Gastrointestinal System Pathology - Diseases Flashcards by Ólafía Anna Hannibalsdóttir

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.

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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

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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

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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.

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Gastroesophageal Reflux Disease - Causes

Associated with sliding hiatal hernia.

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

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Gastroesophageal Reflux Disease - Clinical Manifestation

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

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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

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Neoplasm Cancer Esophagus

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

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Neoplasm Esophagus - Clinical Manifestation

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

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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

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Referred Pain - Esophagus

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

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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.

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Peptic Ulcer Disease - Risk Factors and Complications

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

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Peptic Ulcer Disease - Clinical Manifestation

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

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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

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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.