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OPP 3 Exam 2 > GI Cases powerpoint (includes spinal levels) > Flashcards

GI Cases powerpoint (includes spinal levels) Flashcards

1
Q

Esophagus spinal levels

A

Celiac Ganglion
Sympathetic: T2-8/10
Facilitation: T1-6

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2
Q

Gallbladder Spinal levels

A

Celiac ganglion
Sympathetic: T5-9
Facilitation: T5R

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3
Q

Stomach spinal levels

A

celiac ganglion
Sympathetic: T5-9
Facilitation: T5-9L

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4
Q

Liver spinal levels

A

celiac ganglion
Sympathetic: T6-9
Facilitation: T5R

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5
Q

Spleen spinal levels

A

Celiac ganglion
Symp: T6-8
Facilitation: T7L

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6
Q

Pancreas spinal levels

A

Celiac ganglion
Sympathetic: T6-9
Facilitation: T7R

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7
Q

Small Intestine spinal levels

A

superior mesenteric ganglion
Symp: T8/9-11/12
Facilitation: T10-11

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8
Q

Ascending, transverse colon spinal levels

A

superior mesenteric

symp: T10/11-L1/2
facilitation: T10-11

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9
Q

Appendix spinal levels

A

Superior mesenteric ganglion
Symp: T10
Facilitation: T12

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10
Q

Descending, sigmoid colon and rectum spinal levels

A

Inferior mesenteric ganglion
Symp: L1-2
Facilitation: T12-L2

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11
Q

liver, gallbladder, and duodenum refer where?

A

right shoulder

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12
Q

stomach refers where?

A

between the scapulae

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13
Q

spleen refers where?

A

LUQ

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14
Q

small intestine refers where?

A

around belly button

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15
Q

appendix refers where?

A

periumbilical

traveling to LLQ

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16
Q

kidney and ureter refer where?

A

left flank

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17
Q

common pain for angina?

A

subxiphoid

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18
Q

common pain for cholecystitis?

A

right breast

acute? right shoulder

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19
Q

Keep in mind that what may be presenting as abdominal pain may have its source in

A

the rotatores and/or multifides muscles.

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20
Q

Heartburn” may be a trigger point in the

A

external oblique muscle.

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21
Q

Projectile vomiting and belching can be triggered

A

by palpation of points in the posterior abdominal wall bilaterally.

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22
Q

Diarrhea can result from trigger points in the

A

lower abdominal muscles, which can mimic symptoms of renal pathology.

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23
Q

chapman points: Pyloric stenosis

A

manubrial-sternal junction down the front of the sternum

face of 10th rib at its junction with tip of TP of 10th vertebrae on the right

24
Q

** chapman points: Stomach hyperacidity

A

5th and 6th intercostal space from the mid-clavicular line to the sternum on the left

intertransverse space, midway between the spinous and transverse processes, between 5th and 6th vertebrae on the left

25
Q

chapman points: Liver

A

5th and 6th intercostal space from mid-clavicular line to the sternum on the right

  • intertransverse space, midway between the spinous and transverse processes, between 5th and 6th vertebrae on the right
26
Q

chapman points: Stomach decreased peristalsis

A

6th and 7th intercostal space from the mid-clavicular line to the sternum on the left

– intertransverse space, midway between the spinous and transverse processes, between 6th and 7th vertebrae on the left

27
Q

** chapman points: Liver/gallbladder

A

6th and 7th intercostal space from mid-clavicular line to the sternum on the right

intertransverse space, midway between the spinous and transverse processes, between 6th and 7th vertebrae on the right

28
Q

chapman points: Pancreas

A

7th and 8th intercostal space on the right

intertransverse space, midway between the spinous and transverse processes, between 7th and 8th vertebrae on the right

29
Q

chapman points: Spleen

A

7th and 8th intercostal space on the left

  • intertransverse space, midway between the spinous and transverse processes, between 7th and 8th vertebrae on the left
30
Q

chapman points: Small intestine

A

intercostal spaces between the 8th and 9th, 9th and 10th, and 10th and 11th ribs near the cartileges bilaterally

intertransverse spaces, midway between the spinous and transverse processes, between 8th and 9th, 9th and 10th, 10th and 11th vertebrae on the left

31
Q

** chapman points: Appendix

A

upper edge near the tip of the 12th rib on the R

11th intertransverse space on the right

32
Q

chapman point: intestinal peristalsis (constipation)

A

between ASIS and greater trocanter

face of 11th rib at its junction with tip of TP of 11th vertebrae on the right

33
Q

Rectum chapman point

A

lesser trocanter downward

34
Q

*** Colon (spastic constipation or colitis) Chapman Point

A

an area 1-2” wide, extending from the trocanter to within an inch of the patella on the front, outer aspect of the femur – on the right side = upper 1/5 indicates cecum, next 3/5 ascending colon, last 1/5 for the first 2/5 of transverse colon; on the left side = first 1/5 just above the knee corresponds to the last 3/5 of transverse colon, middle 3/5 is the descending colon, last 1/5 is the sigmoid; extreme upper end of the trocanter on the left side is the recto-sigmoid junction

TP of L2 – TP of L4 a triangular area reaching across to the iliac crest

35
Q

Chapman point hemorrhoids

A

Hemorrhoids, Rectum – on the sacrum close to the ilium at the lower end of the SI jt

Hemorrhoids – just above the ischial tuberosity (anterior points)

36
Q

Chapman’s Reflexes Specific to the Colon

A

Colonic points are along the anterior femur.

Broad ligament and prostate points are along the lateral femur.

37
Q

Sympathetic Innervation

A

Sympathetic innervation is supplied by cell bodies in the spinal cord and fibers that terminate in the prevertebral ganglia (celiac, superior, and inferior mesenteric ganglia); these are the preganglionic neurons.

