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53 Cards in this Set

  • Front
  • Back
Sympathetic innervation to the Heart
Parasympathetic innervation to the heart
Vagus N.
Right side sympathetic innervation to the heart controls which node?
SA node
Increased activity -> supraventricular tachycardia
Left side sympathetic innervation tot he heart controls which node?
AV node
increased activity -> ectopic foci & V-Fib
Effect of parasympathetic activity on the heart
decreases heart rate & contractility
Paroxysmal atrial tachy
acute inferior wall MI
Early HF
What does the right lymphatic duct drain?
heart, lungs, right upper extremities, part of head and neck
What does the thoracic duct drain?
everything except the heart, lungs, and right UE, as well as part of the head and neck
Effects of increased sympathetic tone
inhibits development of collateral circualtion post MI
Decreases lymphatic drainage
increases rate of contraction - risk of arrhythmias
Three vertebral articulations that can produce parasympathetic viscerosomatic disorders
OA, AA, or C2 - vagal nerve interactions
Define a reflex
an involuntary nervous system response to sensory input
define a viscerosomatic reflex
localized visceral stimuli that produces patterns of a reflex response that is segmentally related to a somatic structure
Define a chapman point
tissue abnormalities assumed to be related to visceral pathology (2-3 cm)
What is the pectoralis trigger point?
Right pectoralis MAJOR mm between sternal margin and nipple in the 5th IS - results in supraventricular tachy.
Locate the posterior Adrenal gland chapman's points
Between T11-T12 transverse processes
Pancreatitis - Ranson's criteria
> 55 yrs
WBC > 16,000
Serum LDH > 350
Blood glucose > 200
SGOT > 250

Initial 48 hrs
Hct dec > 10%
BUN ince > 5
Ca++ < 8
PAO2 < 60
Base deficit > 4
fluid sequesteration > 6L
OMM Goals
enhance arterial blood supply
improve lymphatic & venous drainage
decrease viscerosomatic reflex activity
Innervation of the pancreas
greater splanchnic (T5-9), some T10-T11, vagas n.
pancreatitis viscerosomatic reflex
T7 on right or bilateral
typically non-neutral dysfunction
Pancreas anterior Chapman points
lateral to costal cartilage between 7th & 8th ribs on right
Pancreas posterior Chapman points
between transverse processes of T7-8 on the right (mid-way between spinous process and transverse process)
Effects of vagal n. stimulation on pancrease
increases pancreatic juices
stimulate bile production
headache (due to interchange w/somatic innervation in neck)
Rare cause of PUD
Zollinger-Ellison syndrome (gastrin producing tumor) - hallmark sign is profound hypersecreation of gastric acid
Sympathetic innervation of upper GI tract
greater splanchnic n, celiac ganglion
stomach, liver, part of pancrease, part of duodenum
Sympathetic innervation of esophogus
includes: heart, lungs, UE, head & neck
sympathetic innervation of middle GI tract
Lesser splanchnic n., superior mesentaric ganglion
pancrease, duodenum -> 2/3 transverse colon
sympathetic innervation of lower GI tract
least splanchnic n. (T12) & lumbar splanchnic (L1-L2), inferior mesentaric ganglion
distal 1/3 transverse colon, rectum, pelvic organs
effects of increased sympathetic tone on GI tract
decreased O2 & nutrient delivery to tissues -> bowel angina & ischemic bowel
decreased peristalsis
relaxation of gallbladder & ducts
Sympathetic dominant GI complaints
abdominal pain (from ileus, etc)
parasympathetic upper GI tract innervation
Vagus Nerve - lower 2/3 esophogus to mid-transverse colon
left: greater curvature of stomach & pyloric sphincter
right: upper GI tract, liver, gallbladder, right 1/2 colon, lesser curvature of stomach (i.e. everything else)
Parasympathetic innervation of lower GI tract
pelvic splanchnic nerves (S2-4)
innervates left colon & pelvis
effects of increases parasympathetic tone on GI activity
increases acid secretion
contraction of gallbladder & ducts
Peristalsis (I.e. sprue & diarrhea)
parasympathetic dominant GI complaints
nausea & vomiting
hypermotility related to cramping pain
innervation of the pelvic diaphragm
pudendal n. (S2-4) - pelvic splanchnic n.
Upper GI (parasympathetic) reflex vertebral findings
C2 Rl
T3 Rr
T5 Rl
T7 Rr
Upper GI sympathetic reflexes
Esophagus: T3 Rr
stomach: T5-8 Rl
duodenum: T7-8 Rr
T12 Rr, tenderness over the tip of the 12th rib...
Bilateral (R>L) T8-T10
small intestine
T12-L1 rotated right
cecum, ascending colon
L2-3 rotated left
descending colon
functional GI diseases
relates to function, NOT structure
physical complaint w/o organic pathology - consider somatovisceral reflex etiology
Nausea, vomiting, dyspepsia, flatulence, diarrhea, constipation
most common cause of pancreatitisgs
alcoholism (both acute & chronic)
biliary tract disease
penetrating duodenal ulcer
What does the Rome criteria help diagnos?
What are the Rome criteria?
abdominal pain/discomfort relieved w/ defecation, and/or w/ change in stool frequency, and/or w/ change in stool consistency
PLUS.. 2 or more at least 25% of the time: change in stool frequency, change in consistency, difficult stool passage, tenismus, presence of mucus in stool.
symptoms present >3 mos
psychogenic or emotional diarrhea causes
excessive stimulation of parasympathetic nervous system which greatly excites both motility & mucous secretion in the distal colon
Thoracoabdominal diaphragm attachments
right crus: L1-3(4)
Left crus: L1-2(3)
arcuate ligaments
xyphoid process
rib 6-12
quadratus lumborum
psoas m.
Ogilvie's syndrome (acute colonic pseudo-obstruction)
severe abdominal distention
Post-op, severe illness, mild abdominal pain, narcotics/anticholinergics
massive dilation of cecum or right colon
define ileus
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.
pathway of lymphatic drainage of the duodenum
pancreaticoduodenal nodes -> gastroduodenal nodes -> celiac nodes or SMA nodes -> intestinal trunk -> cisterna chyli -> thoracic duct
pathway of lymphatic drainage of the jejunum & ileum
mesentaric nodes -> SMA nodes -> intestinal trunk -> cisterna chyli -> thoracic duct
parasympathetic ganglions
cervical of uterus
myenteric (Auerbach's)
Submucosal (Meissner')
major symptoms of acute inferior wall MI
hypotension & bradycardia regulated by the vagal n.
parasympathetic hyperactivity affects on the heart
Right (to SA node) - sinus bradyarrhythmias
left (to AV node) - AB block
could be due to: dysfunction of occipitomastoid suture, OA, AA (C1) or C2
Mondor's Syndrome
cords that develop in the lateral chest wall from breast implants - cause lateral chest wall pain