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Gastrointestinal Flashcards

1
Q

Upper GI

A

*Mouth
- Initiation of mechanical and chemical digestion

*Esophagus
- Transports food from the mouth to the stomach

  • Stomach
  • Grinding of food, secretion of hydrochloric acid and other exocrine functions, secretion of hormones that release digestive enzymes from the liver, pancreas, and gallbladder to assist with digestion
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2
Q

Lower GI - Large Intestine

A

Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Rectum
Anus

  • Continues to absorb water and electrolytes, stores and eliminates undigested food as feces
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3
Q

Lower GI - Small Intestine

A
  • Duodenum
  • Neutralizes acid in food from the stomach and mixes pancreatic and biliary secretions with food
  • Jejunum
  • Absorbs water, electrolytes, and nutrients
  • Ileum
  • Absorbs bile and intrinsic factors to be recycled
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4
Q

Gland Organs for GI system

A
  • Gallbladder
  • Stores and releases bile into the duodenum to assist with digestion
  • Liver
  • Bile is produced and is necessary for absorption of lipid soluble substances, assists with red blood cell and vitamin K production, regulates serum level of carbohydrates, proteins, and fats
  • Pancreas
  • Exocrine - secretes bicarbonate and digestive enzymes into the duodenum; Endocrine - secretes insulin, glucagon, and other hormones into the blood to regulate serum glucose level
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5
Q

Which structure is responsible for producing bile and is necessary for absorption of lipid soluble substances?

A

Liver

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6
Q

What anatomical structure is covered by the epiglottis?

A

larynx

The larynx is located within the anterior aspect of the neck, anterior to the inferior portion of the pharynx and superior to the trachea. The primary function of the larynx is to protect the lower airway by closing abruptly upon mechanical stimulation. The epiglottis is a flap like structure attached to the entrance of the larynx.

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7
Q

Where is the gall bladder located?

A

The gallbladder is located in the right upper quadrant of the abdomen and is inferior to the liver. It acts to store bile created by the liver and release it into the duodenum.

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8
Q

Where is the spleen located and what is its function?

A

The spleen occupies the LUQ and can be palpated prominently when it is inflamed or enlarged. The organ is shaped like a fist and is usually about four inches in length. The spleen controls the amount of red blood cells and helps to fight infections.

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9
Q

What organ is responsible for regulating serum levels of fats, proteins, and carbohydrates?

A

Liver
The liver is a large organ located in the right upper quadrant of the abdomen below the diaphragm. Additional duties of the liver include producing bile, assisting with drug metabolism, and red blood cell and vitamin K production.

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10
Q

Which of the following structures is responsible for digestion of food and absorption of nutrients into the bloodstream?
stomach
small intestine
large intestine
liver

A

small intestine

The small intestine is responsible for digestion of food and absorption of nutrients into the bloodstream. It is made up of three parts: the duodenum, jejunum, and ileum. The small intestine secretes enzymes that digest proteins and carbohydrates.

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11
Q

Adhesion:

A

Fibrous bands of tissue that bind together normally separate anatomic structures.

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12
Q

Anastomosis:

A

Joining of two ducts, blood vessels or bowel segments to allow flow from one to the other. An anastomosis may be naturally occurring or may be created during embryonic development, surgery or by pathologic means.

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13
Q

Ascites:

A

Fluid in the peritoneal cavity, usually causing abdominal swelling

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14
Q

Barium:

A

A substance that, when swallowed or given rectally as an enema, makes the upper gastrointestinal tract visible on x-ray.

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15
Q

Biopsy:

A

Removal of a sample of tissue taken from the body for study, usually under a microscope.

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16
Q

Colectomy:

A

The surgical removal of part or all of the colon.

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17
Q

Colonoscopy:

A

Visual inspection of the interior of the colon with a flexible, lighted instrument inserted through the rectum.

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18
Q

Colostomy:

A

The surgical creation of an opening from the colon through the abdominal wall.

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19
Q

Constipation:

A

Infrequent or difficult passage of stool, secondary to an increase in the hardness of the stool.

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20
Q

Endoscopy:

A

A method of physical examination using a lighted, flexible instrument that allows a physician to examine the inside of the digestive tract.

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21
Q

Endosonography:

A

A diagnostic tool used to visualize the gastrointestinal organs using high-frequency sound waves.

