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Questions and Answers
What can result from a primary organ disease?
What can result from a primary organ disease?
Which of the following is a treatment goal for gastrointestinal dysfunction?
Which of the following is a treatment goal for gastrointestinal dysfunction?
Why should both somatic dysfunction and any primary organ problems be treated?
Why should both somatic dysfunction and any primary organ problems be treated?
Which of the following is NOT a goal for treating GI dysfunction?
Which of the following is NOT a goal for treating GI dysfunction?
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What is a key factor to consider when determining a treatment approach?
What is a key factor to consider when determining a treatment approach?
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What spinal level is associated with a viscerosomatic reflex of the midgut?
What spinal level is associated with a viscerosomatic reflex of the midgut?
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A patient presents with paraspinal muscle spasms in the lower back region, specifically at L1-L2. Which of the following viscerosomatic reflexes is most likely the cause?
A patient presents with paraspinal muscle spasms in the lower back region, specifically at L1-L2. Which of the following viscerosomatic reflexes is most likely the cause?
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Which of the following locations is NOT associated with the middle 3/5th of the colon?
Which of the following locations is NOT associated with the middle 3/5th of the colon?
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A patient is experiencing referred pain in their upper thoracic region and left upper extremity, along with muscle spasms in the upper thoracic spine. What type of viscerosomatic reflex is MOST likely present?
A patient is experiencing referred pain in their upper thoracic region and left upper extremity, along with muscle spasms in the upper thoracic spine. What type of viscerosomatic reflex is MOST likely present?
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What anatomical landmark is found anterior to the rectum?
What anatomical landmark is found anterior to the rectum?
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Which reflex involves localized somatic stimuli leading to responses in related visceral structures?
Which reflex involves localized somatic stimuli leading to responses in related visceral structures?
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What is a key characteristic of Chapman reflex points?
What is a key characteristic of Chapman reflex points?
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Which of the following is NOT a typical somatic response to visceral pathology?
Which of the following is NOT a typical somatic response to visceral pathology?
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During the integrated GI exam, which technique is used to palpate the abdomen?
During the integrated GI exam, which technique is used to palpate the abdomen?
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If a patient presents with a viscerosomatic reflex in the thoracic region, what may be the primary source of the stimulus?
If a patient presents with a viscerosomatic reflex in the thoracic region, what may be the primary source of the stimulus?
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Which best describes a viscerovisceral reflex?
Which best describes a viscerovisceral reflex?
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Which of the following are components of the palpatory exam of spinal regions?
Which of the following are components of the palpatory exam of spinal regions?
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What specific characteristic of Chapman points is associated with the tissues?
What specific characteristic of Chapman points is associated with the tissues?
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The superior mesenteric ganglion receives fibers from which spinal cord levels via the lesser splanchnic nerve?
The superior mesenteric ganglion receives fibers from which spinal cord levels via the lesser splanchnic nerve?
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Which nerves provide input to the inferior mesenteric ganglion?
Which nerves provide input to the inferior mesenteric ganglion?
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What is the proposed mechanism behind Chapman reflex points?
What is the proposed mechanism behind Chapman reflex points?
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Where are Chapman points typically found in relation to spinal nerves?
Where are Chapman points typically found in relation to spinal nerves?
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What is the characteristic palpation finding for Chapman points?
What is the characteristic palpation finding for Chapman points?
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How do Chapman reflex points differ from trigger points in terms of pain characteristics?
How do Chapman reflex points differ from trigger points in terms of pain characteristics?
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What is the primary treatment method for Chapman reflex points?
What is the primary treatment method for Chapman reflex points?
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Where are trigger points most commonly found?
Where are trigger points most commonly found?
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Which of the following is a distinguishing feature of tender points?
Which of the following is a distinguishing feature of tender points?
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How do trigger points differ from tender points in terms of palpation findings?
How do trigger points differ from tender points in terms of palpation findings?
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Which spinal level is associated with the postierior Chapman's point for the stomach's acidity?
Which spinal level is associated with the postierior Chapman's point for the stomach's acidity?
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The anterior Chapman's point for the pylorus is found along which anatomical structure?
The anterior Chapman's point for the pylorus is found along which anatomical structure?
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What is the parasympathetic innervation of the first two-thirds of the transverse colon?
What is the parasympathetic innervation of the first two-thirds of the transverse colon?
