Gastrointestinal System Pathology - Diseases Flashcards
Hiatal Hernia
Lower esophageal sphincter becomes enlarged, allowing the stomach to pass through the diaphragm into the thoracic cavity. Can be congenital or acquired.
Sliding hernias: widening of the hiatal tunnel
Paraesophageal (rolling) hernia: laxity of gastrophrenic and gastrocolic ligaments. True hernia.
Hiatal Hernia - Risk Factors and Clinical Manifestation
Increase of intraabdominal pressure. Can be caused by: lifting, bending over, chronic or forceful cough.
• Regurgitation
• Heartburn 30 to 60 minutes after a meal
• Supine position may aggravate symptoms
• Substernal pain
• Difficulties to swallow
Hiatal Hernia - Special Implications for the Theapist
- Avoid supine position
- Avoid exercises including Valsalva maneuver
- Patient education
- Slow return to function over the next 6 to 8 weeks
- Chest physio to prevent pulmonary complications
Gastroesophageal Reflux Disease (GERD)
Most common disease we see as a physio.
Acidic stomach content flows back up into esophagus due to the gastroesophageal sphincter not closing properly.
Esophagitis: inflammation of esophagus due to reflux.
Gastroesophageal Reflux Disease - Causes
Associated with sliding hiatal hernia.
Main causes: Food (fatty, spicy), caffeine and nicotine.
Gastroesophageal Reflux Disease - Clinical Manifestation
• Heartburn • Reflux • Belching • Dysphagia • Painful swallowing • Inflammation of esophagus Atypical Symptoms (patients >70 years) - Vomiting, respiratory difficulties, weight loss.
Gastroesophageal Reflux Disease - Special Implications for Therapist
- Exercise - Weight control
- Therapeutic education - Lifestyle
- Avoid supine position
- Sleep on left side
- Chest physiotherapy in case of surgery
Neoplasm Cancer Esophagus
Carcinoma: middle portion of esophagus
Adenocarcinoma: distal portion of esophagus
Neoplasm Esophagus - Clinical Manifestation
• Early asymptomatic • Dysphagia • Odynophagia (pain when swallowing) • Anorexia • Cough • Hoarseness (abnormal voice change) Unexplained weight loss (RED FLAG)
Neoplasm Esophagus - Special Implication for Therapist
- Palpation of lymphatic vessels when screening (cervical, internal jugular, supraclavicular)
- Bone marrow suppression (side effect of chemo)
- Respiratory complication (side effect of surgery)
- Aerobic exercise at minimal level to enhance immune system
Referred Pain - Esophagus
Behind sternum
Horizontal lines across nipples and below pecs.
Slight pain between inferior angles of scapula.
Peptic Ulcer Disease (stomach) - Definition
Break in the lining of the stomach (gastric ulcer) or duodenum (duodenal ulcer) of 5mm or more.
Stress ulcers due to stress.
Peptic Ulcer Disease - Risk Factors and Complications
Tobacco Caffeine Alcohol H.Pylori (bacteria)! Complications: Bleeding, requires hospitalization! 10% mortality.
Peptic Ulcer Disease - Clinical Manifestation
No specific symptoms. • Classic symptoms: - Epigastric pain - Burning - Cramping - Relieved when eating!
Peptic Ulcer Disease - Special Implication for Therapsit
Education: life-style: stop smoking, alcohol, caffeine.
• Proper anamnesis
• Monitoring of vital signs: Systolic blood pressure < 100 mmHg, Pulse > 100 bpm (increase rate when changing position could be sign of hemorrhage)
• Exercising 3x/week: moderate exercising
Peptic Ulcer Disease - Referred Pain
• Back pain can be the only presenting symptom
- Mid-thoracic
- Right upper quadrant (right shoulder)
• Relieve with antiacid
Gastric Cancer - Risk Factors
Gastric adenocarcinoma:90% of malignant tumors in stomach
• H.Pylori infection
• Epstein-Barr Virus
• Dietary factors (low fruit and vegetable, salt, smoked fish, meat with nitrates)
• Smoking
• Obesity (related to pathway to obesity)
Gastric Cancer - Clinical Manifestation
• Weight loss • Abdominal pain • Early satiety • Nausea/vomiting • Gastric outlet obstruction • Bleeding Usually asymptomatic until late stages.
