristalsis along ureters
- contracts bladder to urinate
Where is the anterior and posterior Chapman Point for the adrenals?
Anterior: 2” above and 1” lateral to the umbilicus
Posterior: intertransverse spaces T11-T12
Where is the anterior and posterior Chapman Point for the kidney/ureters?
Anterior: 1” above and 1” lateral to the umbilicus
Posterior Kidney: intertransverse space T12-L1
Posterior Ureters: intertransverse space L1-L2
Where is the anterior and posterior Chapman Point for the bladder?
Anterior: umbilicus/periumbilical area
Posterior: superior edge of L2 transverse process (same as urethra)
Where is the anterior and posterior Chapman Point for the urethra?
Anterior: inner edge of pubic ramus near symphysis
Posterior: superior edge of L2 transverse process (same as bladder)
What is the primary lymphatic drainage of the lower pelvis?
external iliac nodes
-thus, anterior hip tension has an influence on pelvic congestion
True or False: Chapman’s Reflexes are a viscerosomatic reflex
True
What nerve is responsible for referred pain from a kidney stone in a ureter?
genitofemoral n.
