1. Osteopathic Manipulative Medicine
Upper GI System
Osteopathic Manipulative Medicine

2. 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

3. 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

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

5. 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

6. Myofascial Techniques
Motion Testing
Take tissues into ease of motion
Tissues Release
Retest
Continue until motion is free

7. 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

8. 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

9. 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

10. Viscerosomatic Reflexes
alerts clinician to look for visceral cause
HVLA is often ineffective - met with a rubbery resistance

11. 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

12. 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

13. 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

14. Somatic system
somatic pain may persist even after the visceral problem has resolved
treatment is OMT
examples:
Peptic ulcer disease
Postcholecystectomy syndrome

15. 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

16. 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

17. 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

18. 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

19. Upper GI System Osteopathic Clinical Examples
Diaphragm restriction in GERD
Midscapular pain treated with NSAIDS may actually be referred viscerosomatic pain