Disorders of the Intestines Flashcards
What are the key anatomical features of the small intestine?
• Diameter: ~2.5 cm (1”)
• Length: ~6 m (20 feet) (varies in literature)
• Regions:
1. Duodenum (~30 cm / 1 ft) – Absorbs iron
2. Jejunum (~3.7 m / 12 ft) – Absorbs almost everything
3. Ileum (~2.4 m / 8 ft) – Absorbs bile salts, vitamin B12, water, electrolytes
• Functions: Digestion and absorption
• Surface features:
- Villi with columnar epithelial cells and microvilli (increase surface area to ~200-250 m²)
- Core of villus: Contains blood capillaries and lymphatic vessels
What are the key anatomical features of the large intestine?
• Diameter: ~7.5 cm (3”)
• Length: ~1.5 m (5 feet)
• Sections:
- Ascending
- Transverse
- Descending
- Sigmoid
- Rectum
- Anus
• Functions:
- Absorption (water, electrolytes, vitamins B & K)
- Breakdown, storage, and elimination of indigestible substances
• Surface features:
- Columnar epithelial cells (no villi)
-Goblet cells
- Scattered lymphocytes and lymphatic nodules
What is bowel transit time, and why is it important?
• Definition: The time it takes for food to move from the mouth to the anus.
• Normal transit time:
- Average: 30-40 hours
- Maximum: 72 hours (still normal)
- In females: Can reach up to ~100 hours
• Health implications:
- Intestinal bacteria prefer dietary carbohydrates
- If depleted, bacteria break down proteins, producing byproducts
- Some byproducts are linked to diseases such as colorectal cancer, chronic renal disease, and autism
• Bowel movement regularity:
- Normal range: 3 times a day to 3 times a week
What is gastroenteritis (stomach flu)?
• Definition: Acute irritation and inflammation of the stomach and intestines
• Main symptoms: Vomiting and diarrhea
• Onset: Rapid (1-2 days after exposure)
• Duration:
- Symptoms: 1-3 days
- Virus shedding: Up to 8 weeks
• Complication: Dehydration
What are the causes of gastroenteritis?
• Most common cause: Viruses
- Norovirus (most common cause of serious gastroenteritis & foodborne disease outbreaks)
- Rotavirus (most common cause of diarrhea in infants and young children)
• Norovirus characteristics:
- Highly contagious
- Spreads via contaminated food, water, surfaces, person-to-person contact, and airborne droplets from vomit
- Survives extreme temperatures
What are the signs and symptoms of gastroenteritis?
• Watery, usually non-bloody diarrhea (bloody • diarrhea suggests a more severe infection)
• Abdominal cramps and pain
• Nausea and vomiting
• Occasional muscle aches or headache
• Low-grade fever
What is the massage therapy clinical relevance of gastroenteritis?
• Massage is contraindicated (CI’d).
• Norovirus remains contagious for up to 48 hours after symptoms subside.
• Therapists should not treat patients during this period.
• If a patient had vomiting or diarrhea in the last 48 hours, the therapist should disinfect all surfaces the patient contacted.
What is diarrhea, and how is it classified?
• Definition: Increased intestinal motility resulting in excessive frequent bowel movements (4-20 per day) with high fluid content.
• Types:
- Acute diarrhea: Sudden onset, lasts less than 14 days
- Chronic diarrhea: Persists more than 14 days
• Complication: Dehydration
What are the causes of diarrhea?
• Infectious organisms:
- Viruses (Norovirus, Rotavirus)
- Bacteria (E. coli, Salmonella, Campylobacter)
- Food poisoning
- Contaminated water
- Animal contact
• Food sensitivity: Dairy, soy, etc.
• Drugs: Antibiotics, antacids
What is the massage therapy clinical relevance of diarrhea?
• Massage may not be CI’d, depending on the cause.
• If infectious (e.g., Norovirus), massage should be avoided.
• Caution required for abdominal massage (due to increased intestinal motility).
What is constipation?
• A decrease in intestinal activity
• A common digestive complaint
• Characterized by:
- Hard, lumpy stools
- Straining
- Fewer than 3 bowel movements per week
What are the causes of constipation?
