Gastro Lab (week 2) Ileocecal Valve Syndrome
IC VALVE SYNDROME
not taught in gastroenterology
lower esophageal sphincter gets all the press, is discussed in GERD
IC valve mentioned in IBS lecture
common
valve normally tonic and closed
opens with gastroileal reflex after eating
ETIO: REMEMBER MAPED
musculoskeletal disarticulationsm (cx and lumbar)
allergies (incl food intol)
parasites, pregnancy (do GI health panel for lg bowel distal)
(prog relax smooth muscle-->incr GERD, may incr IC synd)
emotions/sympathetic dominance
diet, dehydration (some diet irrit)
ATONIC
reflux of large bowel contents
SIBO, dysbiosis (SIBO-->fibromyalgia)
pain: esp suspect ICVS if pain onset without traumatic mechanism, pain doesn't subside
toxicity
chronic abdominal pain
restless legs syndrome
rosacea
diarrhea/constip (rarely constip, depends on bugs present,
gasses made: hydrogen vs methane, methane-->constip, hydrogen-->diarrhea)
HYPERTONIC
constipation
EVAL OF INTESTINE
GASTROSCOPY
goes to 2nd part of duod
**from there to terminal ileum not visualizable by scopes
often ignored
can see some using barium swallow
also capsule endoscopy, take pix all the way through
breath test for SIBO measures gasses after sugar ingested
COLONOSCOPY
looks all the way thru IC valve to terminal ileum
CLINCIAL PICTURE
RUQ OR RLQ pain
D (hydrogen), constip (methane)
R shoulder pain
low back pain
noncardiac chest pain
viral syndrome, flu like sx dt toxins of SIBO
tinnitus (very common)
HypoHCl sx
Nausea
syncope/near syncope/dizziness
head ache
halitosis
facial pallor (also from hiatal hernia)
dark circle under eyes
adrenal gland imbalances (hypo-->atonic valve, hyper-->hypertonic)
MUSCLE TESTING for ICVS
find a strong muscle: demo on deltoid
iliacus often used for open, quads for closed
brush over McBurney's pt R to L (against the flow)
recheck muscle str
brush pt L to R (with the flow)
recheck
if either muscle-->weak then suspect ICVS
ALTERNATE MUSCLE TEST
find strong muscle: pt supine lift bent leg
resist doc who pushes to extend
have pt contact McBurney's pt with both hands and
pull tissue up & left (against flow from ilium-/->cecum)
recheck m
if weak pulling in valve closed direction then valve stuck closed
next pull tissue down and to R, hold down (with flow from ilium-->cecum)
recheck m
if weak pulling toward valve open direction means valve is too open already
*SSL recognizes that this kind of testing requires a leap of faith
he takes the utility of muscle testing to be fact based on his own experience
TX
visceral manip
diet
temp diet recommendations
NMT: C5 and L1 if open, C3 and L3 if closed
supps
psychophysiology of digestion: chewing
SUPPS FOR OPEN VALVE
liquid chlorophyll esp for open, 1 TBS TID
betaine HCl
pancreatic enzymes
adrenal tissu
adrenal botanicals: eleutherococcus, glycyrrhiza, rhodiola, holy basil
adrenal nutrients: B's, C, Zn, B5
SUPPS FOR CLOSED VALVE
calcium (Lowenberg's test, BP cuff on calf, record pressure at which cramp feeling occurs, min 200-220 w/o cramp sensation, if respond at 160 or less then Ca/Mg/K problem, muscle irritable)
choline-->acetylcholine-->peristalsis
pancreatic of plant enyzmes
factors to balance high cortisol (ASI test): ashwaganda, serine phosphate, plant sterols, DHEA
DIET TRANSITION
chew all food until liquid, esp nuts
avoid or minimize:
high fiber and irritant foods incl: popcorn, chips, pretzels, nuts, seeds, whole grains
raw fruits and veg
potent spices: chili, black, cayenne
methylxanthines: chocolate, alcohol, coffee over 2 cups
dairy, wheat, corn, soy (sensitivities and intolerances)
POPCORN IS #1 NONO
HOMEOPATHIC REMEDY BY FRANK KING
combo of remedies for abdominal incl ICVS
antimonium crudum
arsenicum
cinchona
colocynthis
gambogia
gentiana
mangesia
nat sulph
nux vomica
phosphorus
SSL TALK ABOUT
"the weirder the better"
he used to stick to science
now he goes out on limbs
patients come a long way to see him
DEMO
supine
legs straight
testing iliacus
hold R leg up from above toe slightly out, push down on pt leg let her resist
then both knees up
push down on shin with hand under arm
loose fist over mcburneys
testing quad, don't squeeze muscle, position hand below knee in soft muscle
stimulating golgi tendon apparatus makes any muscle go weak
pushing in and up on mcb
test (if weaker then closed)
push in and down on mcb
test (if weaker then open)
+ muscle test mb related to other pathol incl scar from appendectomy
*I ate a huge bowl of popcorn last night
SSL detected incr weakness of rectus femoris when fist over mcb pt
others repeated test, other students
A VISCERAL TECHNIQUE
taking adhesions out of fascia around iliacus muscle
umbilicus in ctr of diamond betw ribs and inguinal
find ilial crest
dig in above crest and move tissue twd umbilicus
looking for tenderness, area with most
dorsiflex foot same side, slowly rotate knee and foot, internal and external rotation
does it intensify at certain ROM?
focus on area of highest intensity, move foot back and forth
clear tenderness while holding point
if pain does not subside: consider IBD or chronic appendicitis
instead of functional condition
pt knows when tenderness is clear through whole ROM
*he wishes we had another way to test this besides muscle testing
because muscle testing is time consuming
"there's some voodoo going on here"
let that sink in and we'll review it