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22
Q

Enema:

A

Injection of fluid into the rectum and colon to induce a bowel movement.

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23
Q

Fecal diversion:

A

Surgical creation of an opening of part of the colon or small intestine to the surface of the skin to allow for stool to exit the body.

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24
Q

Fecal incontinence:

A

Inability to retain stool, resulting in leakage of stool from the rectum.

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25
Q

Fecal occult blood test:

A

A lab test used to check a stool sample for blood.

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26
Q

Fistula:

A

An abnormal or surgically made passage that forms between two internal organs or between two different parts of the intestine.

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27
Q

Gastrectomy:

A

Surgical procedure in which all or part of the stomach is removed.

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28
Q

Gastroscopy:

A

Procedure to examine the upper gastrointestinal tract using an endoscope which is passed through the mouth and into the stomach.

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29
Q

Helicobacter pylori:

A

A type of bacterium that causes infection in the stomach. The bacterium is often the causative agent in peptic ulcers.

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30
Q

leocolectomy:

A

Surgical removal of a section of the ileum and ascending colon.

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31
Q

lleostomy:

A

The surgical creation of an opening from the ileum through the abdominal wall.

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32
Q

Jaundice:

A

A condition in which the skin and eyes turn yellow because of increased levels of bilirubin in the blood.

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33
Q

Laparoscopy:

A

A surgical diagnostic procedure utilizing a fiber optic instrument inserted through the abdominal wall to view organs.

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34
Q

Large intestine:

A

The portion of the digestive tract made up of the ascending colon, transverse colon, descending colon, sigmoid colon, and appendix.

The large intestine receives the liquid contents from the small intestine and absorbs the water and electrolytes from this liquid to form feces or waste.

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35
Q

Laxative:

A

Medications that increase the action of the intestines or stimulate the addition of water to the stool to facilitate bowel evacuation.

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36
Q

Mesentery:

A

A fold of the peritoneum that carries blood vessels and lymph glands, and attaches various organs to the abdominal wall.

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37
Q

Paracentesis:

A

The removal of accumulated fluid from the abdomen.

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38
Q

Peristalsis:

A

Involuntary contraction and relaxation of the muscles of the intestines which propel food.

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39
Q

Polyps (colon):

A

Small, non-cancerous growths on the inner lining of the colon

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40
Q

Small intestine:

A

The portion of the digestive tract that first receives food from the stomach. The small intestine is comprised of the duodenum, jejunum and ileum.

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41
Q

Stoma:

A

An artificial opening of the intestine through the abdominal wall.

42
Q

Thrombosis:

A

The formation of a blood clot in a blood vessel.

43
Q

Ulcers:

A

A break in the lining of the stomach or in the duodenum.

44
Q

Varices:

A

Large, swollen veins that develop in the esophagus or stomach, often causing internal bleeding.

45
Q

What is the most common cause of intestinal obstruction?

A

Adhesions

Intestinal obstruction refers to partial or complete blockage of intestinal flow occurring most commonly in the small intestine. Each of the presented options is a potential cause of intestinal obstructions, however, adhesions are the most common.

46
Q

Ascites is most often caused by:

A

Cirrhosis

Ascites refers to the accumulation of fluid in the abdominal cavity. This condition can cause a significant decrease in breathing capacity. Infection, heart failure, malnutrition, and cirrhosis are all causes of ascites. However, cirrhosis represents nearly 85% of the cases of ascites.

47
Q

Which term is the most appropriate to describe the resection of a portion of the colon?

A

colectomy

A colectomy refers to a resection of a portion of the colon. A colectomy may have an associated colostomy or ileostomy.

48
Q

An artery and vein that are surgically connected in patients who are undergoing hemodialysis is termed:

A

an arteriovenous fistula

In order for patients to receive hemodialysis, vascular access must be achieved. An arteriovenous fistula is a surgical connection between an artery and vein that allows for easy access to the bloodstream. The vascular access is the point at which blood is removed from the patient’s body for dialysis and then returned.

49
Q

What finding is most likely associated with the observation of an extremely purple-blue stoma while changing a patient’s ileal conduit?

A

ischemia

When changing a patient’s ileal conduit, the stoma should appear dark pink to red in color. A dark-blue or purple-blue stoma may indicate compromised circulation or ischemia, while a pale stoma may indicate anemia.

50
Q

An enterostomy is a surgical procedure that creates an artificial stoma into which organ?