- Failure to respond to the urge to defecate
- Poor dietary habits: Inadequate fibre or fluid intake
- Medications:
• NSAIDs
• Antidepressants
• Opioids
• Antacids - Weakness of the abdominal muscles
- Chronic laxative use
- Inactivity and bed rest
- Pregnancy
- Hemorrhoids (causing pain while defecating)
- Colon obstruction (due to inflamed or twisted bowel, tumor, scar tissue, hernia)
What are the signs and symptoms of constipation?
• Abdominal bloating
• Pain on defecation
• Rectal bleeding (could also indicate colon cancer)
• Low back pain
• Toxicity symptoms:
- Headaches
- Fatigue
- Halitosis (bad breath)
What are the possible complications of constipation?
- Fecal impaction
- Obstruction
What is the treatment for constipation?
• Dietary changes and exercise are the main focus.
• Laxatives, etc., provide relief but do not address the underlying cause.
What is the massage therapy clinical relevance of constipation?
• Massage promotes parasympathetic (“rest and digest”) activation and decreases sympathetic (“fight or flight”) activation.
• Abdominal massage may help stimulate motility locally.
• It is challenging to accurately palpate the intestinal tract due to depth and variation in location among individuals.
What is Irritable Bowel Syndrome (IBS)?
• A long-term or recurrent disorder of gastrointestinal functioning.
• It cannot be linked to a physical problem like an ulcer or cancer.
• Involves the small and large intestines.
• Very common, especially among females.
Characterized by:
• Abdominal pain
• Altered bowel function (constipation and/or diarrhea)
• Bloating
How is IBS diagnosed?
Diagnosis is made after exclusion of other diseases, such as:
• Tumors
• Bacterial inflammation
• Parasitic disease
• Lactose intolerance
• Ulcers
• Biliary tract disease (gall bladder, bile ducts)
• Allergies
• Diverticulosis
• Ulcerative colitis
• Laxative abuse
*IBS is NOT a predisposing factor for colorectal cancer.
What causes IBS?
• No apparent anatomic cause – classed as a “Functional Digestive Disorder”.
Correlations to:
• Inherited sensitivity to GI motility
• Emotional factors
• Diet, drugs, hormones
• Anxiety and depression
• May be a reaction to stress for some individuals.
What is the pathophysiology of IBS?
Small bowel:
• Hyper-reactive to food
• Delayed meal transit in patients prone to constipation
• Accelerated meal transit in patients prone to diarrhea
• Excess mucous production (colonic and small bowel inflammation found in some IBS patients)
• Fecal microflora differs among IBS patients compared to controls
• Hypersensitivity to normal intraluminal pressure
• Heightened pain perception in the presence of normal intestinal gas
Many patients have food intolerances, including:
• Wheat
• Dairy products
• Coffee, tea
• Citrus fruits
• Vinegar
• Spices
What are common symptoms of IBS?
• Abdominal distress
• Pain:
- Diffuse, particularly in the lower abdomen (left > right)
- Acute sharp pain layered over a more constant dull ache
• Variation in stool consistency:
- Hard stools, narrow caliber, painful or infrequent defecation (constipation)
- Diarrhea: small volumes of loose stool, evacuation preceded by urgency
• Dyspepsia (indigestion):
- Upper abdominal pain or discomfort
- Bloating, gas/flatulence, nausea, pyrosis (heartburn)
• Headache, fatigue
• Mental health symptoms:
- Depression, anxiety, difficulty with concentration
- Correlation with socializing difficulties and gut microbiome-brain connection (missing gut bacteria linked to depression)
• Fibromyalgia (pain in muscle/fibrous tissue)
• TMJ/jaw tension
• Sexual dysfunction:
- Dyspareunia (painful sex)
- Poor libido
• Stress triggers: May be triggered by stress
What are the clinical types of IBS?
• Constipation-type IBS:
- Pain in abdomen, triggered by eating
- Relieved by bowel movement
- Bloating, flatulence, nausea, heartburn
• Diarrhea-type IBS:
- Urgent diarrhea during or immediately after a meal
- Pain, bloating, rectal urgency
What is the treatment for IBS?
• Stress relief: Increased stress may worsen symptoms.
• Regular exercise: Helps improve overall symptoms.
• Dietary considerations:
- Reduce or avoid foods that worsen symptoms (e.g., low FODMAP diet)
- FODMAPs: Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are poorly absorbed in the small intestine.