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The anterior Chapman's point for the liver is located at which intercostal space(s)?
The anterior Chapman's point for the liver is located at which intercostal space(s)?
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Which of the options represents the correct posterior Chapman's reflex point for the small intestine?
Which of the options represents the correct posterior Chapman's reflex point for the small intestine?
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What is the sympathetic innervation of the descending colon?
What is the sympathetic innervation of the descending colon?
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The posterior Chapman's point for the appendix is located at which anatomical structure?
The posterior Chapman's point for the appendix is located at which anatomical structure?
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What is the location of the anterior Chapman's point for intestinal peristalsis/colonic atony?
What is the location of the anterior Chapman's point for intestinal peristalsis/colonic atony?
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How long should pressure be maintained when treating a Chapman's point with direct inhibition?
How long should pressure be maintained when treating a Chapman's point with direct inhibition?
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The distal 1/5th of the left iliotibial band (ITB) correlates to which portion of the colon?
The distal 1/5th of the left iliotibial band (ITB) correlates to which portion of the colon?
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Which nerve provides parasympathetic innervation to the heart?
Which nerve provides parasympathetic innervation to the heart?
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What is the location of the anterior Chapman's point for the lungs?
What is the location of the anterior Chapman's point for the lungs?
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The posterior Chapman's reflex point for the colon is located at which of the following?
The posterior Chapman's reflex point for the colon is located at which of the following?
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Which spinal levels provide sympathetic innervation to the stomach?
Which spinal levels provide sympathetic innervation to the stomach?
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What is a primary parasympathetic nerve which will influence the functioning of Liver, Gallbladder and Pancreas?
What is a primary parasympathetic nerve which will influence the functioning of Liver, Gallbladder and Pancreas?
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The anterior Chapman's point for the spleen is found in which intercostal space?
The anterior Chapman's point for the spleen is found in which intercostal space?
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The sympathetic innervation of the small intestine originates from which spinal nerve levels?
The sympathetic innervation of the small intestine originates from which spinal nerve levels?
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If applying direct inhibition to an anterior Chapman's point, what type of pressure is suggested?
If applying direct inhibition to an anterior Chapman's point, what type of pressure is suggested?
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Where are the anterior Chapman's points for the HEENT (Head, Eyes, Ears, Nose, Throat) located?
Where are the anterior Chapman's points for the HEENT (Head, Eyes, Ears, Nose, Throat) located?
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Which spinal level corresponds to the sympathetic innervation to the Gallbladder?
Which spinal level corresponds to the sympathetic innervation to the Gallbladder?
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Study Notes
G.I. Related Viscerosomatic and Chapman's Reflexes
- Krista Lund DO and Ed Goering DO presented this lecture in January 2025
- The presenters have no financial or other conflicts of interest related to the material presented.
- Learning objectives include differentiating viscerosomatic (VS) reflexes and Chapman's reflex points, explaining the theorized mechanism behind Chapman's reflexes, identifying somatic levels related to the GI system, describing the location and treatment of Chapman's reflexes for GI pathology.
- Students need to develop palpatory sensitivity to identify, assess, and treat visceral tissue texture changes, and their associated viscerosomatic reflexes and Chapman's reflex points.
- Required reading includes Elentra - OMS II OPP Department Textbook Chapter GI System, Chapman's Reflexes, and Viscerosomatic Reflexes.
- Review and recall of prior required reading assignments and OPP sessions are also crucial. These include sessions on FOM 5: Viscerosomatic Reflexes and Chapman's Reflex Points, FOM 5: Somatic Dysfunction, Functional Techniques, and Linkage, and FOM 2: Dr. Frank Willard's Expanding Osteopathic Concepts.
Terminology Review
- Visceral dysfunction: Impaired or altered mobility or motility of the visceral system, including fascial, neurological, vascular, skeletal, and lymphatic elements.
- Reflex: An involuntary nervous system response to a sensory input.
- Spinal facilitation: A pool of neurons (premotor, motor, or preganglionic sympathetic neurons in one or more spinal cord segments) that are partially or subthresholdly excited, requiring less afferent stimulation for impulse discharge. This increase can be due to sustained increase in afferent input, aberrant patterns of afferent input, changes within affected neurons, or their chemical environment.