A

small intestine

A stoma is an artificial opening of the intestine through the abdominal wall. An enterostomy is the procedure that creates a stoma in the small intestines. The various types of enterostomy are named according to which intestinal segment is involved (e.g., ileostomy).

51
Q

Constipation and diarrhea are common adverse side effects of which category of medication?

A

Antacids

Antacids can produce both constipation and diarrhea depending on the type of antacid used. Constipation is the most common side effect of aluminum-containing antacids, while diarrhea is common with magnesium-containing antacids.

52
Q

Appendicitis

A
  • inflammation of the inner lining of the appendix
  • typically from obstruction or obstruction of the lumen
  • Eventually the wall of the appendix can be ischemic — perforation, gangrene, peritonitis, or abscess
  • S&S:
  • abdominal pain (starts as umbilical or gastric and then migrates to the RLQ)
  • pts try to lay still with hips flexed
  • N/V and anorexia
  • symptoms typically last <48 hrs
  • Exam findings:
  • rebound tenderness, pain with percussion, guarding, and rigidity.
    McBurney’s, pinch and inch, Rosvings sign
  • Lab tests: CBC, C-reactive protein test, urinanalysis
53
Q

Cholecystitis/Cholelithiasis

A
  • Cholecystitis refers to inflammation of the gallbladder that may be acute or chronic.
  • Etiology -
  • The most common etiology is gallstones (cholelthiasis) that have become impacted within the cystic duct.
  • Gallstones develop from hypomobility of the gallbladder, supersaturation of the bile with cholesterol or crystal formation from bilirubin salts. - These stones can also cause infection which exacerbate the condition.
  • Signs and symptoms -
  • typically asymptomatic, if not – RUQ pain.
  • If lodged in cystic duct: severe RUQ pn, with muscle guarding, tenderness, and rebound pain.
    – radiate to the intrascapular region.
    – jaundice, N/F/V , anorexia, and abdominal rigidity.
  • Treatment -
  • no tx for asymptomatic
  • mild symptoms – low-fat diet can decrease gallbladder stimulation
  • symptomatic, a lithotripsy procedure can be used in an attempt to break up and dissolve the stones.
  • Primary treatment is a laparoscopic cholecystectomy to remove the gallbladder and the lodged stones from the ducts.
  • Acute cholecystitis should resolve itself within a week with analgesics, antibiotics, and intravenous alimentary feedings.
54
Q

Rehab considerations with Cholecystitis and Cholelithiasis

A
  • Must be familiar with all signs and symptoms of cholecystitis in order to refer patients to a physician if a change in their status occurs
  • Post-surgical exercises and ambulation are appropriate post laparoscopic cholecystectomy such as breathing exercises, splinting while coughing, and mobility training
55
Q

Cirrhosis of Liver

A
  • Healthy tissue of the liver is replaced with scar tissue that blocks the flow of blood through the organ and prevents the liver from properly functioning.
  • Etiology - The etiology is usually alcoholism or hepatitis C.
  • Alcohol – block the normal metabolism of protein, fats, and carbohydrates. (heavily drinking for more than a decade.)
    – Inflammation of the liver secondary to hepatitis C is also a large causative factor for cirrhosis. Persistent inflammation and slow damage to the liver will result in cirrhosis of the liver after several decades of infection. Other causes include hepatitis B and D, certain drugs, infections, and toxins, specific hereditary diseases, nonalcoholic steatohepatitis, and blocked bile ducts.
  • Signs and symptoms -
  • fatigue,
  • decreased appetite,
  • nausea,
  • weakness,
  • abdominal pain,
  • spider angiomas,
  • weight loss.
  • Common complications from cirrhosis:
  • ascites (water accumulation in the abdomen secondary to decreased production of albumin by the liver),
  • edema in the lower extremities,
  • jaundice,
  • gallstones,
  • increased itching,
  • ecchymosis,
  • bleeding,
  • increase in sensitivity to medications,
  • accumulation of toxins in the brain,
  • portal vein hypertension,
  • development of varices (enlarged blood vessels in the stomach and esophagus),
  • immune system dysfunction,
  • encephalopathy
  • liver cancer

*Treatment -
- Treatment cannot reverse the process or damage, but can slow the process.
- A liver transplant may be necessary to sustain life.

