GI Flashcards
1
Q
What are 4 functions of the GI system
A
Motility, secretion, digestion, absorption
2
Q
What is the name of the GI’s NS? Where is it located?
A
Enteric NS
80-90% immune system cells in gut
3
Q
What are the 9 regions of GI?
A
R hypochondriac
Epigastric
L hypochondriac
R lumbar
Umbilical
L lumbar
R iliac region
Hypogastric
L iliac
4
Q
3 common esophagus pathologies
A
Hiatal hernia
GERD
Esophageal cancer
5
Q
3 common GI pathologies
A
Gastritis
Peptic ulcer
Gastric cancer
6
Q
7 common GI pathologies
A
Malabsorption
Appendicitis
IBS
Crohn’s
Ulcerative colitis
Colon cancer
Diverticulosis/itis
7
Q
2 common gallbladder pathologies
A
Gallstones (choleithiasis)
Cholecystitis
8
Q
What are 6 risk factors for esophageal cancer
A
Tobacco
Alcohol
GERD
Obesity
>55 years old
Poor diet
9
Q
6 symptoms of esophageal cancer
A
Difficulty swallowing
Wt loss
Hoarse
Chest pain
Progressive indigestion
Cough
10
Q
3 risk factors for stomach cancer
A
65+ yo, M>W, steady fxn decrease over decade
11
Q
6 symps of stomach cancer
A
Fatigue
Bloating post meals
Full after sm meals
Persistent n/v
Wt loss Hoarse Chest
Stomach pain
12
Q
5 symps of intestinal cancer
A
Abdominal pain
Wt loss
Weak or fatigue
Bloody, tarry stools
Lump in stomach
13
Q
What cancer is the 2nd leading deadly cancer? More common that what type?
A
Colorectal cancer
More common than rectal
14
Q
What age range is colorectal cancer the deadliest? What age range is screened?
A
Young adults under 50 yo
45-75
15
Q
3 risk factors for gallbladder cancer
A
W > M, age, h/o chronic probs
16
Q
What is the peritoneum?
A
Continuous sheet with 2 layers
Outer = parietal (attach to abdomen)
Inner = visceral (around organs)
17
Q
What are 3 functions of peritoneum
A
Support, protection, and conduit for vessels/lymph/n’s
18
Q
What is visceral pain? What regions does visceral pain occur?
A
Internal organ
Midline; epigastric, umbilical, hypogastric regions
19
Q
What are 3 common primary pain patterns associated with GI system
A
Inflammation
Organ distention
Necrosis
20
Q
Where does epigastric pain occur?
A
Mid sternum to xiphoid process
21
Q
What 6 structures are involved with epigastric pain?
A
Heart
Esophagus
Stomach
Duodenum
Gallbladder
Liver
22
Q
The organs with epigastric pain are innervated by
A
T3-T5
23
Q
The organs with periumbilical pain are innervated by
A
T9-T11
24
Q
What 3 structures are involved in periumbilical pain
A
Sm intestine, pancreas, appendix
25
What level is umbilicus at
L3-L4
26
What should a PT do if pt has periumbilical pain?
Refer to MD
27
Where does hypogastric pain occur?
T10-T12
28
What structure is involved with hypogastric pain
Lg intestine/colon
29
What is the function of the esophagus
Transport food/liquid from mouth to stomach
30
What is GERD
Back flow of stomach acid and contents into esophagus
31
8ish s/s of GERD
Heart burn
Chest pain
Dysphagia
Lump in throat
Wheezing
Coughing
Sore throat
Hoarse
Ear ache
32
4 complications of GERD
Discomfort strictures of esophagus
Esophagitis
Aspiration pneumonia
Asthma
33
4 alarming symps of GERD
Respiratory distress
Apnea
Dysphagia
Failure to thrive
34
3 tx of GERD
Antacids
H-receptor blockers
Proton pump inhibitors
35
What to do if pt has s/s of GERD
Refer out
36
What is peptic ulcer
Loss of tissue lining lower esophagus, stomach and duodenum
37
2 causes of peptic ulcer
Infection with H pylori
Chronic NSAIDs use (aspirin, ibuprofen, naproxen)
38
What are cardinal symps of peptic ulcer (4)
Epigastric pain
Heart burn, gnawing, cramp, ache
Sm area near midline epigastrum near xiphoid
Waves of pain to back and R sh
39
4 other symps of peptic ulcer
N/v
Wt loss
Loss appetite
Back pain
40
4 signs of peptic ulcer
Perforation
Bleeding
Obstruction
Vomit bright red, coffee ground, melena
41
2 symps of H pylori peptic ulcer
Halitosis and rosacea
42
How does food indicate ulcer?
Pain 30-90 min after eating
Food exacerbated symps
43
How does food indicate pyloric or duodenal ulcer?