- Various types of reflexes are described, including somatosomatic, somatovisceral, viscerosomatic, viscerovisceral, and autonomic reflexes, each involving specific segmentally related somatic or visceral structures
Somatic Response To Visceral Pathology
- Segmental related findings, including vertebral asymmetry, muscle hypertonicity/tenderness, temperature changes, and skin moisture content.
- Abnormal organ and surrounding tissue findings
- Presence of Chapman Reflex Points
Integrated GI Exam
- The Integrated GI Exam involves inspection (general, anterior, posterolateral, and posterior views), palpatory exam of spinal regions, viscerosomatic reflexes, heart, lung, and abdominal assessment.
- Inspection includes examination of the heart and lungs, palpation of the abdomen (inspecting, auscultating, percussing, palpating in 9 regions, and checking structures at the cecal and sigmoid regions, as well as compressing the linea alba), and assessment of Chapman's points.
The Autonomic Nervous System
- The autonomic nervous system has sympathetic and parasympathetic branches.
- Shows the pathways and ganglia involved in the innervation of different GI organs.
- The pathways, organs, and ganglia' relevant to the GI system are illustrated schematically.
Autonomic Nervous System Distribution
- A simplified chart of ANS distribution by region to aid in testing for osteopathic medical students.
- It does not reflect the complexity and variability of the autonomic nervous system, but is only for testing purposes.
Collateral Ganglia
- There are three ganglia relevant to the GI system: Celiac, superior mesenteric, and inferior mesenteric.
- Their location, the nerves they receive fibers from, and the structures they innervate are highlighted.
Chapman Reflex Points
- Chapman reflex points are viscerosomatic reflex responses through facilitated segments, thought to arise from "gangliform contractions" that block lymphatic drainage, causing nervous system dysfunction.
- They typically present as specific organ pathology, located at the end of spinal nerves or in associated tissue (dermatomal distribution).
- Points are characterized by size (from small pellet to pea-sized) and texture (edematous, ridge-like, ropy, fibrospongy, or shotty).
- They are often tender, and pressure upon them can cause them to recede.
Comparing Chapman Reflex Points, Trigger Points, & Tender Points
- Describes the clinical characteristics, location, palpatory qualities, pain characteristics and association, and treatments of Chapman Reflex Points, Trigger Points, and tender points.
Chapman Reflex Points: Anterior and Posterior
- Illustrates the location of anterior and posterior Chapman reflex points for various GI structures using anatomy diagrams, emphasizing bilateral nature when possible.
Treatment of Chapman's Points with Direct Inhibition
- Explains the procedure for locating and treating Chapman's points by firmly pressing in a circular manner around the point, applying gentle rotary or linear traction, and keeping pressure on the point until it recedes and is no longer tender.
- The treatment duration is generally between 15 -60 seconds, with careful consideration to avoid overtreating.
Constipation
- Physiology of constipation and associated somatic dysfunctions, including increased parasympathetic and sympathetic tone, and how these factors affect bowel movements and the associated discomfort.
- OMT treatment is outlined, focusing on techniques like sacrum articulation and distraction, collateral ganglia release and cranial release.
Diarrhea
- Physiology of diarrhea and associated somatic dysfunctions of the parasympathetic and sympathetic nervous systems.
- OMT treatment is outlined similarly.
GI Dysfunction Treatment Goals
- Strategies for treating GI dysfunction, focusing on addressing asymmetries, motion restrictions, tissue texture abnormalities, decreasing pain, eliminating motion restrictions, improving visceral and autonomic activity, decreasing facilitation and trigger points, and enhancing musculoskeletal support.
Treatment Approach
- The presented approach to treating GI dysfunction is dependent on the patient's tolerance level, and includes approaches to the diaphragm, parasympathetic (vagus and pelvic splanchnics), sympathetic (posterior spinal segments, abdominal ganglion) nerves, and visceral manipulation by performing mesenteric or colonic lift, and liver and spleen pumping.
- Recollection of previously learned lymphatic and visceral techniques to improve gut motility is recommended.
Putting it All Together
- Discusses the multiple potential mechanisms affecting the GI system, including primary organ disease, viscerosomatic reflexes, and somatic dysfunction, emphasizing the importance of addressing both the primary organ problem and the resultant somatic dysfunction to facilitate complete recovery.
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Description
Test your knowledge on gastrointestinal dysfunction and related viscerosomatic reflexes. This quiz covers treatment goals, anatomical references, and the connections between organ disease and somatic dysfunction. Perfect for students studying anatomy and physiology.