56
Q

Rehab considerations of cirrhosis of the liver

A
  • Recognize that ascites may develop as well as fluid accumulation in the ankles and feet
  • Report any blood loss through nose bleeds, gum bleeds, tarry stools or excessive bruising
  • Avoid all activities that produce the Valsalva maneuver (increase in intra-abdominal pressure)
  • Adequate rest is required to lower the demands on the liver and improve circulation; avoid unnecessary fatigue with therapeutic or daily activities
57
Q

Constipation

A

Infrequent or difficult passage of stool. secondary to increase in the hardness of the stool, and can also appear as a symptoms of certain gastrointestinal pathologies.

  • MS
  • Spinal cord tumors
  • IBS
  • DMD
  • Endocrine disorder
  • Diverticulitis
  • Inactivity
  • Bowel obstruction or fecal impaction
  • Pregnancy
  • CVA
  • Certain meds
58
Q

Crohn’s Disease

A
  • inflammatory bowel disease
  • lining of the GI tract becomes abnormally inflamed
  • any part of GI tract (typically lower (small bowel, colon)
  • idiopathic
  • S&S:
  • develop gradually or rapidly
  • abdominal pain, cramping, and diarrhea
  • blood in the stool, GI tract ulcer, decresed appetite, and weight loss
  • Complications:
  • anal fissures, intestinal fistula, malnutrition, and bowel obstruction.
  • Risk factors: family hx of Chron’s, smoking, maintain a high fat diet.
59
Q

Diarrhea

A

Abnormal frequency or volume of stool that often appears as a symptom of certain gastrointestinal pathologies.

  • Irritable bowel Syndrome
  • Hyperthryoidism
  • Electrolyte imbalance
  • Endocrine disorder
  • Incomplete obstruction of bowel
  • Diverticulitis
  • Certain medications
  • Caffeine
  • Diet
  • Malabsorption
  • Pelvic inflammatory disease
60
Q

Diverticuilits

A
  • Condition of having inflamed or infected diverticula (outpouches on the colon wall).
  • 1/4 of the population that has diverticulosis gets this. .

Etiology -
dominant theory is that the disease results from a low fiber diet.

Signs and symptoms -
- Abdominal pain is the primary symptom of diverticulitis.
- Tenderness over the LLQ
- Cramping,
- Constipation or diarrhea,
- Nausea,
- F/V,chills

  • Treatment -
  • diet modification,
  • controlling the underlying infection,
  • lowering internal colonic pressure through increased fiber intake.
  • In more severe cases, a nasogastric tube may be required to give the intestines a rest. Surgical intervention is indicated for severe obstruction, perforation or necrosis.
  • Complications can include bleeding infections, intestinal blockage, abscess, perforations or tears in the colon, fistulas or peritonitis.
61
Q

Diverticulosis

A
  • condition of having diverticula.
  • The large majority of individuals with diverticulosis are asymptomatic.
  • Risk factors: constipation, a diet low in fiber, obesity, lack of exercise, connective tissue disorder, and advanced age.
  • Symptoms:
  • bloating,
  • mild cramping,
  • both diarrhea and constipation
  • Treatment includes an increased amount of dietary fiber (20-35 grams per day recommended) to avoid diverticulitis.
62
Q

Rehab considerations for Diverticular disease

A
  • Physical activity assists the bowel function and is extremely important during periods of remission .
  • Breathing techniques will assist in stress reduction and with breath-holding patterns (valsava)
  • Avoid any increase in intra-abdominal pressure with exercise or activity
  • Back pain and/or referred hip pain must be examined for possible medical diseases
63
Q

Erosive Gastritis

A

AKA Acute gastritis

  • Etiology -
  • bleeding from the gastric mucosa secondary to stress, NSAIDs, alcohol utilization, viral infection or direct trauma.
  • Signs and symptoms -
  • dyspepsia (indigestion),
  • nausea,
  • vomiting,
  • hematemesis (vomiting blood)
  • at times, the patient may be asymptomatic.
  • Treatment -
  • Supportive with removal of the stimulus of the disease process and pharmacological intervention. - Surgical procedures may be required if the bleeding continues.
64
Q

Gastritis

A

Gastritis is the inflammation of the gastric mucosa or inner laver of the stomach.

