Osteopathic Manipulative Medicine 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 Lymphatic Techniques 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 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