Gi Omm Lecture 1.db

Front 1

Pain distribution: esophagus

Back 1

Substernal

Front 2

Pain distribution: duodenum, liver, gallbladder, colon, (hepatic flexure)

Back 2

RUQ

Front 3

Pain distribution: stomach

Back 3

Mid-epigastric

Front 4

Pain distribution: pancreas

Back 4

Generalized upper abdominal

Front 5

Pain distribution: small intestine

Back 5

Peri-umbilical

Front 6

Pain distribution: colon (splenic flexure)

Back 6

Left upper quadrant

Front 7

Pain distribution: appendix, cecum

Back 7

Right lower quadrant

Front 8

Pain distribution: sigmoid colon, rectum

Back 8

Left Lower Quadrant

Front 9

the palpatory examination also includes the examination for primary ____ dysfunction and ____ findings.

Back 9

somatic, viscerosomatic

Front 10

Sympathetic Innervations: Esophagus

Back 10

T2-T8

Front 11

Sympathetic Innervations: Upper GI tract

Back 11

T5-T9

Front 12

Sympathetic Innervations: Middle GI tract

Back 12

T10-T11

Front 13

Sympathetic Innervations: Lower GI tract

Back 13

T12-L2

Front 14

Sympathetic Innervations: Stomach, Liver, Gallbladder, Spleen, Parts of Pancreas & Duo

Back 14

T5-T9

Front 15

Sympathetic Innervations: Parts of Pancreas & Duodenum, Jejunum, Ilium, Right Colon

Back 15

T10-T11

Front 16

Sympathetic Innervations: Left Colon, Rectum

Back 16

T12-L2

Front 17

T lvls for Greater Splanchnic Nerve

Back 17

T5-T9

Front 18

T lvls for LesserSPlanchinic Nerve

Back 18

T10-T11

Front 19

Synapses at the Celiac Ganglion

Back 19

Greater Splanchnic Nerve (T5-9)

Front 20

Synapses at the Superior Mesenteric Ganglion

Back 20

Lesser Splanchnic Nerve (T10-11)

Front 21

T lvls for Least Splanchnic Nerve

Back 21

T12

Front 22

T lvls for Lumbar Splanchnic Nerve

Back 22

L1-2

Front 23

Synapses at the Inferior Mesenteric Ganglia

Back 23

Least Splanchnic Nerve (T12) and Lumbar Splanchnic Nerve (L1-2)

Front 24

Innervates the Left Colon and Pelvic Organs

Back 24

Least Splanchnic Nerve (T12) and Lumbar Splanchnic Nerve (L1-2)

Front 25

Autonomic that causes Decreased peristalsis

Back 25

Sympathetic

Front 26

Autonomic that causes Relaxation of gallbladder and ducts

Back 26

Sympathetic

Front 27

Autonomic that causes Increased Vascular Tone leading to decreased oxygen and nutrients to tissues (extreme case bowel angina and ischemic bowel)

Back 27

Sympathetic

Front 28

Parasympathetic Innervation of greater curvature of the stomach and pyloric sphincter

Back 28

Left Vagus CN X

Front 29

Parasympathetic Innervation of Upper GI tract, Liver, Gallbladder and Right Half of the Colon

Back 29

Right Vagus CN X

Front 30

Parasympathetic Innervation of Lower 2/3 of Esophagus

Back 30

Vagus Nerve CN X

Front 31

Parasympathetic Innervation of the left colon and pelvis

Back 31

Pelvic Splanchnic Nerves (S2-4)

Front 32

Autonomic that causes Increases acid secretion

Back 32

Parasympathetic

Front 33

Autonomic that causes Contraction of Gallbladder and Ducts

Back 33

Parasympathetic

Front 34

Autonomic that causes Peristalsis (i.e. Sprue and diarrhea)

Back 34

Parasympathetic

Front 35

Viscerosomatic reflexes Synapse with____, Results in ___.

Back 35

internuncial neurons, facilitation

Front 36

Sympathetic reflexes are found between ___

Back 36

T1 and L2

Front 37

Parasympathetic reflexes are found in the ___ and ___ regions

Back 37

high cervical and Sacral

Front 38

This relationship may explain the high cervical paravertebral manifestations of the vagal viscero-somatic reflex

Back 38

After exiting the skull, the vagus nerve interdigitates with a connecting loop between C1 and C2 within the cervical plexus

Front 39

Parasympathetic of Left half of the transverse colon, descending colon, sigmoid, and rectum

Back 39

Sacral (S2-S3-S4)

Front 40

The pelvic diaphragm is innervated by the ___

Back 40

pudendal nerve (S2-3-4) of the pelvic splanchnic nerves

Front 41

Upper G.I. sympathetic reflexes: Esophagus

Back 41

T3 right

Front 42

Upper G.I. sympathetic reflexes:Stomach

Back 42

T5-T8 Left

Front 43

Upper G.I. sympathetic reflexes: Duodenum

Back 43

T7 -T8 right

Front 44

The parasympathetic reflex from stomach is the___

Back 44

high cervical vagal reflex

Front 45

upper G.I. reflex.