  • Symptoms are similar to GERD, however, they tend to have a higher intensity.
  • Gastritis is classified as erosive or non-erosive based on the level and zone of injury.
65
Q

Rehab considerations for pts with gastritis

A
  • Patients with gastritis secondary to chronic NSAID use may be asymptomatic
  • Knowledge of blood in the stool should result in physician referral
  • Educate each patient to take medications with food and avoid certain types of food and drink
  • The patient should avoid all aspirin-containing compounds
66
Q

Gastroesophageal Reflux Disease (GERDS)

A
  • Result of an incompetent lower esophageal sphincter (LES) that allows reflux of gastric contents.
  • This backwards movement of stomach acids and contents can cause esophageal tissue injury over time as well as other pathology.
  • occurs more than twice weekly and some degree with life.
  • Etiology - The etiologies of GED include weakness of the LES, intermittent relaxation of the LES, direct damage of the LES through NSAIDs, alcohol, infectious agents, smoking, and certain prescription medications.
  • Signs and symptoms -
  • heartburn,
  • regurgitation of gastric contents,
  • belching,
  • nausea after eating
  • feeling like food remains trapped in esophagus
  • chest pain,
  • hoarseness and coughing,
  • esophagitis,
  • hematemesis (vomiting blood).
  • left untreated = may develop esophageal strictures, esophagitis, aspiration pneumonia, asthma, Barrett’s esophagitis, and esophageal adenocarcinoma.
  • Treatment - Treatment is primarily through pharmacological intervention.
  • Barium swallow study
  • Risk facts: obese, pregnant, use cigarettes, abuse alcohol or present with a hiatal hernia or scleroderma
67
Q

Rehab considerations for pts with GERDs

A
  • Avoid certain exercise secondary to an increase in symptoms with activity (recumbency will induce symptoms)
  • Recognize increased incidence of neck and head discomfort secondary to perception of a lump in the throat and subsequent compensation
  • LEFT S/L …..(r s/l promotes acid flowing into the esophagus)
  • Recognize conditions such as chronic bronchitis, asthma, and pulmonary fibrosis may all present with GERD
  • Recognize that tight clothing, exercise, and constipation may all precipitate GERD
  • Consider that certain positioning during postural drainage may encourage acid to move into the esophagus
68
Q

What foods to avoid with GERDS?

A
  • Coffee (caffine)
  • High fatty foods
  • large meals
  • peppermint
  • chocolate
  • Fried foods
69
Q

What should be avoided prior to activity/exercise with GERDs?

A

Avoiding fatty foods immediately before activity allows the gastric emptying to take place and limit the effects of reflux.

Avoid high-calorie meals and fatty food intake before exercise

70
Q

Hepatitis

A
  • Inflammatory process with the liver.
  • Viral hepatitis is most common (A,B,C,D,E or G)
  • Etiology - Many instances of hepatitis are viral in nature.
  • Other etiologies include a chemical reaction, drug reaction or alcohol abuse.
  • Other viruses that can cause hepatitis include Epstein-Barr virus, herpes virus I and II, varicella-zoster virus, and measles.
  • Signs and symptoms -
  • fever,
  • flu symptoms,
  • abrupt onset of fatigue,
  • anorexia,
  • headache,
  • jaundice,
  • darkened urine,
  • lighter stool,
  • enlarged spleen and liver,
  • intermittent pruritus.
  • Treatment - Acute viral hepatitis usually resolves with medical treatment, but can become chronic in some cases. Chronic hepatitis may result in the need for liver transplant.
71
Q

Hepatitis A (HAV)

A
  • virus that affects the liver and its function.
  • Transmission occurs by close personal contact with someone that has the infection or through the fecal-oral route (i.e., contaminated water and food sources).
  • Symptoms:
  • The flu-like symptoms represent an acute infection; this form does not progress to chronic disease or cirrhosis of the liver.
  • Patients usually recover in 6-10 weeks.
  • Treatment is supportive and the virus is self-limiting.
72
Q

Hepatitis B (HBV)

A
  • virus that affects the liver and its function.
  • Transmission of this virus occurs through the
  • sharing of needles,
  • intercourse with an infected person,
  • exposure to an infected person’s blood, semen or maternal-fetal exposure.
  • A small proportion of cases progress to chronic hepatitis since the body cannot always rid itself of HBV.
  • Treatment includes hepatitis B immunoglobulin (HBIG for the unvaccinated patient within 24 hours of exposure.
  • The patient should then receive the vaccination series at 1& 6mths.
  • If the patient is already vaccinated, they may require another dose of the HBV vaccine.
  • Chronic hepatitis is now being treated with interferon alfa-2b, providing remission for some patients.
73
Q

