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Med Con Test 3 > Gastrointestinal System > Flashcards

Gastrointestinal System Flashcards

1
Q

Common signs and symptoms of GI disease

A

nausea & vomiting, diarrhea, anorexia, constipation, dysphagia, heartburn, abdominal pain, GI bleeding, achalasia, bowel incontinence

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2
Q

3 types of GI bleeding

A

Hematemesis - spitting up blood
Melena - black stool
hematochezia - bloody stool

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3
Q

Achalasia

A

inability to relax smooth muscles of GI tract; feeling of fullness in sternal region

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4
Q

Diarrhea

A

Neurogenic: irritable bowel syndrome
Muscular: alcohol, muscular incompetence
Mechanical: obstruction
Other: diet (food additives), laxative medications, infection, strenuous exercise

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5
Q

Constipation

A

Neurogenic: IBS, MS, PD
Muscular: inactivity, back pain/injury
Mechanical: obstruction
Other: diet (lack of fiber), pain medication

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6
Q

GI conditions of esophagus

A
  • hiatal hernia
  • GERD
  • scleroderma esophagus
  • neoplasms
  • varices
  • tracheoesophageal fistula (only seen in peds)
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7
Q

Hiatal Hernia

A
  • enlargement of cardiac sphincter

- stomach protrudes through this opening in the diaphragm into thoracic cavity

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8
Q

hiatal hernia signs/symptoms

A
  • midline/sternal pain 30-60 min after eating; increases w/ tight clothing or lying down
  • may also produce difficulty/pain in swallowing
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9
Q

Treatment of hiatal hernia

A

antacids, elevating upper body in supine

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10
Q

hiatal hernia: PT management

A

treat - be aware of condition
shaker head lifting exercises and education regarding reduction of intra-abdominal pressure
Avoid: full supine position for exercise and valsalva maneuver

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11
Q

GERD

A

inflammation of esophagus
may be result of irritating fluids: infectious agents, chemical irritants, physical agents (NG tube; radiation), gastric juices

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12
Q

Treatment of GERD

A

acid-supresing inhibitor drugs (PPIs); antacids or histamine blockers; lifestyle modifications

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13
Q

PT management of GERD

A
  • weight loss
  • educate on avoiding supine and lying after meal, increase fluid intake between meals - dilute gastric acids
  • screen to rule out angina
  • exercise may aggravate symptoms
  • low-impact exercise may decrease symptoms
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14
Q

Adenocarcinoma is most frequently seen in what population?

A
  • most frequently seen in middle-aged white men
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15
Q

Squamous cell

A
  • common in blacks, associated w/ ETOH/tobacco use
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16
Q

Causes for esophageal cancer

A
  • Vit A and zinc make esophagus more vulnerable to neoplastic changes
  • food/drink remain in esophagus
  • alcohol and tobacco
  • site of metastasize from liver or lung
  • if esophagus is primary site, will not metastasize bc kills pt before it can metastasize
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17
Q

symptoms of esophageal neoplasm/cancer

A
  • dysphagia w/ or w/o pain
  • heartburn when lying down
  • anorexia
  • weight loss
  • hoarseness
  • cough/recurrent pneumonia
  • bleeding
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18
Q

Esophageal CA treatment and prognosis

A

Treatment: surgery, radiation or chemo if unable to resect
Prognosis: poor due to advanced stage at diagnosis
survival rate is < 10 months

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19
Q

PT management esophageal neoplasm/CA

A
  • be aware of lymph node changes during upper quarter screening (enlarged and painless)
  • if pt not receiving chemo, consider low-level aerobic activity to increase immune system function
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20
Q

Esophageal Varices

A

dilation of veins in lower 1/3 of esophagus

liver disease –> portal HTN –> varies

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21
Q

Esophageal Varices signs/symptoms

A
  • painless and massive hematemesis w/ or w/o melena (black stool)
  • postural tachycardia and profound shock d/t blood loss
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22
Q

Treatment of Varices

A

pharmacologic or endoscopic; TIPS: trans-jugular intrahepatic portosystemic shunt
- usually good candidates for liver transplant

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23
Q

PT management of Varices

A
  • Refer to physician
  • avoid valsalva maneuver
  • watch for asterixis signaling developing hepatic encephalopathy
  • assess fluid retention (LE) and presence of ascites
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24
Q

