EXAM #2: OSTEOPATHIC CONSIDERATIONS IN GI

Question 1

What nerve provides 75% of the PNS influence on the body?

Answer 1

CN X (Vagus)

Question 2

What nerves compose the cranial portion of the PNS?

Answer 2

CN III, VII, IX, X

Question 3

What nerves compose the sacral portion of the PNS?

Answer 3

S2, S3, S4

Question 4

What are the effects of increased PNS stimulation on the glands, GI, Liver, Gallbladder/ ducts, GI arterioles?

Answer 4

Glands= copious secretions

GI= stimulation of peristalsis and sphincter relaxation

Liver= promote glycogen synthesis

Gallbladder= contraction

GI arterioles= NO innervation

Question 5

What ganglia are associated with the SNS?

Answer 5

T1 - L2

Question 6

How does the SNS supply the head and upper extremity?

Answer 6

Cervical ganglia (CN II, V, VII)

Question 7

What is the SNS supply to the lower extremity?

Answer 7

Lumbar splanchnic nerves

Question 8

What is the SNS effect on the Glands, Blood Vessels, GI, Liver, Gallbladder, and GI arterioles?

Answer 8

Glands= decrease secretion

BV= constriction

GI= decrease peristalsis and increase sphincter tone

Liver= promote glycogen breakdown

Gallbladder= relax

GI arterioles= constriction

Question 9

What type of tone is typically seen during disease or trauma?

Answer 9

Increased SNS tone

Question 10

What are the effects of increased SNS tone in a disease state?

Answer 10

1) Vasoconstriction leading to decreased nutritional supply to tissue
2) Thickened secretions causing tissue congestion
3) Decreased lymphatic drainage

Question 11

Clinically, what is the osteopathic viewpoint on the clinical impact of increased SNS tone in disease?

Answer 11

Impaired medication delivery

Question 12

How do patients present with lymphatic congestion in regards to their appearance and palpatory ques?

Answer 12

• Appearance= uncomfortable

- Palpation= boggy/soggy

Question 13

What is proper lymphatic motion dependent on?

Answer 13

Contractions of the diaphragm

Question 14

What is the most important diaphragm to treat to improve lymphatic flow?

Answer 14

TI

Question 15

What types of receptors relay the stretch that happens in the GI tract?

Answer 15

• Pacinian corpusles

- Free nerve endings

Question 16

Describe the viscero-somatic relationship.

Answer 16

• Visceral pain is carried by visceral afferent”

- There is “spill-over” into the somatic afferents

Question 17

What thoracic levels are associated with the Upper GI System?

Answer 17

T5-11

Question 18

What throacic levels are associated with the Lower GI System?

Answer 18

T9-L2

Question 19

In the thoracic vertebrae, what type of SD is commonly seen with a chronic GI issue?

Answer 19

• Extension
• Rotation
• Sidebending

All TOWARD the SAME side of the organ involved.

Question 20

What is post-op ileus a consequence of?

Answer 20

Viscero-visceral reflex in response to handling of the bowel during during surgery

Question 21

What ganglia will afferents from the thoracic splancnic nerves go to?

Answer 21

Celiac ganglion

Question 22

What ganglion will afferents from lumbar splancnic nerves go to?

Answer 22

Inferior mesenteric ganglion

Question 23

What is the outcome of hyperactivity of both the SNS and PNS?

Answer 23

IBS

Question 24

What are the three main elements that will hinder lymph flow?

Answer 24

1) Flattened diaphragm
2) Fascial torsion
3) Thoracic inlet impairment

Question 25

What lumbar segments correspond to the left crus?

Answer 25

L1- L2

Question 26

What lumbar segments correspond to the right crus?

Answer 26

L1-L3

Question 27

What viscero-somatic reflexes correspond to the stomach?

Answer 27

``` SNS= T5-9 on left PNS= OA ```

Question 28

What viscero-somatic reflexes correspond to the gallbladder?

Answer 28

``` SNS= T9 PNS= OA ```

Question 29

What viscero-somatic reflexes correspond to the liver?

Answer 29

``` SNS= T6-T9 PNS= OA ```

Question 30

What viscero-somatic reflexes correspond to the pancreas?

Answer 30

``` SNS= T5-T11 PNS= OA ```

Question 31

What viscero-somatic reflexes correspond to the small intestine?

Answer 31

``` SNS= T9-T11 PNS= OA ```

Question 32

What viscero-somatic reflexes correspond to the ascending and transverse colon?

Answer 32

``` SNS= T10-T12 PNS= OA ```

Question 33

What viscero-somatic reflexes correspond to the descending colon and rectum?

Answer 33

``` SNS= L1-2 PNS= S2-4 ```

Question 34

What viscero-somatic reflexes correspond to the appendix?

Answer 34

``` SNS= T12 right with rib PNS= OA ```

Question 35

What viscero-somatic reflexes correspond to regional ileitis?

Answer 35

T10-T12

Question 36

What viscero-somatic reflexes correspond to chronic constipation?

Answer 36

Erector spinae mass in the mid-lumbar region

Question 37

Where can the gallbladder refer pain?

Answer 37

Right shoulder

Question 38

Where can the pancreas refer pain?

Answer 38

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