Gastrointestinal System Flashcards
1
Q
Aspects of the Gastrointestinal System
A
Motility
Secretion
Digestion
Absorption
2
Q
GI System Nervous System
A
GI System has its own Nervous System: The Enetric Nervous System
80-90% of all immune sytem cells are in the gut
3
Q
Quadrants of the Abdomen
A
Right Upper Quadrant
Left Upper Quadrant
Right Lower Quadrant
Left Lower Quadrant
4
Q
Regions of the Abdomen
A
Right Hypochondriac Region
Epigastric Region
Left Hypochondriac Region
Right Lumbar Region
Umbilical Region
Left Lumbar Region
Right Iliac Region
Hypogastric Region
Left Iliac Region Right
5
Q
Common GI Disorders:
Clinical Presentation
A
Abdominal Pain
Dysphagia
Odynophagia (pain while swallowing)
GI Bleeding (Emesis, Melena)
Epigastric Pain w/ Radiation to Back
Symptoms affected by Food
Early Satiety w/ Weight Loss
Constipation
Diarrhea
Fecal Incontinence
Arthralgia
Referred shoulder pain
Psoas abscess
Point tenderness over McBurney’s
Neuropathy
6
Q
Peritoneum Layers
A
Parietal Peritoneum, Outer Layer attached to the abdominal wall
Visceral Peritoneum, Inner Layer wraps around organs
7
Q
Peritoneum
A
One continuous sheet with 2 layers. Between the layers is filled w/ Serous fluid.
Provides support and protection and a conduit that the arteries, veins, nerves, lymphatics travels through
8
Q
Abdominal Pain
A
Visceral (internal organ) pain aligns in the midline (Epigastric, Umbilical, Hypogastric regions)
Site of pain aligning with dermatomes
9
Q
Abdominal Pain Patterns
A
Most common pain patterns associated with GI system is from
Inflammation
Organ Distention
Necrosis
10
Q
Epigastric Pain
(Above Pain)
A
Organs innervated by T3-T5
Mid-Sternum to Xiphoid Process
Heart, Esophagus, Stomach, Duodenum, Gallbladder, Liver
11
Q
Periumbilical Pain
A
Organs innervated by T9-T11
Umbilicus located same level as L3-L4. May have pain in the Lower Back
Small Intestine, Pancreas, Appendix
12
Q
Hypogastric Pain
(Below Stomach)
A
T10-L2
Large Intestine and Colon
13
Q
Pain Patterns:
Esophagus
A
T4-T6
Sub-sternal or Upper Abdomen
14
Q
Pain Patterns:
Stomach
A
T6-T10
Mid-Lower T-Spine or Upper Abdomen
15
Q
Pain Patterns:
Small Intestine
A
T7-T10
Mid T-Spine
16
Q
Pain Patterns:
Pancreas
A
T6-T10
Upper & Lower T-Spine and Upper Abdomen
17
Q
Pain Patterns:
Gallbladder
A
T7-T9
R Upper Abdomen
R Middle & Lower T-Spine
18
Q
Pain Patterns:
Liver
A
T7-T9
R Mid & Lower T-Spine
R C-Spine
19
Q
Pain Patterns:
Bile Duct
A
T6-T10
Upper abdomen and Mid L-Spine
20
Q
Pain Patterns:
Large Intestine
A
T11-L1
Lower Abdomen and Mid L-Spine
21
Q
Pain Patterns:
Sigmoid Colon
A
T11-T12
Upper Sacral region, Suprapubic region, LLQ Abdomen
22
Q
GI System Anatomy, Function, Innervation (Review)
A
Pull up the slides for Images
Slide 9
23
Q
GI System Pathology:
Esophagus
A
Hiatal Hernia, GERD, Esophageal Cancer
24
Q
GI System Pathology:
Stomach
A
Gastritis, Peptic Ulcer, Gastric Cancer
25
GI System Pathology:
Intestines
Malabsorption, Appendicitis, IBS, Crohn's, Ulcerative Colitis, Colon Cancer, Diverticulosis/itis
26
GI System Pathology:
Gallbladder
Gallstones (Cholelithiasis), Cholecystitis
27
Causes of Upper Abdominal Stomach Symptoms
GERD
Peptic Ulcers
Gastritis
Gastroparesis
Gallstones
28
Causes of Lower Abdominal Stomach Symptoms
Celiac Disease
Diverticular Disease
Inflammatory Bowel Disease
Irritable Bowel Syndrome
29
Esophageal Cancer FACTS
7th most common WORLDWIDE
6th leading cause of death
5 year survival rate <20%
1% of all cancer in US
30
Esophageal Cancer SYMPTOMS
Difficulty swallowing, weight loss, chest pain, cough, hoarse, progressive indigestion
31
Esophageal Cancer FACTORS
Tobacco
Alcohol
GERD
Obesity, >55 y.o.,
Poor Nutrition
32
Stomach Cancer FACTS
90% caused by inner stomach lining
Common age 65+, men>women, steady decline in function
33
Stomach Cancer SYMPTOMS
Fatigue
Bloating post-meals
Feel full after consuming small amounts of food
Persistent N/V
Weight loss
Stomach Pain
34
Intestinal Cancer SYMPTOMS
Abdominal Pain
Weight Loss
Weakness or Fatigue
Bloody or Tarry Stools
Lump in Stomach Area
35
Colorectal Cancer FACTS
2nd leading cause of deaths in US
4th most common cancer in US
Death rate decreasing
Screen at 45-75
36
Gall Bladder Cancer FACTS
Asymptomatic
Severity increases after diagnosis
Women > men, increased risk with age, h/o chronic problems
37
Colorectal Cancer PREVALENCE
Colorectal cancer is rising in young adults.
