Osteopathic Recognition Resource Library: Surgery

A 92 yo F patient presents to the ED with constipation, bilious vomiting, and intractable abdominal pain.  An acute abdominal series suggests she has a small bowel obstruction, but can’t rule out the possibility that there is an infarction of some of the bowel.  She’s acutely dehydrated, and appears poorly fed.  IV fluids are started.  Upon admission to the floor, she demonstrates somatic dysfunction at the B/L temporo-occipital suture, from T8-L2, and also along a line from the umbilicus to the solar plexus.  She is treated with soft-tissue OMT, including rib raising, upper lumbar paraspinal inhibition, release of the celiac, superior and inferior mesenteric ganglia, and V-spread, and she defecates voluminously within hours.  the next day the treatment is repeated twice, with the same results.  The following day she is not treated in the morning, and produces no stool, but receives treatment in the afternoon and defecates again.  In the mean time she has a CT angiogram which indicates that she has a significant portion of infarcted small bowel.  She begins to decompensate, has a palliative small bowel resection, and expires two days later, never having regained consciousness after bowel surgery.

outcomes in patients who develop postoperative ileus:  A retrospective chart review. International Journal of Osteopathic Medicine 12 (2009) 32-37.

• Foundations Volume 2, Chapter 27 “General Surgery” 
• Arnold LM, Burman SD, O-Yurvati, AH. Diagnosis and Management of Primary Pulmonary Leiomyosarcoma. JAOA 2010 Apr; 110 (4): 244-46. 

  • Techniques: Pedal Pump, Myofascial release to chest wall and upper thoracic region

• Crow WT, Gorodinsky L. Does osteopathic manipulative treatment (OMT) improves 
  • Techniques: v-spread, rib raising, colonic gutters, Celiac/Sup. and Inf. Mesenteric Ganglia
• Greenman P. Manipulation with the patient under anesthesia. JAOA 1992 Sept; (9): 1159-1170.

  • Techniques:  HVLA of the cervical and thoracic spine

• O-Yurvati AH, Carnes MS, Clearfield MB, Stoll ST, McConathy WJ. Hemodynamic effects of osteopathic manipulative treatment immediately after coronary artery bypass graft surgery. JAOA 2005 Oct;105(10):475-81.
  • Techniques: Sibson’s Fascia/Thoracic Inlet Release, OA Decompression, BLT of Thoracic spine, MF Sternal release, diaphragmatic release 
• Sleszynski SL, Kelso AF. Comparison of thoracic manipulation with incentive spirometry in preventing postoperative atelectasis. JAOA 1993 Aug;93(8):834-8, 843-5.

  • Techniques: Thoracic Lymphatic Pump, ME for ribs

1. Which of the following statements are true regarding gastrointestinal motility:

1. Nitrous oxide, vasoactive intestinal peptide (VIP), and substance P act as stimulating neurotransmitters in the gastrointestinal system.
2. Postoperative hyperextension of the lumbar spine inhibits peristalsis of the intestines and increases “gas” pains.
3. Parasympathetic nerve stimulation increases GI motility via the vagus and pelvic splanchnic nerves.
4. Stimulation of the sympathetic nervous system via the splanchnic nerves increases GI motility.
5. Paravertebral soft tissue relaxation is an unnecessary component of postoperative manipulative treatment.

1. Osteoporosis is an absolute contraindication.
2. Vertebral column fracture is a relative contraindication.
3. Joint hypermobility is a relative contraindication.
4. Acute inflammatory joint disease is an absolute contraindication.
5. Diabetic neuropathy is a relative contraindication.

Rationale

3. Identify the most likely pairing of vertebral level and somatic dysfunction in a patient presenting with an ileus in the region of the duodenal-jejeunal junction:

1. T1-6 on the right
2. T5-9 on the left
3. T10-11 on the right
4. T11-12 on the left
5. T12-L2 on the right

Rationale

4. In which of the following areas is an examiner most likely to find somatic dysfunction in an acute appendicitis?

1. T12 posterior on the right
2. Tip of 12th rib on the left
3. T11 posterior on the right
4. 2 inches proximal and to the right of the umbilicus
5. 1 inch proximal and to the right of the umbilicus