Transcript Osteopathic Considerations Upper Gastrointestinal System

Upper GI System
Osteopathic Manipulative
Medicine
Objectives
• Review previously learned concepts and
techniques which apply to diagnosis and
treatment of upper gastrointestinal disorders
• Identify patterns of viscerosomatic reflexes
which correspond to disease processes in
individual organs
• Incorporate somatic findings in the diagnosis
and treatment of upper GI disorders
Viscerosomatic Reflexes
• DiGiovanna/Schiowitz
–
–
–
–
–
T5-6R - upper esophagus
T6-9R - liver and gall bladder
T8-9B - small intestine
T5-9L - lower esophagus and stomach
T6-9L - spleen and pancreas
• Musculoskeletal pain related to visceral
dysfunction may be the sole presenting
symptom of viscerosomatic reflex
Techniques
• Thoracic Techniques - Sympathetics
– HVLA
– Muscle Energy
– Counterstrain
– Soft tissue
• Lymphatic Techniques
• Cranial & Cervicals - Parasympathetics
– Vagus (Cranial nerve 10)
Fascia
• “Fascia directly or indirectly influences the
health of the body through coordination with
the musculoskeletal system, cooperation in
circulating body fluids, and by allowing
generous passageway for nerves.
Derangement in the fascial planes can result
in veinous congestion, abnormal reflexes,
and a decreased range of motion. Thus
myofascial techniques are crucial in
eliminating fascial restrictions and allowing
the body to return to a healthier state.” DiGiovanna
Myofascial Techniques
•
•
•
•
•
•
Motion Testing
Take tissues into ease of motion
Tissues Release
Retest
Take tissues into ease of motion
Continue until motion is free
Chapman’s Reflexes
• myofascial tender
points related to
specific visceral
dysfunction
• helpful in diagnosis
• anterior points more
helpful - more tender
• firm gentle contact
with rotary motion to
dissipate the swelling
True visceral pain
• pacinian corpuscles
• free nerve endings
• activated by spasm or
stretch
• carried by visceral
afferents
• midline pain, poorly
localized-vague,
deep, diffuse, burning
ache
Viscerosomatic Pain
• pain receptors in
anterior and lateral
parietal peritoneum,
lesser omentum,
mesentaery,
mesocolon
• facilitated cord
segments in somatic
areas related to the
viscera’s
sympathetic
innervation
Viscerosomatic Reflexes
• alerts clinician to look for visceral cause
• HVLA is often ineffective - met with a
rubbery resistance
Sympathetics
• rapid and widespread organ and
somatic changes required to meet
stress (flight/fight)
• activation of one sympathetic fiber
produces 4 to 40 post ganglionic fiber
activations
Parasympathetics
• dominate innervation during restful activity
• Vagus, CN X, exits via jugular foramen
– left - greater curvature of stomach, duodenum
– right - lesser curvature, small intestines, right
colon, and organs and glands up to
midtransverse colon
• stimulation will increase secretion rate of
most glands
Lymphatics
• flow of lymph may be hindered by poorly
efficient, flattened diaphragm, torsion of
the fascias around the lymphatic channels
• slight impedance of lymphatic pathways or
hindrance to the function of the diaphragm
can reduce the body’s ability to recover
from a disease process
Somatic system
• somatic pain may persist even after the
visceral problem has resolved
• treatment is OMT
• examples:
– Peptic ulcer disease
– Postcholecystectomy syndrome
Treatment of Upper GI disorders
• Osteopathic treatment is directed
toward improving the physiologic
function of the patient
• Treatment will
– reduce need for pain medication
– balance autonomic activity
– improve lymphatic flow
Goals of OMT
•
•
•
•
•
•
•
•
improve visceral response to stress
relieve congestion
improve circulation
enhance removal of waste products
improve cardiac output
improve oxygenation and nutrition (cellular)
enhance medication effectiveness
relaxation and comfort - diagnosis/treatment
Treatment
Lymphatics and Fascias
• Mesenteric lift (small intestines) - frees
lymphatic pathways - lift upward and to
right side of abdomen - respiratory
cooperation
• Visceral manipulation of individual viscera
• Doming of diaphragm
• Lymphatic pump techniques
Visceral Manipulation
Basic Tenets
• an organ or viscera in good health has
physiologic motion
– mobility - voluntary or diaphragmatic
– motility - inherent motion
• restriction implies functional impairment
• motion repeated thousands of times daily
can bring about significant changes to
organ and adjacent structures
Upper GI System
Osteopathic Clinical Examples
• Diaphragm restriction in GERD
• Midscapular pain treated with NSAIDS
may actually be referred viscerosomatic
pain