Currently the deadliest cancer among young men and the second deadliest with women
38
Rectal Cancer DIAGNOSIS
Rectal Cancer is more common than Colon Cancer in young patients
Delays in dx occur in 15-50% of cases
At 45 y.o. begin checking
39
Esophagus:
Function
Transports food/liquid from mouth to stomach
40
Esophagus:
GERD
Problems related to backward flow of stomach acid and contents into the esophagus
Sphincter between the esophagus and stomach is malfunctioning and reverses the flow of acid
41
Esophagus:
Peptic Ulcer
Loss of tissue lining the lower esophagus, stomach, and duodenum
42
Esophagus:
Aggravating Factors
Positioning
Restrictive Clothes
Laying down after eating
43
GERD:
Signs and Symptoms
Heartburn, Chest pain, Dyshpagia
Wheezing, hoarseness, coughing, earache, sore throat, and difficulty swallowing
44
GERD:
Complications
Discomfort to strictures of Esophagus, Esophagitis, Aspiration Pneumonia, and Asthma
45
GERD:
Alarm symptoms
Respiratory Distress, Apnea, Dysphagia, and failure to thrive
46
GERD:
Medical management
Treat with Antacids, H-receptor blockers, and Proton pump inhibitors
47
Peptic Ulcer
Majority due to H. Pylori infection
Due to chronic use of NSAIDs
(Aspirin, Ibuprofen, and Naproxen)
48
Peptic Ulcer:
Cardinal Symptoms
Epigastric pain
Heartburn
Aching near Xiphoid
Pain comes in waves and can radiate to the back or R Shoulder
49
Peptic Ulcer:
Signs of Perforation
Bleeding, obstruction including vomiting blood, and melena
50
Ulcers after Food
Pain 30-90 minutes after eating
Pain 2-4 hrs after eating may indicate a pyloric or duodenal ulcer
Pain between 12am-3am indicates duodenal ulcer or cancer pain
Cancer pain is higher intensity than 7/10
51
Early Satiety
1-2 bites of food makes you full
Sensation of fullness is out of proportion with time of previous meal and degree of hunger
Symptom of obstruction, stomach cancer, gastroparesis, peptic ulcer disease, or other tumors
52
Stomach:
Gastritis
Inflammation of the stomach lining
53
Gastritis:
Symptoms
Nausea
Vomiting
Indigestion
Coughing up blood
54
Stomach:
Peptic Ulcers
Occurs when the stomach lining has been worn down and ulcer formation occurs caused by either: infection or long-term use of NSAIDS
55
Peptic Ulcers:
Symptoms
Pain
Heartburn
Nausea
Vomiting
Bleeding
Cyclic Pain
Weight Loss
Lightheadedness
56
Intestines:
Irritable Bowel Syndrome
GI system is abnormally functioning contributing to abdominal pain
57
Irritable Bowel Syndrome:
Symptoms
Diarrhea
Constipation
Chronic pain
58
Intestines:
Malabsorption Syndrome
Nutrients are not absorbed through the GI tract and can contribute to malnutrition
59
Malabsorption Syndrome:
Symptoms
Gas
Bloating
Abdominal Discomfort
Weight Loss
Weakness
Diarrhea
Fatigue
Bloating
Indigestion
60
Constipation
Prolonged retetnion of fecal content in GI tract resulting from decreased motility of colon or difficulty expelling stool
61
Functional Constipation
Straining during poop
Hard, lumpy stools
Incomplete evacuation
Anorectal obstruction
Facilitation of poop
Less than 3 poops per week
Insufficient Criteria for IBS
62
Obstipation
Intractable constipation
Results in fecal impaction that must be removed
63
Influences of Bowel Habits
Diet
Smoking
Medication
Personality
Mood
Stress
Inactivity
Disease of Digestive System
Extra-Abdominal Diseases
64
Constipation:
RED FLAG SYMPTOMS
Occurs suddenly and with unaccountable changes in bowel habits or blood in stools
65
Diarrhea
Abnormal increase in stool frequency and liquidity