Gastric Cancer - Special Implication for Therapist
- Epigastric/back pain differentiation
- Palpation of left supraventricular lymph node
- Chest physio after surgery
Referred Pain - Stomach
Under Xiphoid process!
Less: right shoulder, mid thoracic back pain.
Inflammatory Bowel Disease - 2 Conditions
• Crohn disease: chronic lifelong inflammatory disorder. Body eating itself, autoimmune disease.
- Affects any segment of the intestinal tract, mostly colon/ileum.
- Periods of exacerbation and remission
• Ulcerative colitis: chronic inflammatory disorder of the mucosa of the colon.
Crohn’s Disease - Clinical Manifestation
Abdominal pain: mild to severe Abdominal mass: right lower quadrant Anorexia: can be severe Weight loss: can be severe Remissions and exacerbations.
Ulcerative Colitis - Clinical Manifestation
Abdominal pain: mild to severe, less frequent
Diarrhea: often severe, chronic.
Bloody stools
Anorexia and weight loss: mild to moderate
Remission and exacerbation
Inflammatory Bowel Disease - Special Implications for Therapist
Not really our problem as physios.
Maintain muscle mass and ROM.
Malabsorptive Disorder/Celiac Disease - Definition and Risk Factors
Immune-mediated disorder trigger by the exposure of the digestive tract to gluten. Risk Factors: • Genetics • Thyroiditis • Type 1 diabetes
Celiac Disease - Clinical Manifestation and Recommendation for Therapist
• Diarrhea • Bloating • Indigestion • Flatulence • Weight loss • Abdominal pain • Dermatitis (herpes) Recommendation: multidisciplinary team (nothing without a doctor). Maintain muscle mass, ROM. Make comfortable.
Irritable Bowel Syndrome - Definition
Chronically reoccurring abdominal pain with altered bowel habits in absence of structural, inflammatory or biochemical abnormalities.
Can be diarrhea-dominant, constipation-dominant, mixed-symptoms, unsub-typed.
Disorder of “gut-brain interaction”.
Irritable Bowel Syndrome - Clinical Manifestation
lifelong condition
• Steady/intermittent lower abdominal pain: Deep discomfort with sharp cramp in the morning or after eating, relief with bowel evacuation.
• Constipation and/or diarrhea
Bloating
Flatus (gas)
Nocturnal symptoms suggest another GI condition.
Irritable Bowel Syndrome - Special Implications for Therapist
Treatment: dietary changes, stress reduction, cognitive behavioral therapy.
- Avoid jumping activities.
- Regular physical activity
- Breathing exercises
Neoplasm Intestine Cancer - Risk Factors
- Age
- Gender (male > female)
- History of adenomatous polyps
- IBD
- Obesity
- Tobacco use
- Alcohol
- Diet (low fiber, high animal fat, sugar, protein)
Neoplasm Intestine Cancer - Clinical Manifestation
- Occult blood loss
- Melena
- Hematochezia
- Abdominal pain
- Weight loss
- Change in bowl habits
- Bright red blood from rectum
Neoplasm Intestine Cancer - Implication for Therapist
- Involvement depends on comorbidities
- Impaired posture (adaptive shortening of abdominal musculature)
- Lymphedema (lymphatic massage)
- Exercise therapy (deconditioning prevention)
- Pelvic floor rehab (after surgey)
Intestinal Hernia - Definition
Caused by weakness in the peritoneal cavity through which peritoneum can slide and form a serosa-line sac or bulge.
Intestinal Hernia - Special Implication for Therapist
- Education: Lifting techniques, reduce intraabdominal pressure.
- Exercises therapy: Weight control
- Watch out for other systemic symptoms (nausea, etc…)
Small Intestine and Large Intestine - Referred Pain
Small: Lumbar area, more on front than back (bellybutton and below).
Large: Front lumbar are (wider), less on sacral back area (smaller).
Peritonitis - Definition
Inflammation of the serous membrane lining the wall of the abdominal cavity.
Peritonitis - Clinical Manifestation and Special Implication for Therapist
• Decrease intestinal motility
• Intestinal distention with gas
• Vague generalized abdominal pain -> acute and severe pain: Increase with movement, can refer to shoulder and/or thoracic area.
• Abdomen becomes rigid (involuntary guarding)
• Nausea
• Vomiting
• Fever
Special impl: semi-fowler position to help breathing.
