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98 Cards in this Set
- Front
- Back
Pain distribution: esophagus
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Substernal
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Pain distribution: duodenum, liver, gallbladder, colon, (hepatic flexure)
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RUQ
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Pain distribution: stomach
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Mid-epigastric
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Pain distribution: pancreas
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Generalized upper abdominal
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Pain distribution: small intestine
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Peri-umbilical
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Pain distribution: colon (splenic flexure)
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Left upper quadrant
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Pain distribution: appendix, cecum
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Right lower quadrant
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Pain distribution: sigmoid colon, rectum
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Left Lower Quadrant
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the palpatory examination also includes the examination for primary ____ dysfunction and ____ findings.
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somatic, viscerosomatic
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Sympathetic Innervations: Esophagus
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T2-T8
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Sympathetic Innervations: Upper GI tract
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T5-T9
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Sympathetic Innervations: Middle GI tract
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T10-T11
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Sympathetic Innervations: Lower GI tract
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T12-L2
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Sympathetic Innervations: Stomach, Liver, Gallbladder, Spleen, Parts of Pancreas & Duo
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T5-T9
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Sympathetic Innervations: Parts of Pancreas & Duodenum, Jejunum, Ilium, Right Colon
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T10-T11
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Sympathetic Innervations: Left Colon, Rectum
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T12-L2
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T lvls for Greater Splanchnic Nerve
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T5-T9
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T lvls for LesserSPlanchinic Nerve
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T10-T11
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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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T lvls for Least Splanchnic Nerve
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T12
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T lvls for Lumbar Splanchnic Nerve
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L1-2
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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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Innervates the Left Colon and Pelvic Organs
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Least Splanchnic Nerve (T12) and Lumbar Splanchnic Nerve (L1-2)
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Autonomic that causes Decreased peristalsis
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Sympathetic
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Autonomic that causes Relaxation of gallbladder and ducts
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Sympathetic
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Autonomic that causes Increased Vascular Tone leading to decreased oxygen and nutrients to tissues (extreme case bowel angina and ischemic bowel)
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Sympathetic
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Parasympathetic Innervation of greater curvature of the stomach and pyloric sphincter
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Left Vagus CN X
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Parasympathetic Innervation of Upper GI tract, Liver, Gallbladder and Right Half of the Colon
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Right Vagus CN X
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Parasympathetic Innervation of Lower 2/3 of Esophagus
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Vagus Nerve CN X
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Parasympathetic Innervation of the left colon and pelvis
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Pelvic Splanchnic Nerves (S2-4)
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Autonomic that causes Increases acid secretion
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Parasympathetic
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Autonomic that causes Contraction of Gallbladder and Ducts
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Parasympathetic
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Autonomic that causes Peristalsis (i.e. Sprue and diarrhea)
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Parasympathetic
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Viscerosomatic reflexes Synapse with____, Results in ___.
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internuncial neurons, facilitation
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Sympathetic reflexes are found between ___
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T1 and L2
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Parasympathetic reflexes are found in the ___ and ___ regions
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high cervical and Sacral
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This relationship may explain the high cervical paravertebral manifestations of the vagal viscero-somatic reflex
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After exiting the skull, the vagus nerve interdigitates with a connecting loop between C1 and C2 within the cervical plexus
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Parasympathetic of Left half of the transverse colon, descending colon, sigmoid, and rectum
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Sacral (S2-S3-S4)
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The pelvic diaphragm is innervated by the ___
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pudendal nerve (S2-3-4) of the pelvic splanchnic nerves
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Upper G.I. sympathetic reflexes: Esophagus
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T3 right
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Upper G.I. sympathetic reflexes:Stomach
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T5-T8 Left
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Upper G.I. sympathetic reflexes: Duodenum
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T7 -T8 right
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The parasympathetic reflex from stomach is the___
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high cervical vagal reflex
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upper G.I. reflex.
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The combination C2 left, T3 right, T5 left and T7 right
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Reflex for Small intestine
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Bilateral(R>L) T8-10
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Reflex for descending colon
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L2-3 left
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T12 right with tenderness over the tip of the 12th rib right appendix
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(anterior Chapman tenderpoint)
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The 12th dermatome on the right is the____
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appendiceal viscerosomatic reflex
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Positional variation of the____ can result in perplexing variability in the clinical presentation of acute appendicitis
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appendix
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Referred pain patterns are found in the same distribution as ____
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viscerosomatic reflexes
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discoloration caused by massive nontraumatic ecchymoses in the skin of the lower abdomen and flanks. It results from the infiltration of the extraperitoneal tissues with blood
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Grey-Turner’s sign
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faintly blue coloration as a result of retroperitoneal bleeding
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Cullen’s sign
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Effect of osteopathic manipulative treatment on length of stay for pancreatitis: A randomized pilot study RESULTS
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Average length of stay 3.5 days shorter in OMT versus control
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Which part of the pancreas is NOT reproperitoneal
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small part of tail
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What is the sympathetic Innervation of the Pancreas?
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T5-T9 -> Greater Splanhnic -> Celiac Ganglion
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Where are the TART sympathetic pancreas changes?
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Paraspinal, Midline collateral ganglia
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What is the Viscerosomatic Reflex of the pancreas? What type of dysfunction
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T7 on Right or bilateral; non-neutral
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Where are the Anterior Chapman’s Reflex for the pancreas?
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Lateral to costal cartilage between 7th and 8th ribs on right
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Where are the Posterior Chapman’s Reflex for the pancreas?
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Between transverse processes of T7-8 on the right
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What is the parasympathetic innervation of the pancreas?
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Vagus
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Path of the pancreas lymph?
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Lymph vessels follow blood vessels to the Pancreaticosplenic nodes -> Celiac nodes -> Left Thoracic duct
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Where are the pancreas lymph capillaries? Where are there none?