Accompanied by urgency, perianal discomfort, and fecal incontinence
66
Diarrhea:
Causes
Food
Alcohol
Laxatives
Drug Use
Medication
Travel
67
Chronic Diarrhea
Weight loss indicative of neoplastic or inflammatory bowel disease
68
Diarrhea:
C. Difficile
May cause colitis and can cause severe diarrhea
69
Fecal Incontinence
Inability to control evacuations of stool and associated with urgency, diarrhea, and abdominal cramps
70
Causes of Fecal Incontinence
Partial obstruction of the rectum, colitis, and radiation therapy
Anal distortion secondary to traumatic childbirth, hemorrhoids, and hemorroidal surgery
71
Malabsorption Syndrome:
Treatment
Dietary modifications
Probtiotics
Nutritional Support
Balance electrolytes
72
Malabsorption Syndrome:
Monitoring
Increased risk of Osteoporosis and fractures
Monitor fatigue levels and tolerance
Abdominal Bloating or Weight Loss
73
Intestines:
Diverticulosis
Small puches or pockets in wall of digestive tract
Symptoms: Asymptomatic, bloating, cramps, constipation
74
Intestines:
Diverticulitis
Infection or inflammation in pouch like protrusions in the intestines or colon
Symptoms: asymptomatic, bloating, cramps, constipation, nausea, vomiting, fever, localized pain, tender to touch
75
Intestines:
Inflammatory Bowel Diseases
1.6 million in US diagnosed, majority age 15-25 years
3x greater risk for blood clots
Higher risk for colorectal cancer
76
Inflammatory Bowel Disease:
Ulcerative Colitis
Inflammation or ulceration of inner lining with frequent diarrhea
77
Inflammatory Bowel Disease:
Crohn's Disease
Can affect any part of the GI tract, often in distal small or large intestine
Slow progressive onset, fever, abscess, LBP relief after POOP
78
Irritable Bowel Syndrome "IBS"
Functional disorder of motility in small and large intestines
AKA Spastic colon, Irritable Colon, Nervous indigestion
79
IBS Risk Factors
Common in ages 50 and below
Family hx, Emotional Stress, Anxiety, Food intolerance, Abuse, Digestive infection
80
IBS Patterns
IBS-D: Diarrhea Predominant
IBS-M: Mixed Diarrhea and Constipation
IBS-C: Constipation Predominant IBS
IBS-U Unclassified
80
IBS Clinical Signs and Symptoms
Nausea
Vomiting
Anorexia
Foul Breath
Sour stomach
FARTING / Cramps
Constipation
Diarrhea
White Mucus in POOP
81
Appendicitis
Inflammation of the Appendix
Most common cause of pain in US
Pain worsens with movement (RLQ)
McBurney's Point, Psoas Sign
82
Pancreatitis
Inflammation of the Pancreas that results in autodigestion by its own enzymes
May be acute or chronic
83
Pancreatitis:
Causes
Common cause is Gallstones
Also due to alcoholism, high triglycerides, toxicity from glucocorticoids or acetaminophen
84
Pancreatitis:
Acute Signs and Symptoms
Epigastric pain radiating to the back
Nasuea and Vomiting
Diarrhea and Anorexia
Abdominal Distention
Fever and Sweating
Tachycardia/Malaise
Weakness/Discoloration
85
Pancreatitis:
Chronic Signs and Symptoms
Epigastric Pain to UL Lumbar
Nausea and Vomiting
Weight Loss + Fatty POOPS
Clay colored or Pale POOPS
86
Gallbladder:
Cholelithiasis
Formation of Gall Stones
87
Gallbladder:
Cholecystitis
Inflammation of gall bladder due to a stone causing obstruction
88
Gallbladder:
Symptoms
Asymptomatic, RUQ pain, Tenderness, Interscapular pain, Jaundice, Fever, N+V, Anorexia, Rigidity
89
Spleen:
Symptoms
Pain/Tenderness in LU Abdomen
Referred Left Shoulder Pain
Decreased Blood Pressure
Lightheadedness, Confusion, Dizziness, Blurred Vision
90
Spleen:
Pathophysiology
Rupture in Spleen
91
Spleen:
Injury Causes
Abdominal Trauma