- Fibre supplementation may help constipation and diarrhea.
- Eat smaller, more frequent meals and eat slowly if discomfort occurs after eating.
• Medications:
- Sedatives
- Antidepressants
- Antispasmodics for pain relief
- Antidiarrheals
- Laxatives may help constipation but not pain
- Probiotics may improve IBS symptoms
• Psychotherapy
What is the clinical relevance of massage therapy for IBS?
• Stress relief: As stress can trigger or worsen IBS symptoms.
• Gentle abdominal massage: Avoid deep pressure on painful areas; it may be soothing.
• Positioning: Sidelying may be more comfortable, depending on pain location.
What is Inflammatory Bowel Disease (IBD)?
IBD is an idiopathic disease that possibly involves an immune reaction where the body attacks its own intestinal tract. It includes two major types: Crohn’s Disease and Ulcerative Colitis.
What are the two major types of Inflammatory Bowel Disease (IBD)?
IBD is an idiopathic disease that possibly involves an immune reaction where the body attacks its own intestinal tract. It includes two major types: Crohn’s Disease and Ulcerative Colitis.
What is the relationship between Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD)?
Patients with IBD can also have a coexisting Irritable Bowel Syndrome (IBS).
What is the pathophysiology of Inflammatory Bowel Disease (IBD)?
IBD is characterized by inflammation of the mucosal lining of the intestinal tract. Possible triggers for this immune response include pathogenic organisms, an immune response to antigens (such as proteins from cow milk), or an autoimmune process. There is also a genetic predisposition to the disease.
What are some extra-intestinal manifestations shared by Crohn’s Disease and Ulcerative Colitis?
Extra-intestinal manifestations include:
• Arthritis
• Conditions of the eye, liver, kidney, and skin.
What are common systemic symptoms in patients with Inflammatory Bowel Disease (IBD)?
Systemic symptoms include:
• Fever
• Sweats
• Malaise
• Arthralgia (joint pain)
What is the role of massage therapy in managing Inflammatory Bowel Disease (IBD)?
Massage therapy can help provide relaxation and stress-related pain relief. Gentle abdominal massage may also be soothing. However, care must be taken if the patient has a stoma or colostomy bag.
What is a stoma, and how does it relate to Inflammatory Bowel Disease (IBD)?
A stoma is a small, pinkish circular opening sewn into the body that connects to the digestive system. Patients with an ileostomy or colostomy may have a bag attached to the stoma. An ileostomy bag is usually on the right side, while a colostomy bag is typically on the left side.
How should a massage therapist address patients with an ileostomy or colostomy bag?
• For comfort, treat the patient in sidelying and use pillow support, such as a headrest pillow, around the bag.
• Avoid using lubricant near the stoma, as it can interfere with adhesives used.
• Advise the patient to avoid eating 2-3 hours before the massage to delay intestinal motility.
What are the main characteristics of Crohn’s Disease?
Crohn’s Disease is:
• Idiopathic, inflammatory, chronic, and progressive.
• Inflammation extends all the way through the intestinal wall, from mucosa to serosa.
• A relapsing and remitting disease.
• Can begin in any small segment of the GI tract but has the potential to progress.
• Most commonly appears in early life, with the average diagnosis age being 27 years.
• Genetic influences are significant, especially in people of Ashkenazi Jewish ancestry.
What are the signs and symptoms of Crohn’s Disease?
Common signs and symptoms include:
• Chronic diarrhea
• Abdominal pain, especially in the right lower quadrant
• Weight loss
What are the different manifestations of Crohn’s Disease?
The manifestations of Crohn’s Disease include:
• Stenosing/Stricturing: Affects about 50% of patients with ileitis. It involves muscle hypertrophy followed by collagen/scar deposition, leading to a fixed, scarred obstruction causing painful cramping and requiring surgery. Most patients undergo surgery 8-10 years after disease onset.
• Inflammatory: Affects 30% of patients, localized to the mucosa and submucosa, causing diarrhea and pain due to acute partial obstruction.
• Fistulizing/Perforating: Affects 20% of patients with ileitis, causing inflammation that leads to intra-abdominal fistulae (connections between the diseased bowel wall and other bowel loops or nearby organs like the urinary bladder). Some patients may also experience bowel perforation.
