Gi Omm Lecture 2

Front 1

___ stimulate gallbladder to contract, releasing bile

Back 1

Fats

Front 2

Roots of ___ to greater splanchnic nerve to celiac ganglion

Back 2

T5-T9

Front 3

SNS for Bile Duct – ?

Back 3

Rt T6

Front 4

SNS for Gallbladder – ?

Back 4

Rt T5

Front 5

Stimulation of the ____ nervous system results in reduced bile secretion and relaxation of the gallbladder, leads to?

Back 5

sympathetic, This leads to stasis, predisposing for infection

Front 6

PNS supply for Lesser curvature of stomach, small intestines, right to midtransverse colon, gallbladder

Back 6

right vagus

Front 7

PNS supply for Greater curvature of stomach to duodenum, pylorus?

Back 7

left vagus

Front 8

_____ stimulation results in the contraction of the gallbladder and relaxation of the sphincter of Oddi, leads to?

Back 8

Parasympathetic (vagal), Increased bile formation

Front 9

What is the Lympathic Pathway for the gallbladder?

Back 9

Retroportal node -> abdominoaortic nodes -> thoracic duct

Front 10

Chapman reflex for gallbladder?

Back 10

between the 6th & 7th right ribs anteriorly, near costochondral junction

Front 11

Those with _____ classically present with diarrhea and rectal bleeding

Back 11

Ulcerative Colitis

Front 12

______ is manifested by abdominal pain, diarrhea and weight loss. Bleeding may be present if there is disease in the lower part of the colon.

Back 12

Crohn's Disease

Front 13

Anterior Chapman’s Reflexes for Illiocecal area of colon?

Back 13

Promixal Right Iliotibial band

Front 14

Anterior Chapman’s Reflexes for Ascending of colon?

Back 14

Middle Right Iliotibial band

Front 15

Anterior Chapman’s Reflexes for Hepathic flexure area of colon?

Back 15

Middle distal Right Iliotibial band

Front 16

Anterior Chapman’s Reflexes for Right 2/5 of transverse area of colon?

Back 16

Distal Right Iliotibial band

Front 17

Anterior Chapman’s Reflexes for Sigmoid area of colon?

Back 17

Promixal Left Iliotibial band

Front 18

Anterior Chapman’s Reflexes for Descending colon?

Back 18

Middle Left Iliotibial band

Front 19

Anterior Chapman’s Reflexes for Splenic flexure colon?

Back 19

Middle-distal Left Iliotibial band

Front 20

Anterior Chapman’s Reflexes for Left 3/5 of tranverse colon?

Back 20

Distal Left Iliotibial band

Front 21

What are the ganglion for the Sympathetics of the Large Bowel

Back 21

Celiac, Superior and Inferior Mesenteric Ganglion

Front 22

Sympathetics lvls for Stomach, liver, pancreas, and duodenum

Back 22

T5-9 - Celiac Ganglion

Front 23

Sympathetics lvls for Small intestines and right colon

Back 23

T10-11 - Superior Mesenteric Ganglion

Front 24

Sympathetics lvls for Left colon and pelvic organs

Back 24

T12-L2 - Inferior Mesenteric Ganglion

Front 25

Decreased motility in the gut : constipation, distention

Back 25

Hypersympathetic tone leads to

Front 26

Contraction of the rectal sphincter

Back 26

Hypersympathetic tone leads to

Front 27

Vasoconstriction in the spleen

Back 27

Hypersympathetic tone leads to

Front 28

Decreased mucosal defenses in the stomach

Back 28

Hypersympathetic tone leads to

Front 29

Parasympathetics _____ to the mid-transverse colon

Back 29

Vagus (CN X) nerve

Front 30

Parasympathetics ___Nerves for remaining colon (not mid-transverse)

Back 30

Pelvic Splanchnic (S2, 3, 4)

Front 31

Psychogenic or emotional diarrhea, “is caused by excessive stimulation of the _____nervous system

Back 31

parasympathetic

Front 32

Lymphatic edema or venous congestion of the ___ of the gut wall would reduce the amount of gas tolerated before pain from mesenteric pull would occur.

Back 32

mesenteric tissue

Front 33

What organ is posterior to the large intestine as it transitions from transverse to descending

Back 33

Spleen

Front 34

What organ Rests on the posterior respiratory diaphragm just anterior to the 8-10 ribs

Back 34

Spleen

Front 35

True/False The spleen is Retroperitoneal and Suprarenal

Back 35

TRUE

Front 36

Clinicians see profound effects of altered commensal flora in nearly ____ of the population who are affected by functional IBS

Back 36

15%

Front 37

Diaphragm Right crus levels

Back 37

L1,2,3,(4)

Front 38

Diaphragm Left crus levels

Back 38

L1,2,(3)

Front 39

Treatment Considerations for IBS: Dietary Alterations

Back 39

Avoid coffee, disaccharides, legumes, cabbage

Front 40

Osteopathic considerations for IBS: Parasympathetics

Back 40

Sacrum

Front 41

Functional inhibition of propulsive bowel activity, regardless of the pathogenic mechanism.” There is no physical obstruction to the passage of the luminal contents of the bowel.

Back 41

ILEUS

Front 42

peristalsis is absent or ineffective; no physical obstruction to the passage of the luminal contents

Back 42

Paralytic or adynamic

Front 43

POST-OP ILEUS: Has a ___ component due to the of neurogenic impulses resulting from the incision of the soma.