Tracheoesophageal fistula

A
  • abnormal pathway between esophagus and trachea
  • aspiration risk –> need surgical repair
  • only seen in peds
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25
Q

GI conditions of stomach

A
  • gastritis
  • peptic ulcer disease (PUD)
  • gastric cancer
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26
Q

Gastritis

A

inflammation of stomach lining

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27
Q

acute gastritis

A

often occurs in conjunction w/ serious illness, physiologic stress, medication/NSAID use

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28
Q

chronic gastritis

A

Type A: less common; associated w/ pernicious anemia

Type B: more common; bacterial infection (Helicobacter pylori)

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29
Q

Acute gastritis risk factors w/ NSAIDs

A
  • over 65
  • Hx of ulcer disease
  • using NSAIDs > 3 months
  • high dose or multiple NSAIDs
  • concurrent corticosteroid therapy
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30
Q

Symptoms of Acute gastritis

A

epigastric pain; feeling of abdominal dissension; appetite loss; nausea; occult GI bleeds
Less common: heartburn, low-grade fever, vomiting

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31
Q

Treatment of acute gastritis

A

removal of predisposing factors

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32
Q

symptoms of chronic gastritis

A

possibly asymptomatic; may experience pain, indigestion after eating

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33
Q

PT management of acute gastritis

A

monitor for signs for pts using NSAIDS

- educate proper use, side effects and risks of NSAID use

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34
Q

Peptic ulcer disease

A
  • break in protective gastric mucosa or duodenal mucosa exposing submucosal areas to gastric secretions
  • Average age: 50s
  • Referred pain at T8 level - gastric; T10 - duodenal
  • Helicobacter pylori infection most common risk factor for developing PUD
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35
Q

stress ulcers

A
  • ischemic etiology
  • develop in response to prolonged psychological or physiologic stress ( ICU pts)
  • very few symptoms; painless until perforation/hemorrhage occur
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36
Q

PUD symptoms

A

epigastric pain (burning, gnawing, cramping, aching); occurs in waves lasting several minutes; radiate T6-T10 level; related to secretion of acid and presence of food in stomach

nausea, appetite loss, possible weight loss

rosaria - integumentary sign of PUD

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37
Q

Treatment of PUD

A

Goals:

  • relief of symptoms
  • promotion of healing
  • prevention of complications
  • prevention of recurrences
  • antimicrobials treat H. pylori
  • antacids, PPIs, histamine-blockers
  • surgical repair for perforation
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38
Q

PT management of PUD

A
  • Exercise at least 3x/wk reduces risk of GI bleeding

- closely monitor all-long term NSAID users/eldery

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39
Q

Signs of GI bleeding

A

pallor
activity intolerance
fatigue level
vital signs: signs of bleeding

low BP and tachycardia –> refer immediately, emergent condition!

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40
Q

Gastric Cancer

A
  • > 90% of all malignant stomach tumors
  • chronic H. pylori infection is strong risk factor
  • no good detection of stomach cancers - usually not found til late stage
    Treatment: surgical
    Site of pain: epigastric or back
41
Q

paraneoplastic acanthosis

A
  • seen in gastric adenocarcinoma
  • diffuse thickening of the skin w/ grey, brown or black pigmentation
  • usually in body folds
42
Q

Virchow’s nodes

A

enlargement of L supraclavicular nodes seen in gastric cancer

43
Q

GI conditions of intestines

A
  • intestinal ischemia
  • botulism
  • inflammatory bowel disease (IBD)
  • antibiotic-associated colitis
  • irritable bowel syndrome (IBS)
  • diverticular disease
  • neoplasms
  • malabsorption syndrome
  • obstructive disease
44
Q

malabsorption syndrome

A

group of syndromes marked by decreased absorption/excessive loss nutrients in stool