Pain after 2-4 hours after eating
Food relieves symps
44
What is indicated if pain between 12-3am
Duodenal ulcer or cancer-related pain
45
What is early satiety
1-2 bites feel full
46
What can early satiety by symptoms of
Obstruction, stomach cancer, gastroparesis, peptic ulcer, other tumors
47
What is gastritis
Inflam stomach lining
48
Symps of gastritis
N/v, indigestion, cough blood, pain
49
What is IBS
Abnormal GI fxn, causes abdominal pain
Sm and lg intestine motility dysfxn
50
3 symps of IBS
Diarrhea
Constipation
Chronic recurrent abdominal pain
51
9 clinical s/s of IBS
N/v
Anorexia
Foul breath
Sour stomach
Gas
Cramps
Constipation
Diarrhea
White mucus stools
52
Other names for IBS
Spastic colon
Irritable colon
Nervous indigestion
Fxnal dyspepsia
Pylorospasm
Spasticity colitis
Intestinal neuroses
Laxatives or cathartic colitis
53
6 risk factors for IBS
< 50 yo
Fam hx
Food intolerance
Emotional stress, tension, anxiety
Physical or sexual abuse
Severe digestion tract infection
54
4 IBS patterns
IBS-D
IBS-M
IBS-C
IBS-U
55
What is malabsorption syndrome
Nutrients not absorbed —> malnutrition
56
8 symps of malabsorption syndrome
Wt loss
Gas
Bloating
Abdominal discomfort
Weak
Chronic diarrhea
Fatigue
Indigestion
57
4 tx for malabsorption syndrome
Diet mod
Probiotics
Electrolytes
Vit/minerals
58
What does malabsorption lead to
Increased risk of osteoporosis and patho fxs
59
What is diverticulosis? 4 symps?
Small bulging pouches in digestive tract
Asymp, bloat, cramp, constipation
60
What is diverticulitis
Infection/inflam of pouches in intestine
61
8 s/s of diverticulitis
Asymp
Bloating
Cramp
Constipation
N/v
Local pain
Fever
TTP
62
What does inflam bowel diseases increase the risk of
-3x greater risk for blood clots, especially hospitalizations
-colorectal cancer
63
What is ulcerative colitis? 2 symps?
Inflam of inner lining
Abdominal discomfor, frequent diarrhea (blood or pus)
64
What is Crohn’s disease? 3 symps?
Chronic inflammation condition; Affect any part of GI, distal sm or lg intestine
Slow progressive symp onset fever, abscess, LBP relief after bowel pass
65
3 causes of fecal incontinence
Secondary traumatic childbirth
Hemorrhoids
Hemorrhoid surgery
66
When to use special tests for appendicitis
Change abdominal pain symps
Acute onset w/o MOI
67
What are the 3 “special tests” for appendicitis
McBurney
Psoas sign - hip ext
Obturator sign - hip ER
68
Symps of appendicitis
Low grade fever, constipation or diarrhea, n/v
69
Exam for appendicitis
Rebound tender, Rousing’s sign (opp palp causes appendix pain), psoas and obturator sign
70
What are 8 indications of constipation
-strain during defecation
-hard, lumpy poo
-sense incomplete evacuation
-sense anorectal obstruction
-manual maneuvers to poo
-< 3 poo/wk
-loose stools w/o laxatives
-insuff criteria for IBS
71
What is obstipation
Intractable constipation —> fecal impact must be removed
72
What are red flag symps of constipation
Occurs suddenly and w/ unaccountable bowel habit changed or blood in stools
73
What factors influence constipation
-diet
-smoking
-med SE
-lack ex
-acute/chronic digestive disease
-prolonged bed rest
-personality, mood, emotional stress
74
What is cholelithiasis
Formation of gallstones
75
What is choleocystitis
Inflam GB d/t stone obstruction
76
Symptoms of cholelithiasis/cholecystitis 8
-Asymp
-RUQ pain/tender
-inter scap pain
-jaundice
-n/v
-fever
-anorexia
-abdom rigid or mus guard
77
Symps of spleen rupture
-decreased BP —> lightheaded, confuse, dizzy, lightheaded
-pain/tender LU abdominal, refer L sh
78
Tx for spleen rupture
Rest, surgery, splenectomy
79
What is pancreatitis
Inflam —> autodigestion by own enzymes
80
4 causes of pancreatitis
-gallstones
-chronic alcoholism
-increased triglyceride blood lvls
-toxicity from glucocorticoids, thiazide diuretics, or acetaminophen
81
What 2 things cause chronic pancreatitis
Alcohol and smoking
82
Acute pancreatitis s/s (11)
-n/v
-epigastric pain, rad to back
-anorexia
-diarrhea
-wk
-abdom distention and pain
-bluish color of abdomen or flanks
-tachycardia
-malaise
-jaundice
-fever and sweats
83
What is mechanical obstruction
Blockage d/t adhesion, hernia, twist tumor
84
What is functional obstruction? Causes?
