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43 Cards in this Set

  • Front
  • Back
If there is visceral irritation, what will you see?
hypersympathetic bombardment
What does the ability of the body to heal itself depend on?
ability to remove waste products from tissue and deliver O2 and other nutrients to area of dysfunction, injury or site of surgical intervention
When doing OMM for bowel disease and dysfunction what do you mainly work on?
improving blood and lymphatic flow and balancing ANS innervation to and from bowel
What are some somatic dysfunctions you would expect to find in a pt recovering from gallbladder surgery?
And why?

gallbladder: T6-T9 Right
Colon: T10-T12
Lumbar paravertebral hypertonicity

Surgery causes viscera to shut down gut
narcotics slow down motility of gut
heightened sympathetic response secondary to trauma
bad gallbladder
What is key to diagnosing distressed visceral organs?
What are activated in the walls of viscera during spasm or stretch?
Pacinian corpuscles and free nerve endings
Early in disease states is the visceral pain localized? What are some examples?
No, it is poorly localized early in the disease state.

Gnawing, burning and cramping
When does somatic pain become evident? Is it localized?
when underlying visceral process progresses past visceral serosa and stimulates adjacent somatic sensory nervers

Somatic pain is well localized, asymmetric and aggravated by jarring motions
How does somatic pain work in relation to viscerol pain?
can add to viscerol pain, or overwhelm and mask it.
When does the spinal cord start reacting? What are the changes and where are they seen?
The spinal cord starts reacting from increased and prolonged visceral afferent input

Leads to palpatory tissue changes and tenderness in paraspinal muscles, collateral ganglia and chapman's reflex.

The vertebra become extended, rotated and SB to the involved side
What can happen with the handling of bowel during surgery?
may initiate secondary viscero-visceral reflex and result in a paralytic post-op ileus
What can increased sympathetic tone lead to?
1.increased vascular tone: decreased O2 and nutrients to tissues: increased mucosal sensitivity to H+ concentration and alters mucosal barrier
2. relaxation of gallbladder and ducts
3.decreased peristalsis (constipation)
What are the visceral-somatic areas for the right and left colon?
Left colon: T12-L2
Right colon: T10-T11
What is hyperactivity of the lower GI system associated with?
abdominal distension
What does increased parasymppathetic tone lead to?
increased acid secretion
contraction of gallbladder and ducts
increased peristalsis (diarrhea)
Where does the vagus nerve travel on the left side of the body?
greater curvature of the stomach and extends to the duodenum
Where does the vagus nerve travel on the right side of the body?
lesser curvature of stomach
small intestines
right colon
organs and glands up to mid transverse colon
What is the significance of organs that are innervated by the vagus nerve?
They are all intimately bound together and capable of readily transmitting reflexes to and from each other
When does parasympathetic innervation dominate?
during normal, long term, restful activity.
What happens with there is hyperactivity of both parasympathetic and sympathetic innervation to the bowel?
What occurs if there is impaired lymph flow?
increased tissue congestion and impaired nutrient absorption from the bowel

increased likelyhood of fibrosis w/increased scarring

increased risk of pancreatic complications in gallbladder disease/dysfunction
What is the danger in increased scarring and fibrosis in the gut?
can worsen the prognosis for pts with colitis or Crohns
What can hinder lymph flow?
-poorly efficient, flattened diaphragm
-torsion of fascia around lymphatic channels in mesentery or thoracic inlet
What is usually the first sign of terminal lymphatic drainage dysfunction in the abdomen?
palpable fullness in subxiphoid soft tissue
What are the visceral-somatic reflexes of the stomach?
T5-T9 left
Visceral somatic reflexes of the Duodenum:
T5-T9 BL
Visceral somatic reflexes of gallbladder/ducts:
T6-T9 right (focused on T9)
What are the visceral-somatic reflexes of the liver?
T5 Right
What are the visceral-somatic reflexes of the pancreas?
T7 right
What are the visceral-somatic reflexes of the slpeen?
T7 left
What are the visceral-somatic reflexes of the colon?
T10-T12 BL
What are the visceral-somatic reflexes of the appendix?
T12 Right with RIB
What are the visceral-somatic reflexes with regional ileitis (crohns)?
In addition to segmental paraspinal somatic dysfuntion, what also usually presents?
reflex spasm

guarding, rigidity and myofascial trigger points
If there is chronic constipation, what will you see?
erector spinae mass, mid-lumbar
What is the vagus innervation visceral-somatic reflex?
What are the goals of treating pt with GI problems?
improve visceral response to stress
relieve congestion
improve circulation
enhance removal of waste products
improve CO
improve oxygenation/nutrition at cellular level
enhance resistance to infection
enhance response to medications
decrease discomfort
increase ROM
What are the overlying goals for treating pt with OMM?
balance autonomic activity
improve lymphatic flow
If there is sympathetic dominance what could you do and what would it help?
Rib Raising (T5-12)
soft tissue (T12-L2)
paraspinal inhibition (constipation)
sympathetic collateral ganglia inhibition (celiac, superior and inferior)
sacral rocking

If there was sympathetic dominance, what would the pt complain of?
abdominal pain
If there was parasympathetic dominance, what would the pt complain of?
headaches, nausea, vomiting, diarrhea, cramps
How would you treat parasympathetic dominance?
UCC (vagal nerve as it exits skull)
Cranial (leaves through the jugular foramen)
suboccipital tension release
C3-C5 somatic dysfunction (phrenic nerve to diaphragm)
Sacrum, innominates, lumbosacral dysfunctions (pelvic splancnic nerves)
sacral inhibition
How can you improve lymphatic congestion?
thoracic inlet
pectoral traction
redome abdominal diaphragm
pelvic diaphragm through ischiorectal fossa
lymphatic pumps