What is the relationship between stenosing/stricturing manifestation and Crohn’s Disease?
Stenosing/Stricturing affects about 50% of patients with ileitis in Crohn’s Disease. Early in the disease, muscle hypertrophy occurs followed by collagen/scar deposition. After 7-8 years, this leads to a fixed, scarred obstruction causing painful cramping, and surgical management is required. Surgery is often performed 8-10 years after disease onset.
What is the inflammatory manifestation in Crohn’s Disease?
Inflammatory manifestation affects 30% of patients with Crohn’s Disease. It remains localized to the mucosa and submucosa, causing diarrhea and pain due to acute partial obstruction.
What is the fistulizing/perforating manifestation in Crohn’s Disease?
Fistulizing/Perforating affects 20% of patients with Crohn’s Disease. It causes inflammation that leads to the formation of intra-abdominal fistulae, either between bowel loops or between the diseased bowel wall and nearby organs such as the urinary bladder. Some patients may also suffer from bowel perforation.
What is Ulcerative Colitis?
Ulcerative Colitis is an idiopathic inflammatory disease that primarily affects the colonic mucosa, although it can also involve the submucosa.
What are the common signs and symptoms of Ulcerative Colitis?
Common signs and symptoms of Ulcerative Colitis include:
• Diarrhea
• Abdominal pain
• Hematochezia (the passing of fresh blood with stools, indicating a source closer to the anus)
How can Ulcerative Colitis present in different areas of the colon?
Ulcerative Colitis can present as:
• Proctitis: Involvement of only the rectum.
• Left-sided Colitis: Involvement from the left side of the colon to the splenic flexure.
• Pancolitis: Involvement of the entire colon.
What is the severity of Ulcerative Colitis and how can it vary?
The severity of Ulcerative Colitis can range from minimal to florid ulceration and dysplasia. In some cases, carcinoma may also develop.
What is the typical histological lesion seen in Ulcerative Colitis?
The typical histological lesion in Ulcerative Colitis is the crypt abscess. This occurs when the epithelium of the crypt breaks down and the lumen fills with polymorphonuclear white blood cells (WBCs). The lamina propria becomes infiltrated with leukocytes.
What happens as the crypts are destroyed in Ulcerative Colitis?
As the crypts are destroyed in Ulcerative Colitis, normal mucosal architecture is lost. The resultant scarring shortens the colon and can lead to narrowing.
What is Diverticulosis?
Diverticulosis is a condition of the large intestine in which multiple small diverticula (out-pouchings) develop through the muscular wall of the mucosa. These diverticula can occur anywhere in the gastrointestinal tract and tend to increase in number as individuals age. The most commonly affected area is the sigmoid colon, which has the highest intraluminal pressure.
What is the difference between Diverticulosis and Diverticulitis?
• Diverticulosis: The out-pouches are not inflamed.
• Diverticulitis: The out-pouches are inflamed, often due to fecal matter or undigested food becoming trapped, causing obstruction, distention, and perforation.
What causes Diverticulosis and Diverticulitis?
• Diverticula develop in response to increased intraluminal pressure, which is related to the volume of colonic contents, leading to herniation of the colon wall.
• Contributing factors include decreased physical activity, poor bowel habits, aging, and a low-fiber diet.
What are the common signs and symptoms of Diverticulosis?
• Most patients are asymptomatic until inflammation develops (leading to diverticulitis).
• Abdominal discomfort may occur in different areas depending on the location:
- Left lower quadrant (most common)
- Right lower quadrant (mimics acute appendicitis)
- Transverse colon (mimics peptic ulcer disease, pancreatitis, or cholecystitis)
• Other symptoms include change in bowel habits (constipation/diarrhea), bloating, flatulence, rectal bleeding, and fever.
What are the complications of Diverticulosis/Diverticulitis?
Complications include:
• Bleeding
• Localized abscess
• Obstruction
• Perforation
• Peritonitis
• Recurrence can lead to the formation of scar tissue, narrowing, and obstruction of the colon lumen.
• Less than 10% of diverticulosis patients develop complications like infection, bleeding, or perforation of the colon.
What is the treatment for Diverticulosis/Diverticulitis?
• Increase fiber in the diet.
