September 2007

Abdominal palpation IV

by Dr. Howard Loomis

Imagine if you, as a chiropractor, could accurately identify the source those ambiguous (and even ubiquitous) digestive complaints that seemingly defy diagnosis. Imagine effectively treating patients when pharmaceutical measures have failed, as they often do. I am not talking about diagnosing and treating gastrointestinal diseases but identifying and resolving digestive problems before a disease process begins. If you have been following this column month‑to‑month, you are already aware that clinical proficiency in this area is easily achieved by chiropractors and celebrated by their patients.

This is the fourth and final column on abdominal palpation of the digestive tract. Previously, I have outlined the justification and methodology for palpating the abdomen and correlated those findings to their spinal innervation. I have stressed the importance of identifying when, why, and how a visceral incompetence can and frequently does perpetuate a musculoskeletal problem and prevent its correction. I need only mention it is quite probable that a seemingly unrelated visceral dysfunction perpetuates and prolongs the pain associated with reflex sympathetic dystrophy.

What if you accurately diagnosed and corrected one such problem? What would that do for your reputation within your community and with the associated insurance company and other related health care providers? Remember chiropractic is the only health care science that can combine structure, visceral function, and neurology into a comprehensive diagnosis of each individual patient.

Recap

In last month's column, I described palpation of the upper abdomen and the digestive tract. I discussed the epigastrium and differentiating pain from the following areas:

Epigastrium ‑‑ Pain here corresponds well to the site of irritation:

***  Esophagus (T5‑T6)

... Upper esophagus = pain in the suprasternal notch or beneath the manubrium

... Mid‑esophagus = beneath the mid‑sternum

... Lower esophagus = beneath the xiphoid process or in the epigastrium

***  Stomach (T7‑T9)

***  Duodenum (T9‑T11)

Upper right quadrant ‑‑ Gallbladder and liver (T4‑T9)

Upper left quadrant ‑‑ Jejunum (T9‑L1)

Conclusion

This month, I will finish palpation of the digestive tract.

Midgastric ‑‑ The pancreas (T5‑T9)

... Involvement of the pancreas is one of the most difficult conditions to diagnose, although poorly localized pain in the upper left quadrant or epigastrium or back is frequently encountered. Anorexia, weight loss, and depression are suggestive.

Periumbilical ‑‑ The small intestine (T9‑L1)

... Generally, pain from the small intestine is periumbilical and poorly localized, with a tendency for lesions of the jejunum to be felt in the upper left quadrant, and ileal pain felt in the lower right quadrant. Intestinal pain is frequently colicky in nature. Each wave is brief, lasting less than a minute. In between waves, the patient is symptom‑free. Audible bowel sounds may be heard synchronous with the pain. The patient often feels the need to defecate, and in irritable bowel syndrome and regional enteritis, pain is relieved by bowel movement.

Intestinal obstruction is characterized by colicky pain. Vomiting is characteristic of upper obstruction, while distention with constipation typifies lower bowel obstruction. Persistent or continuous periumbilical colicky pain suggests acute mesenteric artery occlusion and peritonitis.

Lower Left Quadrant ‑‑ The colon (L1‑L3)

... The afferent innervation of the colon, above the sigmoid, is also carried in the sympathetic trunks. Below this level, it is supplied by afferent fibers through its mesentery from the lower thoracic and upper lumbar segmental nerves, without involvement of the sympathetic or parasympathetic pathways. Pain from the transverse and descending colon is typically located in the lower left quadrant. Because the sigmoid colon is most frequently the site of diverticula, the pain of acute diverticulitis is located in the lower left quadrant. The clinical picture has been likened to "left‑sided appendicitis." Previous history of similar attacks, deranged bowel habits, and the absence of epigastric or periumbilical pain favor the diagnosis of diverticulitis.

Lower right quadrant ‑‑ Ileum ‑‑ cecum ‑‑ ascending colon ‑‑ lower thoracic ‑‑ upper lumbar

... Pain emanating from the ileum, cecum, and ascending colon is usually felt in the lower right quadrant. Acute appendicitis usually begins with epigastric or periumbilical pain accompanied by nausea and vomiting. Several hours later the pain shifts to the lower right quadrant when fever and leucocytosis become evident. Poor protein digestion, evidenced by a high urinary indican level and abdominal muscular weakness, is first evidenced in the lower right abdominal quadrant accompanied by the ileocecal valve trigger point.

The sigmoid colon ‑‑ Lower lumbar

... Pain from the sigmoid colon often produces suprapubic pain or pain located posteriorly in the region of the sacrum.

The rectum (S2‑S4)

... The rectum receives afferent nerves through the parasympathetic rami from S2 to S4.

Next time, I will begin discussion of the other abdominal organs with emphasis on the immune (reticuloendothelial) system, which becomes involved when digestive organs are stressed and function inadequately.

(Dr. Loomis can be reached by mail at 6421 Enterprise Lane, Madison, WI 53719 or by phone at 1‑800‑662‑2630. Visit his website at http://www.loomisenzymes.com.)