Back 45

The combination C2 left, T3 right, T5 left and T7 right

Front 46

Reflex for Small intestine

Back 46

Bilateral(R>L) T8-10

Front 47

Reflex for descending colon

Back 47

L2-3 left

Front 48

T12 right with tenderness over the tip of the 12th rib right appendix

Back 48

(anterior Chapman tenderpoint)

Front 49

The 12th dermatome on the right is the____

Back 49

appendiceal viscerosomatic reflex

Front 50

Positional variation of the____ can result in perplexing variability in the clinical presentation of acute appendicitis

Back 50

appendix

Front 51

Referred pain patterns are found in the same distribution as ____

Back 51

viscerosomatic reflexes

Front 52

discoloration caused by massive nontraumatic ecchymoses in the skin of the lower abdomen and flanks. It results from the infiltration of the extraperitoneal tissues with blood

Back 52

Grey-Turner’s sign

Front 53

faintly blue coloration as a result of retroperitoneal bleeding

Back 53

Cullen’s sign

Front 54

Effect of osteopathic manipulative treatment on length of stay for pancreatitis: A randomized pilot study RESULTS

Back 54

Average length of stay 3.5 days shorter in OMT versus control

Front 55

Which part of the pancreas is NOT reproperitoneal

Back 55

small part of tail

Front 56

What is the sympathetic Innervation of the Pancreas?

Back 56

T5-T9 -> Greater Splanhnic -> Celiac Ganglion

Front 57

Where are the TART sympathetic pancreas changes?

Back 57

Paraspinal, Midline collateral ganglia

Front 58

What is the Viscerosomatic Reflex of the pancreas? What type of dysfunction

Back 58

T7 on Right or bilateral; non-neutral

Front 59

Where are the Anterior Chapman’s Reflex for the pancreas?

Back 59

Lateral to costal cartilage between 7th and 8th ribs on right

Front 60

Where are the Posterior Chapman’s Reflex for the pancreas?

Back 60

Between transverse processes of T7-8 on the right

Front 61

What is the parasympathetic innervation of the pancreas?

Back 61

Vagus

Front 62

Path of the pancreas lymph?

Back 62

Lymph vessels follow blood vessels to the Pancreaticosplenic nodes -> Celiac nodes -> Left Thoracic duct

Front 63

Where are the pancreas lymph capillaries? Where are there none?

Back 63

The lymph capillaries commence around the acini and their continuations (exocrine). none in the islets (endocrine)

Front 64

Why do JSCS on psoas with pancreatitis?

Back 64

because of the close physical relationship between the psoas and the pancreas, any dysfunction of the psoas can contribute to the pain of pancreatitis

Front 65

Why do Thoracic/lumbar mobilization important with pancreatitis?

Back 65

encourage lymph flow by removing myofascial restrictions, removing somatic (myofascial) input to a facilitated segment. It is a myofascial release and/or soft tissue technique

Front 66

Why do OA decompression/suboccipital release with pancreatitis?

Back 66

vagus nerve exits via the jugular foramen and the occiput forms one border of this opening

Front 67

Why do A/P Treatment Diaphragm with pancreatitis?

Back 67

thoracic diaphragm is the primary mover of lymph through the thoracic duct. It is a myofascial technique

Front 68

Why do Iliosacral mobilization with pancreatitis?

Back 68

sacrum is attached to occiput via the dura, so treating the sacrum also treats the OA. Also, treating the sacrum allows for better movement of the pelvic diaphragm, which will encourage lymph flow. It is myofascial/soft tissue technique

Front 69

____ includes a myriad of disorders that involve inflammatory changes in the gastric mucosa, including erosive gastritis caused by a noxious irritant, reflux gastritis from exposure to bile and pancreatic fluids, hemorrhagic gastritis, infectious gastritis, and gastric mucosal atrophy.

Back 69

Gastritis

Front 70

____ refers to a discrete mucosal defect in the portions of the gastrointestinal tract (gastric or duodenal) exposed to acid and pepsin secretion.

Back 70

Peptic ulcer disease (PUD)

Front 71

lesser curvature stomach parasympathetic innervation

Back 71

right vagus

Front 72

greater curvature & pyloric sphincter stomach parasympathetic innervation

Back 72

Left vagus

Front 73

What are the stomach lymph nodes?