Blunt Trauma
92
Spleen:
Spontaneous Causes
Splenomegaly
Infectious Mononucleus
Bacterial Infection
93
Spleen:
Treatment
Rest and Observation
Surgical Repair
Splenectomy
94
Intestinal Obstructions:
Mechanical Obstructions
Blockage due to adhesion, hernia, twisting, tumor
95
Intestinal Obstructions:
Functional Obstructions
Ileus - Functional inhibition of propulsive bowel activity
Caused by surgery, trauma, use of narcotics
96
Intestinal Obstructions:
Signs and Symptoms
Sudden onset creamping pain in abdomen, distention, N/V, High-Pitch or absent bowel sounds, bloody stools
97
Intestinal Obstructions:
Treatment
Surgery
Resection and/or Colostomy
98
Intestinal Obstructions:
Mobilization
Early mobilization is beneficial
Deep breathing, bed mobility and transfers
99
Obesity and Bariatric Surgery Considerations
Includes metabolic, psychological, and genetic factors
100
Obesity Classifications
Stage 1: 30-34.9 kg/m2 (High)
Stage 2: 35-39.9 kg/m2 (V High)
Stage 3: >40 kg/m2
Super Morbid Obesity: >50 kg/m2
Super-Super Morbid Obesity: >60 kg/m2
101
Gastric Bypass Surgery:
Adjustable Gastric band
Small pouch in upper stomach using adjustable band
102
Gastric Bypass Surgery:
Sleeve Gastrectomy
Small gastric pouch via permanent stapling, with outlet from pouch
103
Gastric Bypass Surgery:
Roux-en-Y
Creation of gastric pouch, 20-30 ml capacity, distal stomach and proxmial small bowel bypassed
104
Barriers to Exercise s/p Gastric Bypass
Frustration with recommendations
-> Reinforce benefits
Recluctance in public
-> Home program
Lack of time
-> Intermittent activities throughout the day
Joint pain
-> RICE, Aquatic therapy, PCP anti-inflammatory
Lack of interest
-> Practical exercise
105
Post-Op Gastric Bypass
Rapid sustained weight loss
Body Weight 35%, lower 2 yrs. post
27.5% lower than pre-surgery weight 12 years post
Fat Free Mass & Skeletal Muscle are maintained after the 1st year & is well-maintained except with normal aging
106
Gastric Bypass:
Post-Op Dietary Regiment
Dietary Regimen:
No food 1-2 days post-op, progress over 12 weeks w/ supplementation
107
Gastric Bypass:
Post-Op Abdominal Precautions
No lifting >10 lbs
No bending >90 degrees at hips
No Valsalva maneuvers
Soft abdominal binder
108
Gastric Bypass:
Precautions
Protect incision and reduce risk for herniation by decreasing Intra-Abdominal Pressure
109
Mobility Post-Op Gastric Bypass
Progressive Walking program
Strength training after 1 month post-op, focus on major muscle gorups
(1 set, 12-15 reps - 2-3 times weekly)
Bariatric support groups improve compliance
110
Considerations in Acute Care for Bariatric Patients
Assistance from support personnel
Frequent ambulation - ever 2-4 hrs
Airway clearance & active breathing
Skin inspection
111
Acute Care for Bariatric Patients
When to Terminate Exercise
Increased systolic 20 mmHg or more
Decreased diastolic 20 mmHg
HR change by >20 bpm
Severe dyspnea, dizziness
Excessive sweating, fainting
112
Considerations in Acute Care for GI system
Increased Fatigue due to poor nutrition can be contributing factor
Position precautions, Dysphagia can be aggravated in supine
(risk for aspiration penumonia)
113
GI System in Acute Care:
Risks
Risk for pulmonary complications post-operatively due to abdominal pain and resistance to deep breathing/cough
Instruction for splinting for cough/deep breathing
114
Post-Op Education in Acute Care
Abdominal tenderness/guarding
Positioing to reduce strain
LT benefits of Bariatric surgery
Appropriate aerobic+resistance ex.