  • celiac disease
  • cystic fibrosis
  • crown’s disease
  • chronic pancreas
  • pernicious anemia
  • short-gut syndrome
45
Q

maldigestion

A

failure of chemical process of digestion

46
Q

malabsorption

A

failure of intestinal mucosa to absorb digested nutrients

47
Q

digestive defects

A

cystic fibrosis: absent pancreatic enzymes

- lactase deficiency

48
Q

absorptive defects

A

primary: celiac disease
secondary: inflammatory disease of bowel

49
Q

Malabsorption syndrome conditions common in PT

A
  • gastroenteritis d/t NSAID use
  • fibrosis d/t progressive systematic sclerosis or radiation
  • exocrine deficiency of pancreas d/t DM
  • short-gut syndrome following extensive resection of bowel or congenital shortening of small bowel
50
Q

Symptoms of malabsorption syndrome

A

early: weight loss, fatigue, depression, abdominal bloating
possible: steatorrhea; nocturne; dermatitis herpetiformis
common: explosive &/or chronic diarrhea, abdominal cramps, indigestion, flatulence
later: muscle wasting, bone mineral density changes, low BP, abdominal dissension, pernicious anemia (poor uptake of Vit B12)

51
Q

malabsorption of calcium, Vit D, proteins

A

causes osteoporosis, bone pain from compression fx and skeletal deformities

52
Q

electrolyte imbalance and low calcium

A

cause muscle spasms

53
Q

intestinal ischemia

A
  • occur acutely from embolic occlusions of abdominal aorta visceral branches
  • occur secondary to arteriosclerotic changes
  • presents w/ crampy or steady epigastric periumbilical pain BUT may refer to thoracolumbar junction w/ exertion
54
Q

blood supply to intestines

A

celiac, superior and inferior mesenteric arteries

55
Q

PT management of intestinal ischemia

A

Screen back pain for:

  • CAD risk factors
  • PVD/PAD
  • other PMH - recent surgery (abdominal), hx of blood clots
56
Q

Botulism

A

most cases result from ingestion of Escherichia coli, campylobacter, listeria, salmonella

57
Q

Botulism symptoms

A

prolonged bloody diarrhea, dehydration, weight loss, fever, nausea, severe abdominal pain

58
Q

inflammatory bowel disease

A

Crohn’s disease and ulcerative colitis

both are idiopathic; affect Gi tract’s ability to distinguish foreign entities from body’s antigens

possible genetic link and immunologic mechanism

59
Q

Crohn’s disease

A

affects all layers of intestine and is characterized segments of affected intestine w/ normal areas in-between (“skip” areas)

60
Q

ulcerative colitis

A

affects mucosa and submucosa in continuous pattern (no “skips”)

61
Q

Treatment of IBD

A

diet/nutrition; palliative or specific medication; occasionally surgical excision

62
Q

PT management IBD

A
  • watch for referred pain to lumbar region
  • screen LBP, hip, SI pain of unknown origin
  • be aware of low bone mineral content and prevalence of osteoporosis
  • pt’s may be dehydrated; watch for vascular depletion
63
Q

Antibiotic-Associated Colitis

A

long use of antibiotics decrease colonies of normal GI bacteria, leads to colonization of yeast, colds and C-diff

C-diff replaces normal GI flora; releases toxins damaging intestinal mucosa

64
Q

C-diff symptoms

A

voluminous, watery diarrhea; abdominal cramps/tenderness, fever

65
Q

Treatment of C-diff

A
  • must use lavage to remove spores
  • stop antibiotics; probiotics, immunoglobulins, IV fluids
  • very hard to get rid of
66
Q

reactive arthritis

A

acute, aseptic inflammatory arthropathy arising after infectious process, at site remote from primary infection
- may be result of C-diff

67
Q

Prevention of C-diff spreading

A
  • wash hands with soap and water
  • clean room surfaces w/ bleach or EPA approved spore killing disinfectant
  • isolate C-diff pts
68
Q

IBS

A

most common disorder of GI system

  • no inflammation present
  • women>men early adulthood
  • 3 mo abdominal pain and fatigue
69
Q

Treatment of IBS

A

lifestyle changes, eliminate tobacco, alcohol, nicotine, caffeine, start healthier diet and exercise

70
Q

Diverticulosis

A

uncomplicated disease

71
Q

diverticulitis

A

disease with inflammation

72
Q

diverticula

A

outpocketings in intestinal wall; mucosa/submucosa herniates through muscular layers

73
Q

Diverticular Disease

A
  • 80% asymptomatic
  • pass fresh blood/clots and urgency in defecation
  • tomatoes common for triggering (acidic w/ seeds)
74
Q

