GI Flashcards
what is the basic function of the GI system?
process ingested food by mechanical and chemical means, extract nutrients from these food stuffs and excrete waste products
what makes up the upper GI tract?
- Mouth
- Esophagus
- Stomach (largely storage function)
- Duodenum (digestive function)
*this portion aids in the ingestion and digestion of food
what makes up the lower GI tract?
Small intestine → digestion and absorption of nutrients
Large intestine → water and electrolyte absoprtion, stores waste products until elimination
list the 4 layers of GI tract
- Mucosa → epithelium layer of either squamous or columnar cells
- Submucosa → accessory glands, lymphoid tissue, blood vessels, nervous tissue
- Muscularis → longitudinal and circular smooth muscles
- Serosa → outer most layer
T/F: the GI tract is populated by billions of bacteria
TRUE
they exisit in a symbiotic state
altered normal flora can lead to disease
what are Pyer’s patches?
sections of the GI tract that serve an immune function
describe the location and function of the esophagus
muscular tube that connects the pharynx to the stomach
lies posterior to the trachea and heart and in front of the spine
peristalsis moves food from the mouth through lower esophageal sphincter into the stomach
what is the digestive function of the stomach?
primarily hold food
also breaks down protein via enzymatic activity of pepsin
material known as chyme moves from stomach through pyloric sphincter into duodenum
list cells in the stomach and their secretory products
- Parietal cells → HCl, intrinsic factor
- Chief cells → pepsinogen
- Mucous neck and pit cells → mucous
- G cells → produce gastrin
list the digestive function of the small intestine
immediately in the duodenum a mixture of bile, pancreatic juices, proteins, fats, and carbohydrates meet
list the absoprtive function of the small intestine
lacteals → lymphatic capillary that absorbs dietary fats in the villi of the small intestine. These facilitate the transportation of digested fats from the villi of the small intestines
what is malabsorption syndrome?
a group of disorders characterized by reduced intestinal absorption of dietary components and excessive loss of nutrients in the stool
what is malabsorption syndrome associated with?
- muscle weakness, muscle wasting, paresthesia
- numbness and tingling; neurologic damage
- bone pain, fractures, skeletal deformities (arise secondary to calcium deficiencies)
- edema (protein deficiency)
what is the large intestine’s primary absorptive role?
absorbing water
List some diseases of the small and large intestine
- Inflammatory Bowel Disease (Crohn’s Disease)
- Irritable Bowel Syndrome
- Diverticular disease
what is Crohn’s Disease?
a chronic lifelong inflammatory disorder that can affect any segment of the intestinal tract
current trx is directed toward symptomatic relief and control of the disease process on an individual basis
describe IBS
a group of symptoms that represent the most common disorder of the GI system
Abdominal pain and discomfort lasting on average at least one day a week in the last 3 months
3 types: Constipation-predominant, diarrhea-predominant or mixed
describe diverticulosis
hallmark is outpouching (diverticula) in the wall of the colon or small intestine
diverticulosis → diverticula present but uncomplicated
diverticulitis → an infected and inflammed diverticula
treated w/antibiotics
List various s/s of GI disease
- Nausea
- Vomiting (emesis)
- Anorexia
- Cachexia
- Constipation
- Dysphagia
- Achalasia
- Heartburn, indigestion
- Abdominal pain
- Hematemesis
- Hematochezia
- Melena
what is nausea?
a sensation of unease and discomfort in the upper stomach often accompanied by an involuntary urge to vomit
many causes
NOT A DISEASE but a symptom
describe vomiting
involuntary, forceful expulsion of the contents of one’s stomach through the mouth and sometimes the nose
may be caused by:
- anything that precipitates nausea
- concussions
- meningitis
- intestinal blockages
- appendicitis
- brain tumor
what is anorexia?
diminished appetite or aversion to food
this is a nonspecific symptom
has many causes
List some causes of anorexia
- May be associated with N/V and diarrhea
- Cancer pts may suffer from it
- Lack or loss of appetite for food
- Voluntary food restriction
- Often caused by psychological issues
- Can result in heart disease, renal disease, hypokalemia, hypotension, orthostatic hypotension
what is cachexia? what is it associated with?
loss of muscle mass and body weight
primary associated with cancer
- associated with increased metabolic rate, increased sympathetic drive, increased protein degradation
- Involuntary weight loss: weight loss occurs despite getting adequate nutrition or a high number of calories
T/F: anorexia and cachexia are equivalent terms
FALSE
what is constipation?
occurs when fecal matter is too hard to pass easily or when bowel movements are so infrequent that discomfort and other symptoms interfere with daily activites
what are some potential causes of constipation?