List barriers to exercise post-op
115
Considerations for care for GI Disorders
Electrolyte Imbalances
Potential for Orthostatic Hypotension
Increased risk for muscle cramping with dehydration or poor absorption
Potential difficulty swallowing
Recognize back or shoulder pain
116
Clues to Screen for GI Diseases
Usually age >45 years
Prior h/o NSAID GI bleeding
Sx increase after 2. hrs post NSAID
Sx are affected by food
Presence of abdominal sx 4-6 wks of MSK symptoms (cyclical pattern)
Back+Abd. pain at the SAME level
Shoulder, Back, Pelvic, or Sacral pain
Iliopsoas/Obturator Sign
McBurney's Point Sign
Joint pain or arthralgias
117
GI Disease: Mobilization
Make sure colostomy puch is closed and adhered to patient
Coordinate with nursing, adjust PT session for privacy
Use sidelying for comfort post-op
Bend knees when adjusting HOB position to discrease disomfort
118
Gastrointestinal Bleeding
Pain may radiate to mid-thoracic area and could radiate RUQ
119
GI Bleeding:
Coffee-Ground POOP
Perforation in the Ulcer
120
GI Bleeding:
Bloody POOP
Indicative of Ulcerative Colitis
Bright red -> closer to anus
Rectal fissure / hemmorhoid
Colon Cancer
121
GI Bleeding:
Melena
Large quantities of blood in stool, unusual odor
122
GI Bleeding:
Mahogany POOP
Foods (Beets/Red food coloring)
Lower GI bleed
Medications (bismuth)
Tongue might be black or hairy
123
GI Complications of NSAIDS:
Side Effects
Can be Asymptomatic
Side Effects: upset stomach and pain, possible ulceration
124
GI Complications of NSAIDS:
Complications
Leads to bleeding, perforation, stricture formation, and exacerbation of IBD
125
GI Complications of NSAIDS:
Adverse Effects
Suppression of cartilage repair
Fluid retention
Kidney and Liver damage
Skin reactions / Headache
Depression and Confusion
Memory loss + Mood Changes
Ringing in the ears
126
GI Complications of NSAIDS:
What to Assess
Increased BP
Ankle/Foot Edema
Muscle weakness + fatigue
Restless leg syndrome
Polyuria or Nocturia
Pruritus, Confusion
Memory Loss
127
GI Complications of NSAIDS:
When to Refer
Notify if Appendicitis or Peritonitis is suspected
Presence of GI symptoms in absence of musculoskeletal findings
128
Shoulder Pain:
Kher's Sign
Pain in L shoulder when pressure placed on upper abdomen
129
Shoulder Pain:
Danforth Sign
Pain in shoulder with inspiration
130
Shoulder Pain:
Causes
Air or blood in the abdomen
Retroperitoneal bleeding
Perforated duodenal/gastric ulcers
Pancreatic cancer or Pacreatitis
Spleen, Liver, or Stomach bleeding can result in bilateral shoulder pain
131
Obturator or Psoas Abscess
Lower Abdominal Pain
Psoas abscess commonly from direct extension of intraabdoinal infections
Can also be caused by Peritonitis
132
Obturator or Psoas Abscess:
Clinical Manifestations
Fever, Night sweats
Lower abdominal/pelvic/back pain
Pain referred to hip, medial thigh, groin, or the knee
Right side is most ocmmnly affected with appendicitis
133
Obturator or Psoas Bascess:
Tests for Systemic Causes
Heel Tap - Pick up leg and tap heel
Hop Test - Hop on 1 leg
Iliopsoas Test - SLR w/ resistance
Palpate Iliopsoas Muscle
134
Appendicitis or Iliopsoas/Obturator Abscess: Guidelines for Immediate Medical Attention
Positive McBurney's, Iliopsoas/Obturator test, Positive test for rebound tenderness
Suspicion for Retropertioneal Bleeding - Can be from damaged spleen or ectopic pregnancy
135
Appendicitis or Iliopsoas/Obturator Abscess: Guidelines for Physician Referral
Refer clients who rely on laxatives
Joint involvement w/ skin/eye lesions
History of NSAID use w/ back/sh pain
Back pain associated w/ meals/poop
Back pain of unknown cause
136
GI Lab Tests:
Helicobacter Pylori Test
To confirm diagnosis of H. Pylori infection which increases risk for peptic ulcer disease or Gastric carcinoma
137
GI Lab Tests:
CEA
Monitor recurrence of colorectal cancer and response to therapy for both colorectal and breast cancer
Presense of CEA may indicate metastasis
138
GI Lab Tests:
Lactose Intolerance Test
Oral test to ID intolerance or lactase deficiency as cause for cramps, diarrhea
Oral dose, with timed blood draw
Minimal rise in BG or urine levels
139
GI Lab Tests:
Fecal Occult Blood Test
Screening for colon cancer
Multiple stool specimens over days are collected then sent to lab