Hepatitis C (HCV)

A
  • virus that affects the liver and its function.
  • primary etiologies for chronic liver disease and eventual liver failure.
  • Transmission of this virus occurs through the
  • sharing of needles,
  • intercourse with an infected person,
  • exposure to an infected person’s blood, semen, body fluids or maternal-fetal exposure.
  • accounts for the large majority of post transfusion hepatitis cases. Like hepatitis B, this virus is often asymptomatic and the acute infection can be mild.
  • Patients with hepatitis C have an increased frequency of manifesting conditions such as Hashimoto’s thyroiditis, DM, and corneal ulceration.
  • Treatment may include the use of interferon alfa-2b to reduce the inflammation and liver damage but only a small percentage of patients with hepatitis C benefit from the medication.
  • There is no vaccine to prevent this virus and no immunoglobulin fully effective in treating the infection.
  • Chronic hepatitis occurs in about half of the cases, with some of those cases progressing to cirrhosis of the liver.
74
Q

Rehab considerations for pts with hepatitis

A
  • Health care workers that are at risk for contact with hepatitis should receive all immunizations for HBV,
  • If exposed to blood or body fluids of an infected person must receive immunoglobulin therapy immediately
  • Standard precautions should be followed at all times for protection
  • Enteric precautions are required for patients with hepatitis A and E
  • Recognize that arthralgias may be noted, especially in older patients, and will not typically respond to traditional therapeutic intervention
  • Energy conservation techniques and pacing skills should be incorporated into therapy
  • Balance activities along with periods of rest, avoid prolonged bed rest, and provide patient education regarding signs of relapse or chronic hepatitis
75
Q

Irritable Bowel Syndrome

A
  • IBS consists of recurrent symptoms of the upper and lower gastrointestinal system that interfere with the normal functioning of the colon.
  • Etiology - unknown,
  • 1 theory: that the colon or large intestine may be sensitive to certain foods or stress.
  • Other theories hypothesize that the immune system, serotonin, and bacterial infections may all be causative factors.
  • Females have a slightly higher rate of incidence which may be triggered by food sensitivities, stress, anxiety, caffeine, smoking, alcohol or high fat intake.
  • Signs and symptoms -
  • abdominal pain,
  • bloating or distention of the abdomen,
  • N/V,
  • anorexia,
  • changes in form and frequency of stool,
  • passing of mucus in the stool.
  • Treatment - IBS is normally a diagnosis of exclusion from other GI diagnoses and treatment is usually multifactorial.
  • Change in lifestyle and nutrition, decrease in stress, pharmacological intervention, adequate sleep, exercise, and psychotherapy may all assist in alleviating symptoms.
  • Should avoid large meals, milk, wheat, rye, barley, alcohol, and caffeine.
  • does not lead to serious disease.
  • Symptoms can typically be controlled by diet, pharmacological intervention, and stress management.
76
Q

Rehab considerations for pts with IBS

A
  • Emphasize physical activity to assist with bowel function and relieve stress
  • Emphasize breathing techniques to assist in stress reduction and with breath-holding patterns
  • Recognize that biofeedback training may be beneficial
77
Q

Malabsorption Syndrome

A
  • Condition characterized by a group of pathologies where there is reduced intestinal absorption and inadequate nutrition. Celiac disease, cystic fibrosis, pancreatic carcinoma, pernicious anemia, AIDS, Crohn’s disease, and Addison’s disease are a few pathologies that may present with malabsorption syndrome.
    Etiology - Malabsorption syndrome occurs secondary to defects in digestion and/or the inability of the intestinal mucosa to absorb the nutrients from digested food.

S&S -
- abdominal distention
- bloating,
- flatulence,
- diarrhea,
- steatorrhea (presence of fat in feces)
- foul smelling stool
- weight loss
- weakness
- fatigue
- Signs of nutrient deficiency: anemia, edema, m cramps, and excess bloating.

Treatment - Once diagnosed, treatment includes avoidance of the underlying cause for the malabsorption, probiotics, ant. biotics, dietary modification, and nutritional support including vitamins, minerals, and electrolytes.