These nerve fibers synapse with postganglionic neurons in the ganglia, and the fibers leave the ganglia and reach the end organ along the major blood vessels and their branches. Rarely, there is a synapse in the paravertebral (chain) ganglia, as seen with sympathetic innervation of other organ systems.

38
Q

Parasympathetic Innervation

A

The vagus nerve, (CN 10th), innervates the esophagus, stomach, gallbladder, pancreas, first part of the intestine, cecum, and the proximal part of the colon.
The vagus exits the cranium via the jugular foramen (along with the accessory and glossopharyngeal nerves).
Consistent with the typical organization of the parasympathetic nervous system, the preganglionic nerve cell bodies lie in the brainstem (vagus) or the sacral spinal cord (pelvic). Axons from these neurons run in the nerves to the gut (vagus and pelvic nerves, respectively), where they synapse with postganglionic neurons in the wall of the organ, which in this case are enteric neurons in the gut wall.

39
Q

simplified ANS of the GI tract: sympathetic

A 
Tends to inhibit GI function
Frequently activated in pathological situations
Inhibits smooth muscle
Induces contraction of sphincters
Regulates blood flow in the GI tract
40
Q

simplified ANS of the GI tract: parasympathetic

A

Activates physiological processes in the gut wall
Allows filling of the stomach to occur without an increase in intraluminal pressure
Generally involved in relaxation of sphincters
Contraction of smooth muscle layers in the colon
Controls the caliber of the internal anal sphincter

41
Q

Sympathetically Driven Symptoms

A 
Constipation
Bloating
Pain
Contraction of sphincters
Increased vasomotor tone (may lead to decreased mucus production in stomach and intestines)
42
Q

Parasympathetically Driven Symptoms

A 
Nausea
Vomiting
Diarrhea
Hypermotility
Relaxation of sphincters
Increased mucus secretion
Increased acid production in the stomach
43
Q

If increased vasomotor (sympathetic) tone leads to decreased mucus production in stomach (and/or parasympathetic activity causes increased acid production in the stomach), what is the end result?

A

Gastritis, Ulcers (peptic and duodenal), GERD

What is the medical treatment approach?
Antacids, H2-blockers, PPIs, antibiotics

44
Q

Post-Operative Ileus

A

Failure to pass flatus or stool for 3-6 days after surgery

Transient impairment of function and motility

45
Q

Etiology of Post-Op Ileus (POI)

A 
Mechanical irritation
Edema of tissues – mesentery and intestine
Inflammatory molecules which cause the 
Activation of inhibitory neural reflexes
Medications, particularly opiates
46
Q

Standard Medical Treatment for post operative ileus

A 
Nasogastric suctioning
Rectal stimulation
Ambulation
Medications
        - laxatives
        - erythromycin
        - metoclopromide
        - cisapride
        - alvimopan
        -methylnaltrexone
Gum chewing – stimulates the gastrocolic reflex?
NSAIDs
Thoracic epidural analgesia with lidocaine or bupivacaine
47
Q

Hazards of Medical Treatment for post op ileus

A 
Electrolyte imbalance
Dehydration
Gastric perforation
Nasal irritation or erosion of mucosa
Infection
Rectal perforation
Impaired nutrition
Delayed healing
Increased pain from withholding of opiate pain reliever
Increased bleeding due to anti-platelet activity from NSAID
Gastric mucosal erosions from NSAID
Other adverse effects of NSAIDs
Meningitis/spinal headache from epidural analgesia
Cost
48
Q

PathoPhysiology of post op ileus

A

Sympathetic: Increased Tone

Increased vascular tone – decreased O2 and nutrients to the tissues
Decreased peristalsis

Lymphatics

Impaired flow increases tissue congestion
Impaired nutrient absorption from the intestines
Congestion increases the likelihood of fibrosis, and susceptibility to infection

49
Q

plexi

A

autonomic plexi within the wall of the intestine:
Synapses between visceral afferents, the parasympathetic and sympathetic occur here. Plexi modify autonomic activity according to the local needs of that region of the intestine to move bolus, digest, etc.

50
Q

Intestinal cells of cajal

A

pacemakers of the gut

slow waves are generated in interstitial cells of cajal

51
Q

Visceral “Joints”

A 
Sliding surfaces: 
Peritoneum
Pericardium
Pleura
Meninges
52
Q

Visceral “joints” attachments

A

Double layer system - serous fluid creates suction between surfaces of the peritoneum, etc.
Ligamentous system – folds of peritoneum or pleura binding an organ to the wall of the cavity or to another organ
Not present for structural stability like skeletal ligaments
Turgor and Intracavitary pressure – hold the viscera in place, remain constant in mass, yet stick together
Mesenteric system- folds of peritoneum that support the nerves, arteries, veins and lymphatics of the small and large intestines
Omental system – folds of peritoneum that join 2 elements of the digestive tract together and has a neurovascular role

53
Q

What is a visceral somatic dysfunction?

A

Any restriction, fixation or adhesion limits mobility and motility, along with viscerospasm and tethering (ptosis).
Diaphragm moves about 20,000 times per day.
Heart beats about 100,000 times per day
Approximately 30-50 cc’s of blood is ejected from the left ventricle per beat causing a wave propagation through the arteries.

Even the smallest restriction takes on great significance as it is stressed thousands of times per day along a pathologically modified axis of motion.

54
Q

What causes visceral somatic dysfunctions?

A 
Infection/inflammation
Trauma
Surgery
Pregnancy
Scoliosis/short leg syndrome
Craniosacral dysfunction
55
Q

Palpation of the Abdomen

A 
Evaluate for:
Painfulness
Differences in tension
Position of the organ
Tone of the organ

OPP 3 Exam 2 (20 decks)

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