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The lymph capillaries commence around the acini and their continuations (exocrine). none in the islets (endocrine)
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Why do JSCS on psoas with pancreatitis?
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because of the close physical relationship between the psoas and the pancreas, any dysfunction of the psoas can contribute to the pain of pancreatitis
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Why do Thoracic/lumbar mobilization important with pancreatitis?
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encourage lymph flow by removing myofascial restrictions, removing somatic (myofascial) input to a facilitated segment. It is a myofascial release and/or soft tissue technique
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Why do OA decompression/suboccipital release with pancreatitis?
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vagus nerve exits via the jugular foramen and the occiput forms one border of this opening
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Why do A/P Treatment Diaphragm with pancreatitis?
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thoracic diaphragm is the primary mover of lymph through the thoracic duct. It is a myofascial technique
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Why do Iliosacral mobilization with pancreatitis?
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sacrum is attached to occiput via the dura, so treating the sacrum also treats the OA. Also, treating the sacrum allows for better movement of the pelvic diaphragm, which will encourage lymph flow. It is myofascial/soft tissue technique
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____ includes a myriad of disorders that involve inflammatory changes in the gastric mucosa, including erosive gastritis caused by a noxious irritant, reflux gastritis from exposure to bile and pancreatic fluids, hemorrhagic gastritis, infectious gastritis, and gastric mucosal atrophy.
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Gastritis
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____ refers to a discrete mucosal defect in the portions of the gastrointestinal tract (gastric or duodenal) exposed to acid and pepsin secretion.
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Peptic ulcer disease (PUD)
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lesser curvature stomach parasympathetic innervation
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right vagus
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greater curvature & pyloric sphincter stomach parasympathetic innervation
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Left vagus
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What are the stomach lymph nodes?
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Left gastric,Celiac, Sub-pyloric, Right gastro-omental nodes
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Impaired stomach lymph flow leads to:
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Increased tissue congestion and impaired nutrient absorption from the bowel
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Lymph flow from the GI tract & below the diaphragm drain from the small lymphatic channels to the ___ up to the Thoracic Duct (Left)
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Cysterna chyli
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What are the Sympathetic Dominant Complaints?
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Constipation
Abdominal Pain Flatulence Distension |
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What are the Parasympathetic Dominant Complaints?
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Nausea and vomiting
Diarrhea Hypermotility related cramping/pain |
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Inc. tissue congestion
Impaired Absorption Inc. risk of pancreatic complications in gallbladder disease/dysfunction |
Impaired Lymph Flow
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Usually self-limited (85-90%)
Analgesics IV Fluids No oral alimentation Nasogastric suction OMT |
Treatment of Acute Pancreatitis
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Lab significant for:
Increased serum amylase Increased serum lipase Leukocytosis Hyperglycemia |
Acute Pancreatitis
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Put the pancreas at “rest”
Parenteral nutrition should be started in cases of severe pancreatitis that prolongs recovery Once stable, diet should be progressed as tolerated. |
Medical Nutrition Therapy: Acute Pancreatitis
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First goal is to optimize nutritional support
Second goal is to decrease pain by minimizing stimulation of exocrine pancreas Consider pancreatic enzyme replacement Low fat diet |
Medical Nutrition Therapy: Chronic Pancreatitis
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What does parasympathetic innervation do to the pancreas?
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Increases pancreatic juices rich in enzymes
Stimulates the production of bile May cause a headache because of interchange with somatic innervation in neck |
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Peak incidence in sixth decade
More common in males Less common |
Gastric Ulcers
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Incidence greatest between ages of 25-75
Equal incidence in males and females Occur in 6 to 15% of the western population |
Duodenal Ulcers
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Increased mucosal sensitivity to H+ concentration and alters mucosal barrier
Vasoconstriction Decreased peristalsis which leads to constipation Relaxation of gallbladder and ducts (no secretion) |
Sympathetics T5-T9
Increased tone leads to |
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Increased acid secretion
Increased peristalsis which can cause diarrhea Contraction of gallbladder and ducts (secretion) |
Increased Parasympathetics - Vagus (OA, AA, C2) tone
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Hypermotility related cramping/pain
Diarrhea Nausea & vomiting |
GI parasympathetic complaints
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abdominal pain
constipation flatulence distension |
GI sympathetic complaints
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Osteopathic Considerations for PUD: Sympathetics
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Rib Raising
T5-9 T10-11 Chapman’s Reflexes Collateral (celiac) Ganglia |
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Osteopathic Considerations for PUD: ParaSympathetics
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Vagus Nerve:
OA, AA, C2, Cranial Sacrum |
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Osteopathic Considerations for PUD: Lymph
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Thoracic Inlets:
Abdominal Diaphragm via Cervical C3-C5 (phrenic nerve) Thoracolumbar Junction (diaphragm attachment) |
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Osteopathic considerations for GERD:Sympathetics
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Rib raising: T5-T9
Chapman’s reflexes: collateral ganglia |
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Osteopathic considerations for GERD: ParaSympathetics
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SI joint, OA, OM suture
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Osteopathic considerations for GERD: Lymphatics
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Thoracic inlets: abdominal diaphragm
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Osteopathic considerations for Pancreatitis: Sympathetics
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T5-T9, T7 right
Chapman’s reflexes: Anterior: Lateral to costal cartilage between 7th, 8th ribs on right Posterior- Between transverse processes of T7-8 on the right |
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Osteopathic considerations for Pancreatitis: ParaSympathetics
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OA
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Osteopathic considerations for Pancreatitis: Lymph
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Pancreaticosplenic nodes -> Celiac nodes
Thoracic inlets: abdominal diaphragm Thoracolumbar junction (diaphragm attachments) |