• Medications such as antibiotics and pain management.
• Surgery may be required for complicated cases.
How is Massage Therapy clinically relevant to Diverticulosis/Diverticulitis?
• Massage therapy can provide relaxation and stress-related pain relief.
• Gentle abdominal massage may be soothing.
• Sidelying may be more comfortable for patients depending on the location of pain.
What is Appendicitis?
Appendicitis is the inflammation of the vermiform appendix and is considered a clinical emergency. It is one of the more common causes of acute abdominal pain, typically identified by pain in the McBurney’s Point area (about 2/3 of the way from the umbilicus to the right anterior superior iliac spine [ASIS]).
How does dietary fiber affect the incidence of Appendicitis?
The incidence of appendicitis is lower in cultures with a higher intake of dietary fiber. Dietary fiber is thought to decrease the viscosity of feces, reduce bowel transit time, and discourage the formation of fecaliths (stony fecal masses formed from calcium salts and fecal debris).
What causes Appendicitis?
Appendicitis is caused by:
• Obstruction of the lumen of the appendix by a fecalith.
• Twisting of the tissue.
What are the signs and symptoms of Appendicitis?
• Acute inflammation, often presenting as pain in the McBurney’s Point area.
• Patients may lie down, flex their hips, and draw their knees up to reduce movements and avoid worsening the pain.
• Symptoms include:
- Pain (particularly in McBurney’s Point)
- Nausea and vomiting
- Diarrhea
- Low-grade fever
What are conditions that mimic Appendicitis?
Conditions that mimic Appendicitis include:
• Inflammation of the mesenteric lymph nodes.
• Disease of the right ovary and fallopian tube.
• Disease of the distal ileum, such as Crohn’s disease.
What are the complications of Appendicitis?
Complications of Appendicitis include:
• Perforation, leading to peritonitis.
• Abscess formation.
• Septicemia.
What is the treatment for Appendicitis?
Treatment for Appendicitis includes:
• IV antibiotics.
• Surgery (appendectomy).
How is Massage Therapy relevant to Appendicitis?
• Massage is contraindicated (CI’d) for patients with appendicitis.
• Massage therapists should recognize the symptoms that may indicate a medical emergency, such as appendicitis, and seek immediate medical attention for the patient.
What is Peritonitis?
Peritonitis is the inflammation of the visceral and parietal peritoneum. The peritoneum is the serosal membrane lining the abdominal cavity and covering the organs within it. The peritoneum is the largest and most complex serous membrane in the body, and the abdominal cavity is normally a sterile environment. Peritonitis requires prompt medical attention to avoid fatal complications.
What are the causes of Peritonitis?
• Primary: Infection spread from the blood or lymph.
• Secondary (most common): Infection spreads into the peritoneum from the GI or biliary tract.
• Perforation of the bowel (e.g., ruptured diverticulum).
• Perforation of the stomach, intestine, gallbladder, or appendix.
• Pelvic inflammatory disease (PID) in females.
• Post-surgical infection.
• Rupture of ectopic pregnancy (e.g., infected fallopian tube, ruptured ovarian cyst, PID, endometriosis).
• Penetrating wounds (e.g., stab or gunshot).
What are the common signs and symptoms of Peritonitis?
• Acute or insidious onset of symptoms.
• Severe abdominal pain or tenderness (most common symptom).
• Bloating or a feeling of fullness (distention).
• Fever.
• Nausea and vomiting.
• Loss of appetite.
• Diarrhea.
• Low urine output.
• Thirst.
• Inability to pass stool or gas.
• Fatigue.
What are the complications of Peritonitis?
Complications of Peritonitis include:
• Septic shock.
• Dehydration.
• Hepatic encephalopathy (a condition where toxins build up in the bloodstream due to liver disease, leading to brain damage).
What is the treatment for Peritonitis?
Treatment for Peritonitis includes:
• Antibiotics in the hospital.
• Surgery.
• Management to control the infectious source, eliminate bacteria, maintain organ function, and control the inflammatory process.
How is Massage Therapy relevant to Peritonitis?
• Massage is contraindicated (CI’d) for patients with peritonitis.
• Massage therapists should recognize the symptoms of peritonitis as a medical emergency and seek immediate medical attention for the patient.
What is intestinal malabsorption?
