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77 Cards in this Set
- Front
- Back
___ stimulate gallbladder to contract, releasing bile
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Fats
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Roots of ___ to greater splanchnic nerve to celiac ganglion
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T5-T9
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SNS for Bile Duct – ?
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Rt T6
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SNS for Gallbladder – ?
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Rt T5
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Stimulation of the ____ nervous system results in reduced bile secretion and relaxation of the gallbladder, leads to?
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sympathetic, This leads to stasis, predisposing for infection
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PNS supply for Lesser curvature of stomach, small intestines, right to midtransverse colon, gallbladder
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right vagus
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PNS supply for Greater curvature of stomach to duodenum, pylorus?
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left vagus
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_____ stimulation results in the contraction of the gallbladder and relaxation of the sphincter of Oddi, leads to?
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Parasympathetic (vagal), Increased bile formation
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What is the Lympathic Pathway for the gallbladder?
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Retroportal node -> abdominoaortic nodes -> thoracic duct
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Chapman reflex for gallbladder?
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between the 6th & 7th right ribs anteriorly, near costochondral junction
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Those with _____ classically present with diarrhea and rectal bleeding
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Ulcerative Colitis
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______ is manifested by abdominal pain, diarrhea and weight loss. Bleeding may be present if there is disease in the lower part of the colon.
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Crohn's Disease
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Anterior Chapman’s Reflexes for Illiocecal area of colon?
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Promixal Right Iliotibial band
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Anterior Chapman’s Reflexes for Ascending of colon?
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Middle Right Iliotibial band
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Anterior Chapman’s Reflexes for Hepathic flexure area of colon?
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Middle distal Right Iliotibial band
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Anterior Chapman’s Reflexes for Right 2/5 of transverse area of colon?
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Distal Right Iliotibial band
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Anterior Chapman’s Reflexes for Sigmoid area of colon?
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Promixal Left Iliotibial band
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Anterior Chapman’s Reflexes for Descending colon?
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Middle Left Iliotibial band
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Anterior Chapman’s Reflexes for Splenic flexure colon?
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Middle-distal Left Iliotibial band
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Anterior Chapman’s Reflexes for Left 3/5 of tranverse colon?
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Distal Left Iliotibial band
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What are the ganglion for the Sympathetics of the Large Bowel
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Celiac, Superior and Inferior Mesenteric Ganglion
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Sympathetics lvls for Stomach, liver, pancreas, and duodenum
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T5-9 - Celiac Ganglion
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Sympathetics lvls for Small intestines and right colon
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T10-11 - Superior Mesenteric Ganglion
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Sympathetics lvls for Left colon and pelvic organs
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T12-L2 - Inferior Mesenteric Ganglion
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Decreased motility in the gut : constipation, distention
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Hypersympathetic tone leads to
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Contraction of the rectal sphincter
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Hypersympathetic tone leads to
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Vasoconstriction in the spleen
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Hypersympathetic tone leads to
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Decreased mucosal defenses in the stomach
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Hypersympathetic tone leads to
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Parasympathetics _____ to the mid-transverse colon
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Vagus (CN X) nerve
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Parasympathetics ___Nerves for remaining colon (not mid-transverse)
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Pelvic Splanchnic (S2, 3, 4)
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Psychogenic or emotional diarrhea, “is caused by excessive stimulation of the _____nervous system
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parasympathetic
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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.
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mesenteric tissue
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What organ is posterior to the large intestine as it transitions from transverse to descending
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Spleen
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What organ Rests on the posterior respiratory diaphragm just anterior to the 8-10 ribs
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Spleen
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True/False The spleen is Retroperitoneal and Suprarenal
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TRUE
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Clinicians see profound effects of altered commensal flora in nearly ____ of the population who are affected by functional IBS
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15%
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Diaphragm Right crus levels
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L1,2,3,(4)
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Diaphragm Left crus levels
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L1,2,(3)
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Treatment Considerations for IBS: Dietary Alterations
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Avoid coffee, disaccharides, legumes, cabbage
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Osteopathic considerations for IBS: Parasympathetics
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Sacrum
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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.
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ILEUS
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peristalsis is absent or ineffective; no physical obstruction to the passage of the luminal contents
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Paralytic or adynamic
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POST-OP ILEUS: Has a ___ component due to the of neurogenic impulses resulting from the incision of the soma.
