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  • ACT Series, 7: Postural Drainage & Percussion (PD&P)

    ACT Series, 7: Postural Drainage & Percussion (PD&P)

    As we continue our deep dive into airway clearance when percussion is added to postural drainage it is known as postural drainage and percussion or PD&P in the United States. PD&P is also known by...
  • ACT Series, 6: Postural Drainage

    ACT Series, 6: Postural Drainage

    As we continue our deep dive into airway clearance the first technique for airway clearance was postural drainage (PD). This technique was first seen in a 1934 paper by H.P. Nelson. It operated on...
  • ACT Series, 5; Autogenic Drainage

    ACT Series, 5; Autogenic Drainage

    As we continue our deep dive into airway clearance our second breathing technique for airway clearance is autogenic drainage (AD). This technique was developed in 1967 by Jean Chevaillier and was...
  • ACT Series, 4; Active Cycle Breathing

    ACT Series, 4; Active Cycle Breathing

    As we continue our deep dive into airway clearance our second, most basic, and next easiest airway clearance technique (ACT) is breathing. Breathing is another important part to all other airway...

 Cilia are thought to play an important role in organ placement during the embryonic stage of development in human beings. There are three main medical terms used to describe the position of thoracic and abdominal organs in the human body. They are Situs Solitus, Situs Inversus, and Situs Ambiguous. These terms can be further broken down into several others to further explain exact placements of certain organs or combinations of organs. But today we will focus on these three terms; Situs Solitus, Situs Inversus, and Situs Ambiguous.

According to NORD (National Organization for Rare Disorders) approximately fifty percent of PCD (Primary Ciliary Dyskinesia) patients have some form of organ displacement in the human body. The other approximately fifty percent of PCD patients without organ displacement, as well as the rest of the human population without organ displacement, fall into the Situs Solitus category. A recent study published this month by the U.S. National Library of Medicine cites that out of the fifty percent of people with PCD who have organ displacement, twelve percent of those patients have Situs Ambiguous, also known as Heterotaxy Syndrome, leaving the remaining thirty-eight percent in the Situs Inversus category. It’s important to note here that while fifty percent of people with PCD have some sort of organ displacement, only twenty-five percent of people with organ displacement actually have PCD as well. So what does Situs Solitus, Situs Inversus, and Situs Ambiguous actually mean in terms of organ placement and or displacement?

Let’s begin with Situs Solitus. Situs Solitus is the normal position of the thoracic and abdominal organs. This means the heart is on the left side of the body along with the aorta, bilobed lung, single spleen, stomach, and the systemic atrium of the heart is on the left side of the heart along with the cardiac apex. On the right side of the body is the inferior vena cava, trilobed lung, liver, gall bladder, and the pulmonary atrium is located on the right side of the heart.

Meanwhile in Situs Inversus the thoracic and abdominal organs are reversed or mirrored from their normal positions (Situs Solitus). In the most common situation of Situs Inversus, Situs Inversus Totalis, there is a complete transposition of all abdominal organs and the heart is on the right side (known as Dextrocardia). Dextrocardia literally means right-hearted. This common situation of Situs Inversus rarely involves other heart health issues as well as any other medical issue; with the rare exception of PCD. Levacardia on the other hand is where the heart remains on the left side of the body (normal position) but other organs are reversed or mirrored including in the abdominal cavity. Levacardia usually also always involves other structural defects of the heart which can be life threatening at birth and may require immediate medical intervention.

Then we come to the most confusing; Situs Ambiguous, also known as Heterotaxy Syndrome . Situs Ambiguous is an organ displacement abnormality that involves both components of Situs Solitus and Situs Inversus inside the same patient. These patients exhibit abnormal organ arrangement across the left-right axis of the body. They have neither the normal, usual, reversed, or mirrored placement arrangements. Situs Ambiguous patients tend to have severe cardiac abnormalities, spleen abnormalities (Asplenia or Polysplenia), intestinal rotation, and malabsorption of the abdominal organs. The mortality rate is high in Situs Ambiguous mainly due to the complexities of the malformations, in particular the severe cardiac malformations.

So which Situs are you? Only your physician is qualified to clarify that answer for you. There are many imagining options out there to help your physician determine organ placement; MRIs, Ct-scans, Ultrasounds, and X-rays. Unfortunately the older population and even some of the younger population today may be walking around with organ displacement and not even know it. Their physicians may not even be aware of it either. How can this be you ask? Back in the day when organ displacement was seen on an X-ray, it was often dismissed as the X-ray was backwards and no further investigation was initiated. That is a less common occurrence in modern medicine today. Unusual findings are almost always investigated by a patient’s care team. However it’s possible some organ displacements are still missed to this day, especially if the patient has no other health issues that warrant x-rays or other health interventions or investigations.

Be sure to visit us next week for another Topic Thursday!

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