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Flashcards in Osteopathic Approach To GI Complaints Deck (27)
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How do you determine whether an SD is primarily MSK or secondary to viscerosomatic reflex?

Failure of SD to respond to OMT points to viscerosomatic problem


Pain patterns help to make a ddx in pts with GI complaints. In the GI tract, ____ ____ and ______ are found in walls of viscera and are highly sensitive to stretch, spasm, inflammation, and ischemia

Pacinian corpuscles; free nerve endings


Describe visceral pathology as a result of a viscerosomatic reflex

Increased stretch/irritation to GI nerves —> increased afferent signals to CNS —> afferent fiber synapse in dorsal horn of spinal cord

Prolonged afferent activity leads to facilitation of the neurons and corresponding spinal segments

Visceral pathology results in somatic changes paraspinally as paravertebral TTA and increased tenderness based on increased sensitivity of segment from spinal facilitation [pattern usually reflexes to soma on side of organ]


What is the percutaneous reflex of Morley?

Direct transfer of inflammatory irritation from viscera to peritoneum (not a visceral afferent reflex!)

Ex: appendicitis —> peritonitis; morley reflex responsible for abdominal wall rigidity, pain, and rebound tenderness


Sympathetics components of GI system

Thoracic splanchnic n —> celiac and superior mesenteric ganglion

Lumbar splanchnic n —> inferior mesenteric ganglion

Celiac ganglion is T5-T9 = distal esophagus, stomach, proximal duodenum, liver, gallbladder, spleen, portions of pancreas

SMG is T10-11 = distal duodenum, portions of pancreas, jejunum, ascending colon, proximal 2/3 of transverse colon

IMG is T12-L2 = distal 1/3 of transverse colon, descending colon, sigmoid colon, rectum


Parasympathetic components of GI system

Vagus n., pelvic splanchnic nn (S2-4)

[note anterior vagal trunk = left vagus n., posterior vagal trunk = right vagus n.]

Right vagus n. = lesser curvature of stomach, liver/gallbladder, small bowel, right colon to mid-transverse colon

Left vagus n. = greater curvature of stomach, ends at duodenum

Pelvic splanchnics = descending colon, sigmoid colon, rectum


Possible sympathetic-related pathologies of GI tract


Constipation/flatulence (increased water absorption)

Abdominal distention with hypoactive bowel sounds


Possible parasympathetic pathologies associated with GI tract

Increased secretion of all GI glands

Diarrhea/fecal incontinence (decreased water absorption); hyperactive bowel sounds


Conditions associated with GI autonomic neuropathy

Gastroparesis, GERD, achalasia, cyclic vomiting syndrome, IBS, reflux esophagitis, etc


During inhalation, as the thoracic diaphragm contracts and moves _____, the pelvic diaphragm moves _____

Inferiorly; inferiorly

[reversed with exhalation — thoracic and pelvic diaphragm both expand and move superiorly — acts as a pump for movement of vasculature and lymphatic fluids]


Significance of vasculature and lymphatics in the abdomen, particularly in reference to acute abdominal etiologies

Acute etiologies often require surgical intervention. Potentially resulting vasculature and lymphatic stasis can cause bacterial overgrowth, leading to systemic sepsis

Inflammation and infection increase metabolic process — more ILs and other cytokines

Lymphatic congestion leads to accumulation of waste, decreased medicine distribution, decreased cell nutrition, increased fibrosis/scarring, worse prognosis of IBD, bloating, cramps, reduced oxygenation


3 large collecting intestinal nodes and where they drain

Celiac (drains stomach, duodenum, spleen, liver)

Superior mesenteric (drains jejunum, ileum, ascending/transverse colon)

Inferior mesenteric (drains descending/sigmoid colon, rectum)

These large intestinal nodes drain into cisterna chyli (L1-L2 area, lies on abdominal aorta) —> thoracic duct —> L subclavian v.


What are some GI disorders influencing the metabolic energetic model?



Food sensitivity (lactose intolerance)

Sleep disorders (OSA)

Thyroid d/o

Inflammatory conditions, malabsorption d/o, inability to eliminate metabolic waste


Metabolic changes associated with diarrhea



Diarrhea may lead to metabolic acidosis (loss of sodium bicarb)


Metabolic changes associated with constipation


Hypercalcemia and hypokalemia

Note that geriatrics are predisposed to constipation d/t decreased physical activity


Metabolic changes associated with vomiting

Metabolic alkalosis with hypokalemia (loss of HCl)


Anti-inflammatory foods

Olive oil
Walnuts and almonds
Spinach and kale
Salmon and mackerel
Blueberries and oranges


OMT used to correct SDs can affect the underlying visceral functions through the ____ reflex network


[visceral dysfunction defined as impaired or altered mobility or motility of visceral system and related fascial, neurological, vascular, skeletal, and lymphatic elements]


What are some signs that your OMT is complete and you should stop?

Relaxation of soft tissue in treated area

Altered autonomic tone has occurred

Peripheral vasodilation (increase skin temp, redness, sweating)

Increase in HR or RR

Urgency in using the restroom


5 models OMT approach to GI pt: biomechanical

Postural mm, spine, extremities — posture and motion

Myofascial relationships of organs


5 models OMT approach to GI pt: resp/circ

Diaphragms: thoracic inlet, thoracoabdominal, pelvic

Venous and lymphatic drainage


5 models OMT approach to GI pt: neurologic

ANS homeostasis

Tx sympathetic ganglion, parasympathetic vagus n., and parasympathetic pelvic splanchnics


5 models OMT approach to GI pt: metabolic/energetic

Tx other models first, taking into consideration relationships to internal organs and endocrine glands

Homeostasis, energy balance, regulatory processes, inflammation and repair, absorption of nutrients, and removal of wastes are targeted goals


5 models OMT approach to GI pt: behavioral

Psychological and social activities — diet, exercise, restroom habits


Contraindications to rib raising

Spinal or rib fracture

Recent spine surgery


Contraindications to mesenteric release

Aortic aneurysm

Open surgical wound


Contraindications to sacral tx

Local infection

Incision in area

Decubitus ulcer