Ileus (inability for instincts to contract and remove waste properly), “fxnal inhibition of propulsive bowel activity”
Causes: surgery, trauma, narcos
85
5 s/s of intestinal obstruction
-distention
-n/v
-bloody stools
-sudden onset cramp in abdomen
-high pitch or absent bowel sounds
86
3 tx for obstructions
-surgery
-resection
-colostomy
87
What does chronic diarrhea w/ wt loss indicate
Neoplasticism (abnormal tissue growth) or inflam bowel disease
88
What does c diff cause
Colitis and severe diarrhea
89
What is stage 1 obesity classification
30-34/9 kg/m2 (high risk disease)
90
What is stage 2 obesity classification
35-39.9 kg/m2 (very high risk)
91
What is stage 3 obesity classification
Greater than or equal to 40 kg/m2
92
What is stage 4 obesity classification
Greater than or equal to 50 kg/m2 (super morbid obese)
93
What is stage 5 obesity classification
Greater than or equal to 60 kg/m2 ( super super morbid obese)
94
What is an adjustable gastric band
Small pouch in upper stomach using adjustable band
95
What is sleeve gastrectomy
Small gastric pouch via permanent stapling with outlet from pouch
96
What is roux-en-y
-creation of gastric pouch
-20-30 mL capacity
-distal stomach and proximal sm bowel bypassed
97
5 barriers to ex post gastric bypass
-frustration with ex rec
-reluctant to ex in public
-lack of time
-joint pain
-lack of interest/motivation
98
What is the dietary regimen for gastric bypass
No food 1-2 days post-op
Progress over 12 wks and long term supplementation
99
4 abdominal precautions post gastric bypass
-no lifting >10 lbs
-no bending >90 degrees at hips
-no valsalva
-soft abdominal binder when out of bed
100
What are 2 things abdominal precautions post gastric protect against
Protect incision and decrease risk of herniation by decreasing intra-abdominal pressure
101
What is mobility regimen post gastric
-POD 1 walking
-progressive walking program
-strength 1 month post op (maj mus)
102
What are 3 considerations for bariatric in acute care
-early and frequent ambulation (2-4 hrs while awake)
-airway clearance and active breathing ex
-skin inspection
103
5 reasons to stop ex with bariatric in acute
-increase systolic 20mmHg or more
-decrease diastolic 20 mmHg or more
-HR change by >20bpm (up/down)
-severe dyspnea, dizzy
-excessive sweat, faint
104
5 main considerations for GI system in acute care
-increased fatigue
-positioning precautions (dysphagia agg with supine, asp pneumonia)
-non-pharm pts who can’t tolerate NSAIDs
-risk pulm complications
-splinting for cough/deep breathing
105
What are 5 risk considerations for GI disorder care
-electrolyte imbalance
-potential OH
-increased risk for mus cramp w/ dehydration
-potential dysphagia
-back or sh pain may be GI referral
106
S/s of pancreatic cancer (10)
-indigestion
-new onset diabetes
-pale and smelly poo
-mid back pain
-fatigue
-upper abdominal pain
-n/v
-unexplained wt loss
-jaundice
-loss appetite
107
9 things to screen for GI disease
->45 yo
-prior h/o NSAID induced GI bleed
-symps increase w/in 2hr post NSAID use
-symp affected by food
-abdom or GI symptoms w/in 4-6 wks, esp cyclic pattern
-back and abdom pain at SAME lvl
-sh, back, pelvic or sacral pain
-iliopsoas/obturator sign, McBurney sign
-jt pain w/ skin rash
108
What are 3 most common SE of NSAIDs
-upset stomach
-pain
-possible ulceration
109
When is immediate medical attention needed
-appendicitis or iliopsoas/obturator abscess suspected (+ McBurney, iliopsoas/obturator test, + rebound tender)
-suspect retroperitoneal bleeding
110
When would physician referral be needed
-appendicitis or peritonitis (lie pt down, NPO, heat no go)
-associated GI symps w/o MSK issue
111
What are 2 main causes of psoas abscess
-intrabdom infection (staph or vertebral osteomyelitis)
-peritonitis
112
4 clinical signs of psoas abscess
-fever
-night sweats
-lower abdom/pelvic/back pain
-pain referred to hip/medial thigh/groin/knee
113
4 test for systemic cause for pain in hip/thigh for psoas abscess
Heel tap
Hop test (hop on one leg)
Iliopsoas mus test (SLR w/ resist)
Palpate iliopsoas
114
Guidelines for physician referral
-reliant on laxatives
-jt involve w/ skin/eye lesions —> IBD
-hx NSAID use w/ back/sh pain w/ s/s peptic ulcer
-back pain assoc with meals or relieved w/ pooing
-unknown MOI BP, no MSK involvement, and hx of cancer