Diverticular disease symptoms

A

severe abdominal pain in L quadrant or mid-abdominal region referring to low back; pelvic pain (women); alternating constipation/diarrhea; increased flatus; fever; anemia (blood loss)

75
Q

diverticular disease treatment

A

dietary changes; laxatives; exercise; may require antibiotics; NG tube or parenteral feedings

76
Q

intestinal polyps

A

growth/mass protruding into intestinal lumen from mucosa

- may be neoplastic or non-neoplastic

77
Q

adenocarcinoma of colon

A

leading cause of death in men, 3rd leading cause of death in women
- colonoscopies for prevention and early detection

78
Q

adenocarcinoma risk factors

A
  • increase age
  • male
  • adenomatous polyps
  • ulcerative colitis or CD
  • family hx
  • immunodeficiency
  • sedentary
  • tobacco
  • low fiber, high-fat or high protein diets
79
Q

adenocarcinoma signs/symptoms

A

cardinal sign: bright red blood from rectum
symptom: persistent stomach pain, diarrhea, constipation
many cases asymptomatic until metastasis occurs

80
Q

adenocarcinoma treatment

A

surgical removal of tumor; may accompany w/ radiation

81
Q

PT management of adenocarcinoma

A

spread of cancer to prostate can refer pain to sacral or lumbar spine

  • pt reports of vague, dull, aching
  • watch for reports of simultaneous or alternating abdominal pain at same level back pain
  • watch for associated GI symptoms
82
Q

obstructive disease

A

organic, mechanical, functional causes

obstruction, distension, constipation

83
Q

obstructive disease symptoms

A

cramping pain/tenderness in periumbilical area; constitutional symptoms

  • dehydration, hypovolemia and metabolic acidosis can develop w/in 24 hours of obstruction
84
Q

PT management of obstructive disease

A

consider alternative methods of activity w/in limitations set by surgeon post op

85
Q

adhesions

A

fibrous bands formed after abdominal surgery

86
Q

intussusception

A

telescoping of bowel in on itself

87
Q

volvulus

A

torsion of an intestinal loop, twisted on its mesentery

88
Q

hernia

A

abnormal protrusion of part of an organ or tissue through the structure normally containing it

inguinal, femoral, umbilical, incisional(ventral)

89
Q

hernia symptoms

A

intermittent or persistent bulge and pain; pain increases w/ changes in positions, Valsalva’s maneuver or physical exertion; relieved by stopping precipitating activity; fever, tachycardia, vomiting, abdominal distention

90
Q

Hernia treatment

A

surgical repair of defect (herniorrhaphy)

91
Q

appendicitis

A

inflammation of vermiform appendix
may progress to necrosis, perforation –>peritonitis
significant complications from delayed diagnosis

92
Q

appendicits symptoms

A 
abdominal pain (RLQ); anorexia, nausea, vomiting, low grade fever
older adults little to no symptoms until perforation occurs
93
Q

appendicitis treatment

A

surgical removal (prior to perforation)

94
Q

PT management of appendicitis

A

screen w/:

  • McBurney’s point
  • rebound tenderness (Blumberg)
  • constitutional symptoms
  • localization of pain on coughing or valsalva maneuver
95
Q

Peritonitis

A

inflammation of serous membrane lining abdominal cavity
primary (spontaneous)
secondary (due to trauma, surgery or contamination by bowel contents)

96
Q

Peritonitis symptoms

A

fluid/electrolyte imbalances and include severe abdominal pain, nausea, vomiting, high fever; rigid, board-like abdomen
positive Blumberg sign

97
Q

Peritonitis treatment

A

surgical drainage, repair; antibiotics; supportive measures to correct fluid, electrolyte and nutritional disorders

98
Q

Kerr’s sign

A

L shoulder pain that occurs w/ splenic irritation

associated w/ peritonitis d/t blood, infectious fluid in abdominal cavity containing spleen

99
Q

PT management of peritonitis

A

monitor vitals
semi-Fowler’s position (but for respiration exercises w/ less pain)
watch for signs of wound dehiscence
use safety measures in fever/infection produces confusion/disorientation

Med Con Test 3 (4 decks)

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