Review: OAT GI patient Flashcards

1
Q

How do you determine whether an SD is primarily MSK or secondary to viscerosomatic reflex?

A

Failure of SD to respond to OMT points to viscerosomatic problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

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

A

Pacinian corpuscles; free nerve endings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe visceral pathology as a result of a viscerosomatic reflex

A

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]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the percutaneous reflex of Morley?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Sympathetics components of GI system

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Parasympathetic components of GI system

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Possible sympathetic-related pathologies of GI tract

A

Ileus

Constipation/flatulence (increased water absorption)

Abdominal distention with hypoactive bowel sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Possible parasympathetic pathologies associated with GI tract

A

Increased secretion of all GI glands

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Conditions associated with GI autonomic neuropathy

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

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

A

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]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

3 large collecting intestinal nodes and where they drain

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some GI disorders influencing the metabolic energetic model?

A

Crohns

Celiac

Food sensitivity (lactose intolerance)

Sleep disorders (OSA)

Thyroid d/o

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Metabolic changes associated with diarrhea

A

Hyperthyroidism

Hyperkalemia

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Metabolic changes associated with constipation

A

Hypothyroidism

Hypercalcemia and hypokalemia

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Metabolic changes associated with vomiting

A

Metabolic alkalosis with hypokalemia (loss of HCl)

17
Q

Anti-inflammatory foods

A
Olive oil
Tomatoes
Walnuts and almonds
Spinach and kale
Salmon and mackerel
Blueberries and oranges
18
Q

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

A

Somatovisceral

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

19
Q

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

A

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

20
Q

5 models OMT approach to GI pt: biomechanical

A

Postural mm, spine, extremities — posture and motion

Myofascial relationships of organs

21
Q

5 models OMT approach to GI pt: resp/circ

A

Diaphragms: thoracic inlet, thoracoabdominal, pelvic

Venous and lymphatic drainage

22
Q

5 models OMT approach to GI pt: neurologic

A

ANS homeostasis

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

23
Q

5 models OMT approach to GI pt: metabolic/energetic

A

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

24
Q

5 models OMT approach to GI pt: behavioral

A

Psychological and social activities — diet, exercise, restroom habits

25
Q

Contraindications to rib raising

A

Spinal or rib fracture

Recent spine surgery

26
Q

Contraindications to mesenteric release

A

Aortic aneurysm

Open surgical wound

27
Q

Contraindications to sacral tx

A

Local infection

Incision in area

Decubitus ulcer