Gastrointestinal Flashcards
Gastroesophageal Reflux Disease (GERD)
Results from incompetent lower esophageal sphincter that allows reflux of gastric contents that can damage esophageal tissue.
Etiology: Weakness, intermittent relaxation, or damage to lower esophageal sphincter due to NSAIDs, alcohol, infectious agents, smoking, and certain prescription meds.
Signs/Symptoms: Heartburn, regurgitation, belching, chest pain, hoarseness and coughing, esophagitis.
Treatment: Pharmacological intervention
PT implications: Recumbent position will cause symptoms. L sidelying preferred over R sidelying to decrease risk of acid flowing into esophagus.
Gastritis
Inflammation of inner layer of stomach.
Symptoms similar to GERD but with higher intensity.
Classified as erosive or non-erosive based on level and zone of injury.
Erosive Gastritis (acute gastritis)
Etiology: Bleeding from gastric mucosa secondary to stress, NSAIDs, alcohol utilization, viral infection, or direct trauma.
Signs/symptoms: Dyspepsia (indigestion), nausea, vomiting, and hematemesis (vomiting blood).
Treatment: Removal of stimulus of disease and pharmacological intervention. Surgery if bleeding continues
Non-Erosive Gastritis (chronic type B)
Etiology: Usually from helicobacter pylon infection (H. pylori).
Signs/symptoms: Usually asymptomatic but will show symptoms with progression.
Treatment: Pharmacological intervention including a proton pump inhibitor and antibiotics.
Peptic Ulcer Disease
Disruption or erosion of GI mucosa. Imbalance between protective mechanisms of stomach and secretion of acids.
Etiology: H. pylori infection and chronic NSAID use. Stress, alcohol, foods, and smoking.
Signs/symptoms: Vary on location and severity of ulcer. Includes epigastric pain, burning or heartburn, nausea, vomiting, bleeding, bloody stools, pain that is relieved by eating.
Treatment: Pharmacological or surgical intervention.
PT implications: Monitor fatigue level, pallor, exercise tolerance, HR, and BP to signs of bleeding.
Malabsorption Syndrome
Reduced absorption and nutrition. Celiac disease, cystic fibrosis, pancreatic carcinoma, pernicious anemia, AIDS, Crohn’s, and Addison’s are some diseases that may present with malabsorption syndrome.
Etiology: Defects in digestion or inability of the intestinal mucosa to absorb to absorb nutrients.
Signs/symptoms: Weight loss, chronic diarrhea, and anemia. Also fatigue, abdominal bloating, steatorrhea (oil covered stool), abdominal cramps, indigestion, bone pain, and excessive gas.
Treatment: Probiotics, antibiotics, dietary modification, vitamins, minerals, and electrolytes.
PT implications: Increased risk for osteoporosis and fracture. Increased risk for swelling and muscle spasms.
Irritable Bowel Syndrome (IBS)
Etiology: Unknown but colon or large intestines may be sensitive to certain foods or stress. Possibly also due to immune system, infection, or serotonin.
Signs/symptoms: Abdominal pain, bloating or distention of abdomen, nausea, vomiting, anorexia, changes in form/frequency of stool, passing of mucus in stool.
Treatment: Lifestyle changes, nutrition changes, decrease in stress, pharmacological intervention, adequate sleep, exercise, psychotherapy.
Diverticulities
Inflamed or infected diverticula.
Etiology: Unknown but likely from low fiber diet.
Signs/symptoms: Abdominal pain, tenderness over L side of lower abdomen, cramping, constipation or diarrhea, nausea, bloating, fever, chills, and vomiting.
Treatment: Diet modification (increased fiber). NG tube may be used in severe cases
Hepatitis
Inflammatory process in liver.
Etiology: Many or viral in nature. Others include chemical reaction, drug reaction, or alcohol abuse. Other viruses include Epstein-Barr, herpes I and II, varicella-zoster virus, and measles.
Signs/symptoms: Fever, flu, abrupt onset of fatigue, anorexia, headache, jaundice, darkened urine, lighter stool, enlarged spleen and liver, and intermittent pruritis.
Treatment: Acute usually resolves with medical treatment. Chronic may require liver transplant.
Hepatitis A
Transmittion via close personal contact with someone that has infection or through fecal-oral route. Does not progress to chronic disease or cirrhosis. Usually recover in 6-10 weeks.
Hepatitis B
Transmission occurs through sharing needles, intercourse with infected person, exposure to infected blood, semen, or maternal-fetal exposure. Often asymptomatic and acute infection can be mild. 10% progress to chronic hepatitis. Vaccinations for treatment.
Hepatitis C
Transmission occurs through sharing needles, intercourse with infected, exposure to infected blood, semen, body fluids, or maternal-fetal exposure. Often asymptomatic and acute infection can be mild.
Increased frequency for Hashimoto’s thyroiditis, diabetes, and corneal ulceration.
Chronic in 50% of cases and cirrhosis of liver in 20% of those cases.
Cirrhosis of the Liver
Healthy tissue replaced with scarred tissue that prevents blood from flowing through organ.
Etiology: Usually alcoholism or hepatitis C
Signs/symptoms: Fatigue, decreased appetite, nausea, weakness, abdominal pain, spider angiomas, and weight loss.
Treatment: Based on causative factors. Liver transplant may be needed in later stages.
PT implications: Note any loss of blood. Avoid Valsalva.
Cholecystitis and Cholelithiasis
Cholecystitis is inflammation of the gallbladder that can be acute or chronic.
Etiology: Most common is gallstones (cholelithiasis) that have become impacted in the cystic duct. Gallstones form from hypomobility fo the gallbladder, supersaturation of the bile with cholesterol or crystal formation from bilirubin salts.
Signs/symptoms: Can be asymptomatic. Or R upper quadrant pain that can radiate into intrascapular region. Other symptoms include jaundice, fever, nausea, vomiting, anorexia, and abdominal rigidity.
Treatment: Low fat diet, lithotripsy procedure to break up gall stones, or laparoscopic cholecstectomy to remove gallbladder and stones from ducts.
Antacid Agents
Action: Neutralize gastric acid and increase intragastric pH.
Indications: Episodic minor gastric indigestion or heartburn, peptic ulcer, GERD
Side effects: Acid rebound phenomenon, constipation or diarrhea, electrolyte imbalance
Examples: Basaljel, tums, milk of magnesia, bromo seltzer
