class 6: other systems 2 Flashcards
what position do we avoid in pregnancy
Avoid supine hypotensive syndrome
what is the average weight gain in pregnancy
25-35 lbs. essential for baby’s nourishment.
what sidelying do we like
left side lying
Postural changes: preg
Forward head, kyphosis, increased lordosis, anterior pelvic tilt
Postural stress continues even postpartum due to lifting and
carrying of baby
do you go to the bathroom more then 8 times a day - what kind of incontinence if yes
urge
treatment for Postural changes seen with preg
Postural education, stretching of tight muscles and strengthening of
weaker ones, pelvic stabilization exercises, pelvic tilts
BP throughout preg
decreased in first and second trimester and increases in the last trimester
Supine-lying and preg
can cause compression of inferior vena cava (after 4th month).
This declines cardiac output and may cause supine hypotensive syndrome
(No supine lying after 1st trimester)
Resting HR increases by what in preg
increases by 10-20 beats/min.
Left side-lying - preg
is considered the best as it decreases compression
of inferior vena cava, maximizes cardiac output, decreases GERD
as internal organs are relaxed and improves maternal and fetal
circulation
what happens to the ligaments in preg
they get more lax because of the hormone relaxin
therefore in PT intervention we have avoid hyper extension
what is Preeclampsia
Pregnancy induced acute hypertension after the 20th week of
gestation
Increase in protein in urine, hyperreflexia, edema, headache,
sudden weight gain seen
It is an emergency!
what is the BP reading for Preeclampsia
A blood pressure reading more than 140/90 mm Hg.
Second abnormal blood pressure reading four hours after the first
confirms the diagnosis
what is the max time a preg person should lie in supine
5 mins
Vaginal bleeding -preg
Contraindications to Exercise
what is Placenta previa after 26 weeks gestation:
placenta is located on the uterus position in which it may
detach before the baby is delivered
Contraindications to Exercise
what happens to CO and blood volume during preg
both increase
exercise and Maternal type I diabetes
Contraindications to Exercise
Treatment for Diastasis Recti
head left
head lift with PPT
Treatment for Diastasis Recti - head lift
Patient is in hook-lying position and crosses arms around the stomach area for support.
Have client exhale and lift only the head off the floor while at the same time, using her hands to gently approximate the rectus muscles toward midline, then lower the head slowly and relax
Treatment for Diastasis Recti - head lift and pelvic tilt
Patient is positioned in hook-lying. Arms are crossed over the diastasis for support as described in the “head lift” exercise.
Have patient slowly lift only the head off the floor while approximating the rectus muscles and performing a posterior pelvic tilt, then slowly lower the head and relax.
what is Gastroesophageal Reflux Disease (GERD)
Reflux of gastric content of the gastroduodenal
contents into the esophagus.
what are the sym of GERD
- Heart Burn- 30 minutes after eating and at night lying down
- Dysphagia
- Sour Taste- from regurgitation of acids
- Hoarseness of voice
- Atypical pain of the head and neck
Complications seen with GERD
- Aspiration pneumonia, asthma
- Esophagitis
what is the treatment of GERD
Maintain upright positions
Eat meals at least 3-4 hours before sleep
Avoid supine- tends to straighten the esophagus
Sleep on left side preventing nocturnal reflex
Exercise must be completed 2-3 hours after eating or before meals
Avoid spicy, chocolate, fatty food, peppermint
when does preeclamsia occur
during preg in the third trimesters
what is gestiational DM
inc in blood glucose during preg
Mid-back/Scapula - referral pain
Esophagus, gallbladder, stomach, pancreas
what is eclampsia
a rare but serious medical emergency that causes seizures in pregnant or postpartum people
left Shoulder- referral pain
Heart, diaphragm, spleen, tail of
pancreas
right Shoulder- referral pain
Gallbladder, liver, head of
pancreas.
Pelvis/Low Back/Sacrum - referral pain
Colon, appendix, pelvic viscera
Pancoast Tumor (upper lung tumor) referral pattern
Pain referred in C8-T2 nerve distribution “mimics TOS”, Pain top of
shoulder, Ipsilateral shoulder
what is ectopic preg
a pregnancy that occurs when a fertilized egg implants outside of the uterus, usually in a fallopian tube.
cause bleeding and pain
RUQ: pain pattern
Peptic ulcers, gallbladder
pathology, head of pancreas
RLQ: pain pattern
Appendix, Crohn’s disease
LUQ: pain pattern
Tail of pancreas, spleen
pathology
LLQ: pain pattern
Diverticulitis, ulcerative
colitis, IBS
what is hiatal hernia
a condition where the upper part of the stomach pushes up into the chest through the diaphragm, the muscle that separates the chest and abdomen
where does a hiatal hernia pain refer to
causes shoulder pain.
what is diatasis recti
the split of the rectus abd from the linea alba
what is a femoral hernia
femoral hernia is a protrusion of a loop of the intestine through a weakened abdominal wall, located in the lower abdomen near the thigh.
where do we see femoral hernia pain
lateral pelvic
wall pain and groin pain
how do we diagnose diastasis recti
While lifting your upper body slightly, as if to do a crunch, use two fingers to gently push down into the center of your stomach just above your belly button, at your belly button, and just below.