78
Q

Rehab considerations for pts with malabsorption syndromes

A
  • Recognize increased risk for osteoporosis and pathologic fractures
  • Monitor fatigue level, pallor, bone pain, and exercise tolerance
  • Recognize weight loss and abdominal bloating
  • Recognize increased risk for muscle spasms secondary to electrolyte imbalances
  • Recognize increased risk for generalized swelling secondary to protein depletion
79
Q

Non-errosive Gastritis

A

Aka chronic type B gastritis

Etiology - This condition is typically a result of a helicobacter pylori infection (H. pylori).

Signs and symptoms - The patient is usually asymptomatic but will show symptoms if the gastritis progresses.

Treatment - H. pylori is a carcinogen and must be treated aggressively. Pharmacological intervention is most common and typically includes a proton pump inhibitor and antibiotics.

80
Q

Peptic Ulcer Disease

A
  • disruption or erosion in the gastrointestinal mucosa.
  • There is an imbalance between the protective mechanisms of the stomach and the secretion of acids within the stomach.
  • Etiology - Many ulcers are caused by the H. pylori infection and chronic NSAID use.
  • Irritants that increase risk of ulcer include stress, alcohol, particular medications, foods, and smoking.
  • Signs and symptoms -
  • epigastric pain,
  • burning or heartburn,
  • N/V
  • bleeding,
  • bloody stools,
  • gastric ulcer – pain shortly after eating
  • duodenal ulcer – relief after eating (but pain 2-3 hours after that will wake at night)
  • Symptoms specific to the etiology of H. pylori can also include halitosis, rosacea, and flushing.
  • Complications can include hemorrhage, perforation, obstruction (secondary to scarring), and malignancy.
  • Treatment - Treatment is primarily through pharmacological intervention, however, in more severe cases, surgical intervention may be required.
81
Q

S&S of perforation

A
  • abdominal guarding
  • rigidity or rebound tenderness
  • more generalized but sharp abdominal pain that worsens with movement
  • Emergent if perforation is suspected – signs of septic shock, anuria, hypotension, or tachycardia
82
Q

Rehab considerations for pts with peptic ulcer disease

A

• Asymptomatic patients with history of ulcer should be monitored for signs of bleeding
• Fatigue level, pallor, and exercise tolerance must be monitored for signs of bleeding
• Recognize that heart rate increase or blood pressure decrease may be signs of bleeding
• Recognize that back pain is a sign of a perforated ulcer located on the posterior wall of the stomach and duodenum
• Recognize that pain that radiates from the midthoracic area to the right upper quadrant and shoulder may signify blood and acid within the peritoneal cavity secondary to a perforated and bleeding ulcer

83
Q

Ulcerative Colitis

A
  • inflammatory bowel disease – chronic inflammation and formation of ulcers in GI tract
  • innermost lining of the large intestine and rectum (sigmoid colon is the most common)
  • S&S:
  • abdominal pain and cramping
  • diarrhea*
  • blood in the stool*
  • urgency too defecate
  • weight loss
  • fatigue
  • fever
  • symptoms are often intermittent, alternating between exacerbation and remission.
  • systemic symptoms can also occur (arthritic joints, skin disorder, visual issues)
  • increased CA risk
  • Primary test for UC is endoscopy.
84
Q

Pain beginning as either umbilical or gastric pain that migrates to the RLQ is a common symptoms of which pathology?

A

Appendicitis

85
Q

Which of the following types of hepatitis is transmitted via a fecal-oral route?

A

hepatitis A

Hepatitis A (as well as hepatitis E) is spread by feces, saliva, and contaminated food/water. A large risk factor for contracting hepatitis A is visiting or living in an underdeveloped country.

86
Q

Which of the following is characterized by progressive, chronic inflammation of the liver with loss of normal tissue that is replaced by fibrosis?

A

cirrhosis

Cirrhosis of the liver is a condition where healthy tissue is replaced by scar tissue that blocks the flow of blood through the organ and prevents proper functioning. The onset of cirrhosis is typically the result of alcoholism or hepatitis C.

87
Q

What condition is characterized by stomach pain that occurs repetitively several hours after a meal?

duodenal ulcer
appendicitis
gastroesophageal reflux disease
gastric ulcer

A

duodenal ulcer

The duodenum is the most proximal segment of the small intestine, where food empties from the stomach. A patient with a duodenal ulcer will typically report pain two to three hours after a meal. In contrast, a patient with a gastric ulcer will typically report pain shortly after eating.

