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Organ System Anatomy, Physiology and Pathology - BPT06 > Gastrointestinal System Pathology - Diseases > Flashcards

Gastrointestinal System Pathology - Diseases Flashcards

1
Q

Hiatal Hernia

A

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.

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2
Q

Hiatal Hernia - Risk Factors and Clinical Manifestation

A

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

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3
Q

Hiatal Hernia - Special Implications for the Theapist

A
  • 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
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4
Q

Gastroesophageal Reflux Disease (GERD)

A

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.

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5
Q

Gastroesophageal Reflux Disease - Causes

A

Associated with sliding hiatal hernia.

Main causes: Food (fatty, spicy), caffeine and nicotine.

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6
Q

Gastroesophageal Reflux Disease - Clinical Manifestation

A 
• Heartburn
• Reflux
• Belching
• Dysphagia
• Painful swallowing
• Inflammation of esophagus
Atypical Symptoms (patients >70 years)
- Vomiting, respiratory difficulties, weight loss.
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7
Q

Gastroesophageal Reflux Disease - Special Implications for Therapist

A
  • Exercise - Weight control
  • Therapeutic education - Lifestyle
  • Avoid supine position
  • Sleep on left side
  • Chest physiotherapy in case of surgery
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8
Q

Neoplasm Cancer Esophagus

A

Carcinoma: middle portion of esophagus
Adenocarcinoma: distal portion of esophagus

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9
Q

Neoplasm Esophagus - Clinical Manifestation

A 
• Early asymptomatic 
• Dysphagia
• Odynophagia (pain when swallowing) 
• Anorexia
• Cough 
• Hoarseness (abnormal voice change) 
Unexplained weight loss (RED FLAG)
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10
Q

Neoplasm Esophagus - Special Implication for Therapist

A
  • 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
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11
Q

Referred Pain - Esophagus

A

Behind sternum
Horizontal lines across nipples and below pecs.
Slight pain between inferior angles of scapula.

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12
Q

Peptic Ulcer Disease (stomach) - Definition

A

Break in the lining of the stomach (gastric ulcer) or duodenum (duodenal ulcer) of 5mm or more.
Stress ulcers due to stress.

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13
Q

Peptic Ulcer Disease - Risk Factors and Complications

A 
Tobacco
Caffeine 
Alcohol
H.Pylori (bacteria)!
Complications: Bleeding, requires hospitalization! 10% mortality.
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14
Q

Peptic Ulcer Disease - Clinical Manifestation

A 
No specific symptoms.
• Classic symptoms:
- Epigastric pain
- Burning
- Cramping
- Relieved when eating!
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15
Q

Peptic Ulcer Disease - Special Implication for Therapsit

A

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

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16
Q

Peptic Ulcer Disease - Referred Pain

A

• Back pain can be the only presenting symptom
- Mid-thoracic
- Right upper quadrant (right shoulder)
• Relieve with antiacid

17
Q

Gastric Cancer - Risk Factors

A

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)

18
Q

Gastric Cancer - Clinical Manifestation

A 
• Weight loss
• Abdominal pain
• Early satiety
• Nausea/vomiting
• Gastric outlet obstruction
• Bleeding
Usually asymptomatic until late stages.
19
Q

Gastric Cancer - Special Implication for Therapist

A
  • Epigastric/back pain differentiation
  • Palpation of left supraventricular lymph node
  • Chest physio after surgery
20
Q

Referred Pain - Stomach

A

Under Xiphoid process!

Less: right shoulder, mid thoracic back pain.

21
Q

Inflammatory Bowel Disease - 2 Conditions

A

• 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.

22
Q

Crohn’s Disease - Clinical Manifestation

A 
Abdominal pain: mild to severe
Abdominal mass: right lower quadrant
Anorexia: can be severe
Weight loss: can be severe
Remissions and exacerbations.
23
Q

Ulcerative Colitis - Clinical Manifestation

A

Abdominal pain: mild to severe, less frequent
Diarrhea: often severe, chronic.
Bloody stools
Anorexia and weight loss: mild to moderate
Remission and exacerbation

24
Q

Inflammatory Bowel Disease - Special Implications for Therapist

A

Not really our problem as physios.

Maintain muscle mass and ROM.

25
Q

Malabsorptive Disorder/Celiac Disease - Definition and Risk Factors

A 
Immune-mediated disorder trigger by the exposure of the digestive tract to gluten.
Risk Factors:
• Genetics
• Thyroiditis
• Type 1 diabetes
26
Q

Celiac Disease - Clinical Manifestation and Recommendation for Therapist

A 
• Diarrhea 
• Bloating 
• Indigestion 
• Flatulence 
• Weight loss 
• Abdominal pain 
• Dermatitis (herpes)
Recommendation: multidisciplinary team (nothing without a doctor). Maintain muscle mass, ROM. Make comfortable.
27
Q

Irritable Bowel Syndrome - Definition

A

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”.

28
Q

Irritable Bowel Syndrome - Clinical Manifestation

A

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.

29
Q

Irritable Bowel Syndrome - Special Implications for Therapist

A

Treatment: dietary changes, stress reduction, cognitive behavioral therapy.

  • Avoid jumping activities.
  • Regular physical activity
  • Breathing exercises
30
Q

Neoplasm Intestine Cancer - Risk Factors

A
  • Age
  • Gender (male > female)
  • History of adenomatous polyps
  • IBD
  • Obesity
  • Tobacco use
  • Alcohol
  • Diet (low fiber, high animal fat, sugar, protein)
31
Q

Neoplasm Intestine Cancer - Clinical Manifestation

A
  • Occult blood loss
  • Melena
  • Hematochezia
  • Abdominal pain
  • Weight loss
  • Change in bowl habits
  • Bright red blood from rectum
32
Q

Neoplasm Intestine Cancer - Implication for Therapist

A
  • Involvement depends on comorbidities
  • Impaired posture (adaptive shortening of abdominal musculature)
  • Lymphedema (lymphatic massage)
  • Exercise therapy (deconditioning prevention)
  • Pelvic floor rehab (after surgey)
33
Q

Intestinal Hernia - Definition

A

Caused by weakness in the peritoneal cavity through which peritoneum can slide and form a serosa-line sac or bulge.

34
Q

Intestinal Hernia - Special Implication for Therapist

A
  • Education: Lifting techniques, reduce intraabdominal pressure.
  • Exercises therapy: Weight control
  • Watch out for other systemic symptoms (nausea, etc…)
35
Q

Small Intestine and Large Intestine - Referred Pain

A

Small: Lumbar area, more on front than back (bellybutton and below).
Large: Front lumbar are (wider), less on sacral back area (smaller).

36
Q

Peritonitis - Definition

A

Inflammation of the serous membrane lining the wall of the abdominal cavity.

37
Q

Peritonitis - Clinical Manifestation and Special Implication for Therapist

A

• 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.

Organ System Anatomy, Physiology and Pathology - BPT06 (34 decks)

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