Back 73

Left gastric,Celiac, Sub-pyloric, Right gastro-omental nodes

Front 74

Impaired stomach lymph flow leads to:

Back 74

Increased tissue congestion and impaired nutrient absorption from the bowel

Front 75

Lymph flow from the GI tract & below the diaphragm drain from the small lymphatic channels to the ___ up to the Thoracic Duct (Left)

Back 75

Cysterna chyli

Front 76

What are the Sympathetic Dominant Complaints?

Back 76

Constipation
Abdominal Pain
Flatulence
Distension

Front 77

What are the Parasympathetic Dominant Complaints?

Back 77

Nausea and vomiting
Diarrhea
Hypermotility related cramping/pain

Front 78

Inc. tissue congestion
Impaired Absorption
Inc. risk of pancreatic complications in gallbladder disease/dysfunction

Back 78

Impaired Lymph Flow

Front 79

Usually self-limited (85-90%)
Analgesics
IV Fluids
No oral alimentation
Nasogastric suction
OMT

Back 79

Treatment of Acute Pancreatitis

Front 80

Lab significant for:
Increased serum amylase
Increased serum lipase
Leukocytosis
Hyperglycemia

Back 80

Acute Pancreatitis

Front 81

Put the pancreas at “rest”
Parenteral nutrition should be started in cases of severe pancreatitis that prolongs recovery
Once stable, diet should be progressed as tolerated.

Back 81

Medical Nutrition Therapy: Acute Pancreatitis

Front 82

First goal is to optimize nutritional support
Second goal is to decrease pain by minimizing stimulation of exocrine pancreas
Consider pancreatic enzyme replacement
Low fat diet

Back 82

Medical Nutrition Therapy: Chronic Pancreatitis

Front 83

What does parasympathetic innervation do to the pancreas?

Back 83

Increases pancreatic juices rich in enzymes
Stimulates the production of bile
May cause a headache because of interchange with somatic innervation in neck

Front 84

Peak incidence in sixth decade
More common in males
Less common

Back 84

Gastric Ulcers

Front 85

Incidence greatest between ages of 25-75
Equal incidence in males and females
Occur in 6 to 15% of the western population

Back 85

Duodenal Ulcers

Front 86

Increased mucosal sensitivity to H+ concentration and alters mucosal barrier
Vasoconstriction
Decreased peristalsis which leads to constipation
Relaxation of gallbladder and ducts (no secretion)

Back 86

Sympathetics T5-T9
Increased tone leads to

Front 87

Increased acid secretion
Increased peristalsis which can cause diarrhea
Contraction of gallbladder and ducts (secretion)

Back 87

Increased Parasympathetics - Vagus (OA, AA, C2) tone

Front 88

Hypermotility related cramping/pain
Diarrhea
Nausea & vomiting

Back 88

GI parasympathetic complaints

Front 89

abdominal pain
constipation
flatulence
distension

Back 89

GI sympathetic complaints

Front 90

Osteopathic Considerations for PUD: Sympathetics

Back 90

Rib Raising
T5-9
T10-11
Chapman’s Reflexes
Collateral (celiac) Ganglia

Front 91

Osteopathic Considerations for PUD: ParaSympathetics

Back 91

Vagus Nerve:
OA, AA, C2,
Cranial
Sacrum

Front 92

Osteopathic Considerations for PUD: Lymph

Back 92

Thoracic Inlets:
Abdominal Diaphragm via Cervical C3-C5 (phrenic nerve)
Thoracolumbar Junction (diaphragm attachment)

Front 93

Osteopathic considerations for GERD:Sympathetics

Back 93

Rib raising: T5-T9
Chapman’s reflexes: collateral ganglia

Front 94

Osteopathic considerations for GERD: ParaSympathetics

Back 94

SI joint, OA, OM suture

Front 95

Osteopathic considerations for GERD: Lymphatics

Back 95

Thoracic inlets: abdominal diaphragm

Front 96

Osteopathic considerations for Pancreatitis: Sympathetics

Back 96

T5-T9, T7 right
Chapman’s reflexes: Anterior: Lateral to costal cartilage between 7th, 8th ribs on right
Posterior- Between transverse processes of T7-8 on the right

Front 97

Osteopathic considerations for Pancreatitis: ParaSympathetics

Back 97

OA

Front 98

Osteopathic considerations for Pancreatitis: Lymph

Back 98

Pancreaticosplenic nodes -> Celiac nodes
Thoracic inlets: abdominal diaphragm
Thoracolumbar junction (diaphragm attachments)