- diet
- dehydration
- side effects of meds (opioids)
- inactivity/prolonged bed rest
- acute or chronic disease of digestive system
- underlying organic disease
- age
- lesion or structural abnormalities within colon
- slow-transit alimentary canal
- defactory disorders/defective reflex
- LBP
what is dysphagia?
difficulty swallowing
can be due to neurological issues, mechanical obstruction, or trauma
define achalasia
failure of the smooth muscle fibers to relax
lower esophageal sphincter (LES) fails to relax and/or open when needed
accumulation of food in the esophagus
T/F: a hiatal hernia can contribute to heartburn/indigestion?
TRUE
List the types of abdominal pain
- Mechanical → stretching of the wall of a hollow organ or the capsule of a solid organ
- Inflammatory
- Referred pain → arises when visceral pain fibers and pain fibers from the skin synapse on the same second order pain fibers
list some potential abdominal referred pain locations
- the gall bladder refers pain is to the top of the right stomach
- stomach problems may refer to the spine between the shoulder blades
- Intestinal dysfunction may be referred to the middle of low back
- ischemic pain → metabolites are released in the area of ischemia resulting the generation of pain. may progressively get worse
what is hematemesis?
vomiting blood
if it is blood red → injury is esophageal in origin
if coffe like appearance → indicates the presence of coagulated blood, injury is in the stomach in origin
what is hematochezia?
unaltered red blood passed rectally
if bright red → usually lower colon or rectum (often secondary to hemorrhoids
what is melena?
passing of dark, tarry stools
caused by bleeding from any intestinal site
tumors, ulcers, inflammation, etc.
T/F: acute GI bleeds are medical emergencies?
TRUE
blood loss can be huge and result in anemia, hypovolemia, tissue hypoxia
what is the impact of aging on the GI tract?
- decrease in taste bud function and sense of smell → decreased interest in food and depressed appetite
- decreased salivary secretions
- loss of smooth muscle tone
- slower gastric emptying
- decreased gastric motility, reduced nutrient absorption
List some diseases of the mouth
- Aphthous Ulcers (Canker sores)
- Fever blisters/cold sores
- fungal infections
- Cancers of the oral cavity
what are canker sores?
common small, painful, shallow oral cavity ulcers that are often triggered by stress, fever, certain foods
occur mainly in children and young adults and is mostly self limiting and disappear in a few weeks
not contagious
what are fever blisters/cold sores?
result of a viral infection and occur on and around one’s lips (outside the mouth)
often grouped together and caused by the herpes simplex virus
VERY contagious
describe the herpes virus
- orally transmitted
- initial infection-asymptomatic, virus lingers in the trigeminal nerve
- fever, sunlight, cold, trauma, infection leads to viral multiplication
- virus travels down axons and erupts in the mucosa as a cold sore or fever blister
- Major problem for immune compromised patients
name a common oral fungal infection
Thrush (oropharyngeal candidiasis)
what can cause Thrush?
DM, HIV, anemia, antibiotics or glucocorticoid therapy, disseminated cancer
may be spread in vulnerable pts into esophagus
NG tube may help spread the infection
what type of cancer is most common in the oral cavity
squamous cell carcinomas
sites of origin → vermillion border of the lower lip, floor of the mouth, lateral border of the tongue
often painless and therefore ignored
List some diseases of the esophagus
- Dysphagia → difficulty in swallowing
- lack of pharyngeal sensation
- inadequacy in the swallowing mechanism
- esophageal pain
- center of the chest
- pressing or burning sensation
- distinguish this pain from angina or other cardiac pain
- esophageal bleeding (hematemesis)
- common sign of esophageal diseases
- tends to be red
- Hiatal hernia
- GERD
how can a hiatal hernia impact the esophagus?