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somatovisceral
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POST-OP ILEUS: Has a ___ component as a result of bowel handling during surgery.
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viscerosomatic
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POST-OP ILEUS: Increases vascular tone -->
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decreased oxygen and nutrients to tissues
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Osteopathic considerations for Ileus: Parasympathetics
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Sacrum
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Osteopathic considerations for Ileus: Lymphatics
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Mesentery
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Sympathetic Innervation for Stomach, Liver, Pancreas, Duodenum
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Greater Splanchnic Nerve (T5-9)
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Sympathetic Innervation for Small Intestines and Right Colon
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Lesser Splanchnic Nerve (T10-11)
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Sympathetic Innervation for the Left Colon and Pelvic Organs
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Least Splanchnic Nerve (T12) and Lumbar Splanchnic Nerve (L1-2)
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Synapses at the Celiac Ganglion
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Greater Splanchnic Nerve (T5-9)
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Synapses at the Superior Mesenteric Ganglion
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Lesser Splanchnic Nerve (T10-11)
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Synapses at the Inferior Mesenteric Ganglia
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Least Splanchnic Nerve (T12) and Lumbar Splanchnic Nerve (L1-2)
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Generally rotational component of SD for lower bowel will be ____ of visceral dysfunction especially if organ is paired
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toward side
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HVLA for lower bowel often unsuccessful especially if palpation of paraspinals demonstrates___
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rubbery texture
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Goal of Mesenteric Lifts
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Decongest colon to promote appropriate nutrient delivery and waste removal
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With dz of the colon, the ____ganglion is often palpable and tender
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inferior collateral sympathetic
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Mesenteric Lifts: Bowel is gently taken at___ towards its mesenteric attachments and to the extent allowed by its motion barrier.
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right angles
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Mesenteric Lifts: ___ is applied to its attachments
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Gentle tension
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Mesenteric Lifts: Activated when Pt takes shallow breath to use ___. Repeat 2-3 times.
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Respiratory Force
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The 4 F’s of cholecystitis
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Female
Fat – increased BMI Forty – over 40 years old Fertile – multiparous or currently pregnant |
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Often affects terminal ileum
Inflammation extends thru the intestinal wall |
Crohn’s Disease
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Usually large intestinal mucosa
Bleeding, mucus Diarrhea |
Ulcerative Colitis
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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 |
Clinical Features of IBS
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What are the ROME III basic criteria for IBS?
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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 |
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Development of oral tolerance
Develop appropriate inflammatory response Production of neurochemicals “Second Brain” |
Presence of a distinct immune system: G.A.L.T.
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Treatment Considerations for IBS: Pharmacological
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Stool Bulking Agents – Increased dietary fiber
Antispasmodics Anti-diarrheal Agents Antidepressants Antiflatulence Therapy – “Disappointing results” |
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Treatment Considerations for IBS: OMT
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Improve the “structure-function” relationship
Normalize autonomic activity in the intestine Promote good lymphatic flow Normalize joint somatic dysfunction (especially T10-L2) |
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Thoracoabdominal Diaphragm Attachments
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Right crus to L1,2,3,(4)
Left crus to L1,2,(3) Arcuate ligaments Xyphoid process Ribs 6-12 Quadratus Lumborum Psoas M |
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Osteopathic considerations for IBS: Sympathetics
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T5-T9
T10-T11 T12-L2 Chapman reflexes |
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Osteopathic considerations for IBS: Lymphatics
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Pelvic Diaphragm
Spleen Presacral Fascia |
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Resolves spontaneously after 2-3 days
More severe in colon decreased to absent BS Mild distention Pain XR: gas in small intestine and colon |
Post Operative Ileus
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More than 3 days post surgery
All segments of the bowel decreased to absent BS Distention Emesis XR: gas in small intestine and colon |
Paralytic Post Op Ileus
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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 |
Obstructive or mechanical (ILEUS IS NOT)
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(which med) exert spasmogenic effects on the gastrointestinal tract that results in decreased peristaltic activity
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opiods
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Osteopathic considerations for Ileus: Sympathetics
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T5-T9
T10-T11 T12-L2 Chapman reflexes lateral IT band |
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Contraindications of Mesenteric Lifts
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Abscess
Abdominal aneurysm Acute infection |