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Flashcards in Visceral Lectures Deck (36)
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1

List the anatomiccal layers from surface to organ through the abdominal wall.

Skin
Superficial fascia
Anterior rectus sheath/investing fascia
Rectus abdominus
Deep investing fascia
Transveralis fascia
Peritoneum
Empty space (hand drops)
Viscera

2

Describe indirect treatment of visceral organs.

Layer palpation to level of organ.
Fascial (local) listening.
Motion testing in various planes.
BLT: stack in directio nof EASE and wait for release (~30 seconds)
Re-assess.

3

Describe direct treatment of visceral organs -- release of colon for constipation.

Start at distal portion (sigmoid colon) and insert fingers gently on lateral wall of colon.
Pull gently/firmly toward umbilicus.
Wait for release.
Repeat moving proximally along colon (descending; ascending; cecum)

4

Viscerosomatic reflexes T6-9 Right

Liver (R)
Gallbladder (R)

5

Viscerosomatic reflexes T7 (2)

Spleen (L)
Pancreas (R)

6

Viscerosomatic reflexes T10-11

Right colon
Adrenals
Kidneys
Ovaries
Testes

7

Viscerosomatic reflexes T12-L2

Left colon

8

Viscerosomatic reflexes T12

Appendix

9

Sympathetic preganglionics
-spinal levels?
-divisions?

T5-L2
Greater (T5-9)
Lesser (T10-11)
Least Splanchnic (T12)
Lumbar splanchnic (L1-L2)

10

Celiac Ganglion Post-Ganglionic to: (7)

FOREGUT:
Distal esophagus
Stomach
Liver
Gallbladder
Spleen
portions of pancreas
proximal duodenum

11

Superior Mesenteric Ganglion Post-Ganglionic to: (10)

MIDGUT:
Portions of pancreas
Duodenum
Jejunum
Ileum
Asc colon
Prox 2/3 of transverse colon
ALSO:
Adrenals
Gonads
Kidneys
Upper 1/2 ureter

12

Inferior Mesenteric Ganglion Post-Ganglionic to: (7)

HINDGUT:
Distal 1/3 of transverse
Desc colon
Sigmoid
Rectum
ALSO:
Lower 1/2 Ureter
Bladder
Genitals

13

Indications for visceral manipulation

liver dysfunction
gallbladder dysfunction
stomach (GERD; hypomotility)
small intestinal mobility/motility
colon (constipation; IBS; iliocecal valve)
pain of non-surgical nature
lymphatic congestion
immune dysfunction (spleen)
vascular supply problems.

14

Absolute contraindications to visceral manipulation

acute abdomen
appendicitis
pancreatitis
splenomegaly
GI obstruction
abdominal aortic aneurysm
post-abdominal/pelvic surgery (NO direct)
GI infection (colitis; duodenitis; ileitis)
tumor.

15

Relative contraindications to visceral manipulation

Abdom hernia/diastasis
Pain of unknown origin

16

Viscerosomatic reflex T5-6 (R)

Upper esophagus

17

Viscerosomatic reflexes T5-9 (L)

Lower esophagus
Stomach

18

Viscerosomatic reflexes T8-9

Small intestine

19

Name 3 techniques to treat the sympathetics in the abdomen

Chapman reflexes
Rib raising
Ventral abdominal ganglion inhibition

20

Name 3 techniques to treat the parasympathetics to the abdomen

Cervical (OA, AA)
Soft tissue (suboccipital)
Cranial (occipitomastoid suture)

21

Describe true visceral pain
-where are the receptors?
-carried by what type of fibers?
-where is the pain and what does it feel like?

pacinian corpuscles; free nerve endings
activated by spasm or stretch
carried by visceral afferents
midline, poorly localized, vague, deep, diffuse, burning ache.

22

Describe viscerosomatic pain
-where are the receptors?

pain receptors in anterior and lateral parietal peritoneum, lesser omentum, mesentery, mesocolon
facilitated cord segments in somatic areas related to viscera sympathetic innervation.

23

Describe the percutaneous reflex of Morley.

NO pain receptors in visceral peritoneum (greater omentum; spleen)
Awareness of pain only if affecting adjacent pain-sensitive structure.

24

Where does cranial nerve X exit?
Describe its innervations (6).

Jugular foramen
Left: greater curvature of stomach; duodenum
Right: lesser curvature of stomach; small intestines; right colon; organs/glands up to mid-transverse colon.

25

Discuss visceral manipulation and who it was defined by.

Jean-Pierre Barral
Organ/viscera in good health has physiologic motion
Restriction implies functional impairment
Motion repeated thousands of times daily

26

Mobility vs. motility in terms of visceral manipulation and testing

Mobility: voluntary or diaphragmatic; skeletal muscle effects --direct movement of organ via PALPATION

Motility: inherent motion --listening

Paired organs test together!
Pressure on suspected organ while monitoring will inhibit the influence on the monitored organ.

27

Visceral rhythm:
-how many cycles/min?
-motion is ...?

7-8 cycles/min
Motion is toward and away from midline

Inspiration: cranial FLEXION; swelling of organ
EXpiration: cranial EXtension; organ gets smaller

28

How many cycles before results should be expected in visceral treatment?
-how long should you wait between treatmnets?

15 cycles
Wait 3-4 weeks b/t treatments.

29

Contraindications to visceral tx.

Acute infection (except bladder)
Foreign bodies
Calculi (relative)
Thrombosis

30

Describe the liver flip technique.
-is it direct or indirect?

Physician standing behind seated patient.
Reach under ribcage with PADS of fingers (2-3)
Lift fingers enough to move liver
Move up and down ribcage.