A disruption of normal absorption of nutrients (carbohydrates, fats, vitamins, minerals, etc.) across the gastrointestinal (GI) tract.
What are the causes of intestinal malabsorption?
Causes include:
• Antibiotics
• Celiac disease
• Pancreatitis
• Dairy allergies
• Colorectal cancer
• Radiation therapy
What are the signs and symptoms of intestinal malabsorption?
• Diarrhea
• Steatorrhea (excess fat in the feces)
• Flatulence, bloating, abdominal pain & cramps
• Weakness, muscle wasting
• Weight loss, abdominal distension
What is the massage therapy clinical relevance for intestinal malabsorption?
• Provide relaxation and stress-related pain relief
• Gentle abdominal massage may be soothing
• Sidelying may be more comfortable depending on the location of pain
What is celiac disease?
An autoimmune disorder that results in malnutrition, triggered by the ingestion of gluten-containing grains (wheat, barley, rye).
How does celiac disease affect the intestines?
When gluten is ingested:
- The immune system forms antibodies to gluten.
- These antibodies attack the intestinal lining, leading to inflammation.
- This damages the villi, impairing nutrient absorption (especially fat, calcium, iron, and folate (B vitamins)).
Who is at high risk for celiac disease?
People with:
• Type 1 diabetes
• Lupus
• Rheumatoid arthritis (RA)
• Liver disease
• Thyroid problems
What factors may trigger celiac disease to become active?
Celiac disease can become active for the first time after:
• Surgery
• Pregnancy
• Childbirth
• Viral infection
• Severe emotional stress
What are the signs and symptoms of celiac disease?
• Diarrhea or constipation
• Weight loss
• Recurring abdominal pain and bloating
• Gas
• Pale, foul-smelling stool
• Unexplained anemia
• Musculoskeletal complaints (muscle cramps, bone pain, joint pain)
• Tingling/numbness in the legs (due to low calcium & nerve damage)
• Delayed growth and failure to thrive (in children)
• Fatigue
• Dermatitis herpetiformis (gluten-triggered skin rash)
• Amenorrhea (associated with excessive weight loss)
What is the primary treatment for celiac disease?
Permanent removal of gluten from the diet
What is the massage therapy clinical relevance for celiac disease?
• Provide relaxation and stress-related pain relief
• Gentle abdominal massage may be soothing
• Sidelying may be more comfortable depending on the location of pain
• Adjust pressure to any altered sensation in legs
What is a polyp?
A benign (non-cancerous) epithelial neoplasm (growth) that protrudes into the intestinal lumen.
How prevalent are colonic polyps, and who is more affected?
Highly prevalent in the general population, especially with increasing age. Males are affected more than females.
What are the two methods of classifying polyps?
Method of attachment & histologic classification
What are the two types of polyps based on their attachment?
- Pedunculated – Polyps with a stalk
- Sessile – Polyps without a stalk
Why are sessile polyps more concerning than pedunculated polyps?
If cancerous, invasive cells can migrate directly into the submucosa and surrounding structures
More difficult to remove due to their flat attachment
What are the two histologic classifications of polyps?
• Adenomatous
• Hyperplastic
What is an adenoma?
A benign tumour of epithelial tissue in a gland or gland-like structure.
What percentage of polyps are adenomatous?
About two-thirds of all polyps are adenomatous.
Do all adenomatous polyps become cancerous?
No, but nearly all malignant polyps are adenomatous.
What is the most common type of intestinal neoplasm?
Adenomatous polyps
Why are adenomatous polyps removed when detected?
• They are slow-growing overgrowths of colonic mucosa
• Risk of malignancy, especially in larger polyps
How does polyp size affect malignancy risk?
• 90% of adenomas are <1 cm, with a low malignancy risk
• 10% are >1 cm, with an increased risk (10%) of containing invasive cancer
What are the three types of adenomas?
- Tubular
• Most common
• Found anywhere in the colon
• Typically sessile, rounded, smooth surface, small (<1 cm) - Villous
• Most common in the rectum
• Larger than other types
• Sessile, raised, broad-based, shaggy, or cauliflower-like surface
• Highest risk of developing carcinoma - Tubulovillous
• Has characteristics of both tubular & villous
• Intermediate risk for cancer
