Kania GI DSAs Flashcards
a retrospective cohort study on post-operative OMT in GI surgical patients found what?
OMT within 48 hours of major GI operation is associated with decreased time to flatus and decreased postoperative hospital length of stay.
time to bowel movement and to clear liquid diet did not differ significantly.
most common cause of prolonged hospital stay after an abdominal operation
postoperative ileus
ileus persisting longer than 48 hours after an operation may be considered pathologic
current knowledge of treatment that works for postoperative ileus
avoidance of opiates
correction of electrolyte imbalances
interventions suggested to address possible etiologic mechanisms of POI (post operative ileus)
- early postoperative feeding and bowel stimulation with magnesium hydroxide
- administration of glutamine (nutrient fro small bowel enterocytes)
- prokinetic agents (ghrelin agonists, mu-receptor antagonists)
What OMT can do for the bowels
modulate autonomic nervous input to the GI tract by reducing sympathetic tone and augmenting parasympathetic effects.
areas that were treated after GI surgery in the study
durations of treatment ranged from 15-35 minutes
types of treatment ranged from cranial manipulation to direct myofascial release.
Frequently treated areas included the costophrenic and costovertebral areas and the cervical spine.
why might OMT be useful in post-operative GI patients?
known modulatory effect on the autonomic nervous system
distinct biochemical and anesthetic effects
May increase NO levels in the blood
decreased pain and opioid use may lead to earlier ambulation and improved intestinal motility
importance of the core
the foundation from which all other function has grown
movement emanates from the core
patients with back pain- interferes first with the deep muscles of the core (transversus abdominis, lumbar multifidus)- appear to become neurologically inhibited.
eating too many chilis
inflammation to the gut can cause viscerosomatic reflex to motor neurons feeding the abdominal wall and inhibit the transversus abdominis.
other forms of inflammation that could impact the abdominal wall
chronic constipation IBS IBD food intolerance dysbiotic conditions dysmenorrhea cystitis
etc.
bloating– 4 factors
subjective sensation of bloating
objective abdominal distension
volume of abdominal contents
changes to muscular activity of the abdominal wall
compensatory muscle activation
when pain is present, local intrinsic musculature becomes inhibited.
What is it about the transversus abdominis or multifidus that they can be inhibited by pain?
feed-forward mechanism (you can’t fire a canon from a canoe)- to generate force a stable base is required. Failure to achieve stability–> neurophysiologically, outer - unit muscles have a higher threshold to stimulus
Arnd-Shultz Law: weak stimuli accelerate physiologic activity, medium stimuli inhibit it, and strong ones halt it.
Myophysiology: the deeper a muscle is located in the body, the higher its number of slow twitch fibres and vice versa.
central sensitization
when there is a pain stimulus, the afferent drive to the cord appears to create a central sensitization which will affect musculature sequentially depending on how deep, tonic, or inner-unit it is.
(examples: intolerance to foods- wheat, corn, high fructose corn syrup, etc.; drugs; alcohol)
cross-segmental central sensitization
chronic nociceptive stimulation is able to provoke extensive sensitization to as many as 6-10 segments in the superficial and deeper laminae of the cord.