the esophagus and stomach stay where they should be, but part of stomach squeezes through the hiatus to sit next to the esophagus
called a paraesophageal hernia
list some symptoms of hiatal hernias
- esophageal pain
- GERD
- dyspnea
- may affect cardiac and cardiac function
list some pt implications for pts with hiatal hernia
- have pt avoid valsalva maneuvers in supine position
- avoid coughing, vomiting, straining, or sudden physical exertion
- surgical repair, dietary modification
what is GERD?
inflammation of the esophagus secondary to retrograde flow of gastric juices
defect in the lower esophageal sphincter
symptoms → heart burn, dysphagia, frequent belching, painful swallowing
list some causes of GERD
- obesity
- pregnancy
- smoking
- asthma meds
- Calcium channel blockers
- antihistamines
- pain killers
- sedatives
- antidepressants
- body position
list some PT implications for GERD
- avoid vigorous activities
- any intervention requiring a supine position should be scheduled before meals and avoided just after eating
- for nocturnal reflux, encourage the individual to sleep on the left side with a pillow in place to maintain this position
- avoid activities that increase intra-abdominal pressure
- elevate head of the bed
- lifestyle mod
- wear loose clothing (patient should)
- pt remain upright at least 3 hrs after meals
- avoid meals near bedtime or nap time
- lose weight if obese
List specific symptoms of stomach pathologies
- epigastric pain
- hematemesis
- melena
- frequent vomiting
List some diseases of the stomach
- Gastritis
- Peptic ulcers
what is gastritis?
generalized inflammation of the protective lining of the stomach mucosa
acute → hemorrhagic or acute erosive
chronic → less common, possibly an autoimmune disorder, long term inflammation
list some causes of gastritis
- H pylori
- decreased mucous production-decreased protection of the mucosa
- associated with presence of a serious illness
- chemically induced (NSAIDs or aspirin)
- stress induced gastritis/physiologic induced
- XRT
- alcohol abuse
- Commonly seen in severly ill
T/F: gastritis is essentially the same thing as an ulcer
FALSE
an ulcer is a deeper open sore in the lining of the stomach
list symptoms of gastritis
- epigastric pain with sense of abdominal distension/bloating
- loss of appetite
- abdominal pain
- heart burn, low grade fever, N/V
- asymptomatic or symptoms assocaited w/eating
- hematomesis
- black, tarry stools (melena)
what are some implications for PT pertaining to gastritis?
- know which patients are on stomach injuring drugs
- know how much they are taking
- be alert for symptoms
- encourage pts to only take meds as prescribed/per manufacture recommendations
- with food
- antacids
what are peptic ulcers?
breach in the protective mucosal lining exposing deeper layers (submucosal and muscularis) areas to injury by gastric secretions
ulcers reach into muscularis layers, damaging blood vessels, causing hemorrhage
what are the 2 subtypes of peptic ulcers?
- gastric ulcers
- affects the lining of the stomach
- middle and older aged Americans are more likely to develop gastric ulcers
- duodenal ulcers
- found in the duodenum
- 2-3 X’s more common than gastric ulcers
- more common in younger individuals
how are peptic ulcers diagnosed?
- based on symptoms
- bleeding
- test for H pylori
- endoscopic exam of the stomach
- symptoms include steady midline pain in the T/S
- epigastric pain near xiphoid
- pain may accompany consumption of food
- hemorrhage with resulting anemia
list some diseases of the intestine
- Diarrhea and dysentery
- colorectal carcinomas
- colorectal tumors
- Peritoneum/peritonitis
what is diarrhea/dysentery? What causes it? What are some PT implications?
Increase in stool mass, frequency or fluidity
problem → excess loss of water
can be caused by bacterial, viral infection
implications → excessive water loss
list some special implications for PTs regarding colorectal tumors
- hx of corticosteroid trx → bone demineralization, muscle weakness
- impaired posture
- adaptive shortening of the anterior abs
- stooped posture
- increased stress on lower back muscles
- removal of lymph nodes → increased risk of developing lymphedema
- mets → prostate, lungs, liver
- ostomy management
define peritoneum/peritonitis
inflammation of the serous membrane lining the walls of abdominal cavity
multiple causes → bacterial, chemical, surgery
tends to widespread