Back 43

somatovisceral

Front 44

POST-OP ILEUS: Has a ___ component as a result of bowel handling during surgery.

Back 44

viscerosomatic

Front 45

POST-OP ILEUS: Increases vascular tone -->

Back 45

decreased oxygen and nutrients to tissues

Front 46

Osteopathic considerations for Ileus: Parasympathetics

Back 46

Sacrum

Front 47

Osteopathic considerations for Ileus: Lymphatics

Back 47

Mesentery

Front 48

Sympathetic Innervation for Stomach, Liver, Pancreas, Duodenum

Back 48

Greater Splanchnic Nerve (T5-9)

Front 49

Sympathetic Innervation for Small Intestines and Right Colon

Back 49

Lesser Splanchnic Nerve (T10-11)

Front 50

Sympathetic Innervation for the Left Colon and Pelvic Organs

Back 50

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

Front 51

Synapses at the Celiac Ganglion

Back 51

Greater Splanchnic Nerve (T5-9)

Front 52

Synapses at the Superior Mesenteric Ganglion

Back 52

Lesser Splanchnic Nerve (T10-11)

Front 53

Synapses at the Inferior Mesenteric Ganglia

Back 53

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

Front 54

Generally rotational component of SD for lower bowel will be ____ of visceral dysfunction especially if organ is paired

Back 54

toward side

Front 55

HVLA for lower bowel often unsuccessful especially if palpation of paraspinals demonstrates___

Back 55

rubbery texture

Front 56

Goal of Mesenteric Lifts

Back 56

Decongest colon to promote appropriate nutrient delivery and waste removal

Front 57

With dz of the colon, the ____ganglion is often palpable and tender

Back 57

inferior collateral sympathetic

Front 58

Mesenteric Lifts: Bowel is gently taken at___ towards its mesenteric attachments and to the extent allowed by its motion barrier.

Back 58

right angles

Front 59

Mesenteric Lifts: ___ is applied to its attachments

Back 59

Gentle tension

Front 60

Mesenteric Lifts: Activated when Pt takes shallow breath to use ___. Repeat 2-3 times.

Back 60

Respiratory Force

Front 61

The 4 F’s of cholecystitis

Back 61

Female
Fat – increased BMI
Forty – over 40 years old
Fertile – multiparous or currently pregnant

Front 62

Often affects terminal ileum
Inflammation extends thru the intestinal wall

Back 62

Crohn’s Disease

Front 63

Usually large intestinal mucosa
Bleeding, mucus
Diarrhea

Back 63

Ulcerative Colitis

Front 64

Altered bowel habits and abdominal pain
Small-volume stool without any evidence of blood
Diarrhea and/or constipation
Absence of detectable structural abnormalities
Onset of symptoms during periods of stress or emotional upset
Recurrent without progressive deterioration
Women 2-3x more often than men
Younger than 45yoa
Absence of other systemic symptoms:
no fever or weight loss

Back 64

Clinical Features of IBS

Front 65

What are the ROME III basic criteria for IBS?

Back 65

Recurrent abdominal pain or discomfort** at least 3 days per month in the last 3 months, associated with 2 or more of the following:
1. Improvement with defecation
2. Onset associated with a change in frequency of stool
3. Onset associated with a change in form (appearance) of stool

Front 66

Development of oral tolerance
Develop appropriate inflammatory response
Production of neurochemicals
“Second Brain”

Back 66

Presence of a distinct immune system: G.A.L.T.

Front 67

Treatment Considerations for IBS: Pharmacological

Back 67

Stool Bulking Agents – Increased dietary fiber
Antispasmodics
Anti-diarrheal Agents
Antidepressants
Antiflatulence Therapy – “Disappointing results”

Front 68

Treatment Considerations for IBS: OMT

Back 68

Improve the “structure-function” relationship
Normalize autonomic activity in the intestine
Promote good lymphatic flow
Normalize joint somatic dysfunction (especially T10-L2)

Front 69

Thoracoabdominal Diaphragm Attachments

Back 69

Right crus to L1,2,3,(4)
Left crus to L1,2,(3)
Arcuate ligaments
Xyphoid process
Ribs 6-12
Quadratus Lumborum
Psoas M

Front 70

Osteopathic considerations for IBS: Sympathetics

Back 70

T5-T9
T10-T11
T12-L2
Chapman reflexes

Front 71

Osteopathic considerations for IBS: Lymphatics

Back 71

Pelvic Diaphragm
Spleen
Presacral Fascia

Front 72

Resolves spontaneously after 2-3 days
More severe in colon
decreased to absent BS
Mild distention
Pain
XR: gas in small intestine and colon

Back 72

Post Operative Ileus

Front 73

More than 3 days post surgery
All segments of the bowel
decreased to absent BS
Distention
Emesis
XR: gas in small intestine and colon

Back 73

Paralytic Post Op Ileus

Front 74

physical obstruction to luminal passage secondary to
adhesions
volvulus
mass
normal to increased BS
crampy abdominal pain
XR: gas is proximal to obstructive etiology only

Back 74

Obstructive or mechanical (ILEUS IS NOT)

Front 75

(which med) exert spasmogenic effects on the gastrointestinal tract that results in decreased peristaltic activity

Back 75

opiods

Front 76

Osteopathic considerations for Ileus: Sympathetics

Back 76

T5-T9
T10-T11
T12-L2
Chapman reflexes lateral IT band

Front 77

Contraindications of Mesenteric Lifts

Back 77

Abscess
Abdominal aneurysm
Acute infection