Upper GI System

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Upper GI System

• Osteopathic Manipulative Medicine

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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

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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

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Techniques

• Thoracic Techniques - Sympathetics
• HVLA
• Muscle Energy
• Counterstrain
• Soft tissue
• Lymphatic Techniques
• Cranial Cervicals - Parasympathetics
• Vagus (Cranial nerve 10)

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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

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Myofascial Techniques

• Motion Testing
• Take tissues into ease of motion
• Tissues Release
• Retest
• Take tissues into ease of motion
• Continue until motion is free

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Chapmans 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

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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

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Viscerosomatic Pain

• pain receptors in anterior and lateral parietal
  peritoneum, lesser omentum, mesentaery, mesocolon
• facilitated cord segments in somatic areas
  related to the visceras sympathetic innervation

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Viscerosomatic Reflexes

• alerts clinician to look for visceral cause
• HVLA is often ineffective - met with a rubbery
  resistance

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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

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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

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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 bodys ability to recover from a
  disease process

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Somatic system

• somatic pain may persist even after the visceral
  problem has resolved
• treatment is OMT
• examples
• Peptic ulcer disease
• Postcholecystectomy syndrome

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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

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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

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TreatmentLymphatics 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

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Visceral ManipulationBasic 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

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Upper GI System Osteopathic Clinical Examples

• Diaphragm restriction in GERD
• Midscapular pain treated with NSAIDS may actually
  be referred viscerosomatic pain