If you feel more than two fingers-width of space between your abdominal muscles, you likely have diastasis recti.
what is inguinal hernia
A condition in which soft tissue bulges through a weak point in the abdominal muscles
diastasis recti - 3-4 cm treatment
abdominal bracing + headlifts
inguinal hernia pain location
causes groin pain
what is a Umbilical hernia
A condition in which the intestine protrudes through the abdominal muscles at the belly button.
diastasis recti - >4 cm treatment
bracing and breathing exercises
diastasis recti - >6 cm treatment
send them out to the dr to get checked
Umbilical hernia pain location
causes pain around the umbilical ring in the mid to lower
abdomen
what is Cholecystitis
Blockage or impaction of gallstones in the cystic duct resulting in inflammation of the gallbladder
with Cholecystitis where do we see pain
Pain in right upper quadrant, radiating to the right
scapula
sym of Cholecystitis
Nausea, vomiting, low grade fever
Pain increases with ingestion of fatty food
what is the special test for Cholecystitis
Murphy’s Sign
how do we do Murphy’s Sign
Palpate near right subcostal margin as patient takes a deep breath; if pain and tenderness is elicited during inspiration, the test is positive
what are the two types of Peptic Ulcers
Gastric (Stomach) Ulcers
Duodenal Ulcers
what is GERD 2/2
problem of the lower esophageal sphinter
this opens and allows for reflux
what is Gastric (Stomach) Ulcers
Ulcerative lesions in the stomach caused by chronic use of NSAIDS, stress, anxiety, H. pylori bacteria
when does pain increase in Gastric (Stomach) Ulcers
Pain increases with the presence of food due to acid secretion, pain after eating
how do we relieve pain with Gastric (Stomach) Ulcers
Pain relieved with antacids, medically treating the H. pylori infection
what is Duodenal Ulcers
Ulcerative lesions in the duodenum caused mainly by H. pylori infection
what side should a pt with gerd sleep on
their left side to prevent nocturnal relfexia
this relaxes the GI organs
when does pain increase for Duodenal Ulcers
Pain increases with absence of food, early mornings and in between meals
when is pain releived with Duodenal Ulcers
Pain relieved by medically treating the H. pylori infection
Pain is burning, cramping in epigastric area, can refered to where
the right shoulder
peptic ulcer disease throw up
Coffee ground emesis and melena
(dark) tarry stools
where is the referreed pain for prostate pain
low back pain
what are the two types of Inflammatory Bowel Disease (IBD)
Crohn’s disease and ulcerative colitis
ulcerative colitis effects what area
only the large instestine and the rectum
continuous lesion
what are the symptoms of ulcerative colitis
rectal pain
bleeding
bloody stool with pus
fecal urgency
wieght loss
what areas does Crohn’s disease effect
anywhere in the GI track
skip lesions
Crohn’s disease sym
pain relieved with passing gas
abd pain
wt loss
where do we see Crohn’s disease pain
RLQ
where do we see ulcerative colitis pain
LLQ
what is IBS
Spastic, nervous or irritable colon
a common digestive condition that affects the large intestine and causes discomfort and changes in bowel habits.
what are the sym of IBS
̶Pain is relieved by defecation
̶Sharp cramps in the morning or after eating
̶Nausea, vomiting, bloating, foul breath, diarrhea
̶Symptoms disappear while sleeping
̶Ribbon like stools
IBS causes
Emotional stress, anxiety, high fat, lactose foods
where is IBS pain located
LLQ
what is the treatment of IBS
Stress reduction, dietary modification, exercise
what is kehr sign
pain referred to the left shoulder on gentle palpation of the abdomen when the patient is lying down with legs elevated.
It is classically associated with splenic rupture.
what is Appendicitis
Inflammation of the vermiform appendix. Progression can lead to a swollen/gangrenous appendix
- If perforated can lead to peritonitis
what are the sym of Appendicitis
̶Pain in right lower quadrant, comes in waves progressing to steady
̶Anorexia, Nausea, Vomiting, elevated temperature, leukocytosis, fever
̶Tender at McBurney’s point, Rovsing’s sign for pain migration, Blumberg’s sign for rebound tenderness
where is pain for Appendicitis
̶Pain in right lower quadrant
where do we see hiatal hernia pain
the left shoulder
it is 2/2 a weakness of the diaphragm
where is McBurney’s Point
on the abdomen, about 1.5–2 inches from the top of the right hip bone towards the navel
what is Rovsing’s Sign
pain felt in the right lower abdomen upon palpation of the left side of the abdomen.
what is blumberg sign
clinical sign that indicates pain when pressure is released from the abdomen, rather than when it’s applied.
It’s a sign of peritonitis, or inflammation of the peritoneum, the membrane that lines the abdominal wall and covers the abdominal organs.
where is referrede pain for the diaphram
L shoulder
severe right scapula pain - what do we think it is based a referred pain
gallbladder
what MSK disease is chron’s disease associated with
reactive arthy: cant see, cant pee, cant climb a tree (OA of the bigs joints)
what disease do we see bloody diarrhea
ulcerative colitis
passing gas vs passing stools disease
passing stool relieves pain in IBS
passing gas relevied the pain the chron’s disease
what is the pinch and inch sign for
divertulitis and apendicitis
A: pain in the RLQ with pinch on the right side
D: pain the LLQ with pinch on the left side
what is diverticulitis
inflammation of irregular bulging pouches in the wall of the large intestine
does supine lying after the 1st trimester cause - hyper or hypotension syndrome
hypotension syndrome
decrease blood flow back to the heart