88
Q

Which of the following conditions is commonly associated with helicobacter pylori?

gastroesophageal reflux disease
dysphagia
gastric ulcers
inflammatory bowel disease

A

gastric ulcers

Helicobacter pylori is a gram-negative bacterium found in the stomach. The bacterium is associated with chronic gastritis and gastric ulcers, and is linked to the development of duodenal ulcers and stomach cancer.

89
Q

Upper right quadrant pain with radiation to the right scapula is most consistent with:

A

Gallstones

Gallstones (cholelithiasis) can refer pain to the upper right quadrant, although are often asymptomatic. Kidney stones refer pain to the lower right or lower left quadrant; appendicitis refers pain to the lower right quadrant; aortic aneurysm refers pain to the upper left quadrant.

90
Q

What substance contributes to the formation of gallstones?

bile
insulin
pepsin
hydrochloric acid

A

Bile

Gallstones are usually composed of cholesterol that has crystalized from bile. Bile is especially important for digestion and absorption of fats and fat-soluble vitamins in the small intestine.

91
Q

Output from a colostomy appears to be mostly liquid. Which type of colostomy would MOST likely produce this type of output?

1.Sigmoid colostomy
2.Descending colostomy
3.Ascending colostomy
4.Transverse colostomy

A

Ascending colostomy

92
Q

What is a colostomy?

A
  • Surgical opening in the colon created for the elimination of feces.
  • This type of procedure can be required when an injury or pathology prohibits the colon from functioning properly.
  • There are several unique types of colostomies including ascending, transverse, descending, and sigmoid.
  • The farther along the intestinal tract that fecal material travels, the more it resembles the consistency of normal defecation.
93
Q

What is significant about the sigmoid colon and a sigmoid colostomy?

A
  • Final portion of the large intestine and serves as a connection to the rectum.
  • A sigmoid colostomy is the MOST COMMON TYPE of colostomy, located a few inches lower than a descending colostomy.
  • As a result, this type of colostomy has additional working colon and can produce SOLID stool on a regular schedule.
94
Q

What is significant about the descending colon and the descending colostomy?

A
  • Located on the left side of the abdomen follows the transverse colon and the splenic flexure.
  • A descending colostomy results in a large portion of the colon remaining active and therefore the OUTPUT is often FIRM, although tends to be somewhat IRREGULAR.
95
Q

What is significant about the ascending colon and ascending colostomy?

A
  • Located on the right side of the abdomen, is the beginning portion of the large intestine.
  • The ascending colon extends upward to a bend in the colon called the hepatic flexure.
  • An ascending colostomy results in only a very short portion of the colon remaining active and as a result the OUTPUT is primarily LIQUID containing many digestive enzymes.
96
Q

What is significant about the transverse colon and transverse colostomy?

A
  • Located across the upper portion of the abdomen, follows the ascending colon and the hepatic flexure.
  • Ends with a bend in the colon called the splenic flexure.
  • A transverse colostomy may produce SOFT OF LOOSE stool at infrequent intervals.
97
Q

If a patient is positive for helicobacter pylori bacterium. What do they likley have?

A

Gastric ulcer disease

98
Q

Chron’s disease

A
  • Type of IBD
  • Chronic, lifelong, inflammatory disorder
  • Any portion of the intestinal tract (most common ileum or colon)
  • Increased CA risk

S&S:
* Skin lesion, granulomas, thickened bowel wall, fissures/fistulas.
* Abdominal pain
* Diarrhea
* Anorexia/weight loss

  • Check for signs of dehydration (dry lips, dry hands, HA, brittle hair, incoordination, disorientation)
  • Increased risk for Osteoporosis.
  • common complication of chron’s is a psoas abcess (due to direct extensio nof intr-abdominal infections into the psoas m fibers)
99
Q

Psoas abscess

A
  • common complication of Chron’s disease.
  • most commonly results from direct extension of intraabdominal infections such as appendicitis, diverticulitis, and CD.
  • S&S: fever, lower abdominal pain, or referred pain
  • Flexion deformity of the hip may develop from a spasm.
  • (+) psoas sign
  • Exacerbated by hip extension
  • tender or painful mass may be palpated in groin.
100
Q
A
101
Q
A

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