GI Flashcards
1
Q
What is the function of the GI tract?
A
process ingested food by mechanical and chemical means, extract nutrients from these food stuffs and excrete waste products.
2
Q
What structures are a part of the Upper GI tract?
A
- Mouth
- esophagus
- stomach (largely storage function)
- duodenum (digestive function)
3
Q
What is the job of the upper gi tract?
A
Aids in the ingestion and digestion of food
4
Q
What structures are a part of the lower GI tract?
A
Small and large intestine
5
Q
What is the job of the small intestine?
A
Digestion and absorption of nutrients
6
Q
What is the job of the large intestine?
A
- Water and electrolyte absorption
- Stores waste products until elimination
7
Q
From mouth to anus, the GI tract has how many layers? What are they?
A
- Mucosa: epithelium layer of either squamous or columnar cells
- Submucosa: Accessory glands, lymphoid tissue, blood vessels, nervous tissue
- Muscularis: longitudinal (top to bottom) and circular smooth muscles
- Serosa: Outermost layer
8
Q
T/F GI tract is open to the external environment at both ends outside of the body (what is inside the tract is outside of the body)
A
True
9
Q
GI tract is populated by billions of what?
A
Bacteria in a symbiotic state - altered normal flora leads to disease
10
Q
T/F Intestinal tract acts as a physical barrier.
A
True
11
Q
What lymphocytes are found in the intestinal tract that act in immune function?
A
Pyer’s Patches
12
Q
What is the purpose of mastication done by the mouth?
A
increase surface area of food - digestion easier
13
Q
What initiates digestion in the mouth?
A
Amylase
14
Q
What is the purpose of mucus production by the salivary glands in the mouth?
A
- Moistens food
2. Cleans the mouth
15
Q
The esophagus connects what two things?
A
Throat (pharynx) to the stomach
16
Q
T/F The esophagus lies in behind the heart and in front of the trachea and spine
A
False, behind (posterior) the trachea and heart, and in front of the spine
17
Q
Peristalsis -
A
the involuntary constriction and relaxation of the muscles of the intestine, creating wave-like movements that push the contents of the canal forward
18
Q
The stomach excretes what to aid in digestion?
A
- Mucus
- Enzymes-Gastrin, pepsin (pepsinogen)
- Hydrochloric acid (low pH)
- Parietal cells- HCl, intrinsic factor
- Chief Cells – pepsinogen
- Mucous neck & pit cells-mucous
- G cells-produce gastrin
19
Q
What is chyme?
A
Contents of the stomach
20
Q
Pyloric sphincter -
A
Distal end of stomach
21
Q
Gastric emptying -
A
- emptying-forty minutes to a few hours
- movement of chyme through pyloric sphincter
22
Q
What 3 parts make up the small intestine?
A
- Duodenum
- Jejunum
- Ileum
23
Q
T/F Small intestine has digestive and absorption functions.
A
True
24
Q
Small intestine excretes what to aid in digestive function?
A
- Bile: breakdown fats
- Pancreatic juices (cystic fibrosis limits this): break down proteins, starches, fats
- Come through pancreatic duct - Proteins, fats & carbohydrates
25
What are lacteals?
- aid in absorption function
- lymphatic capillary that absorbs dietary fats in the villi of the small intestine.
- Facilitate the transportation of digested fats from the villi of the small intestines
26
How does weight loss surgery affect nutrient absorption?
resection decreases nutrient absorption
27
What is malabsorption syndrome of the small intestine?
group of disorders characterized by reduced intestinal absorption of dietary components and excessive loss of nutrients in the stool
28
malabsorption syndrome of the small intestine is associated with what symptoms?
- Muscle weakness, muscle wasting, paresthesia
- Numbness and tingling; neurologic damage
- Bone pain, fractures, skeletal deformities (hypocalcemia)
- Edema (protein deficiency)
29
What is the main function of the large intestine?
Water is absorbed here and the remaining waste material is stored here
30
Crohn's disease -
| Tx -
- chronic lifelong inflammatory disorder that can affect any segment of the intestinal tract.
- Current treatment is directed toward symptomatic relief and control of the disease process on an individual basis.
31
Irritable bowel syndrome -
- 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 three months
32
3 types of Irritable bowel syndrome -
1. Constipation-predominant
2. diarrhea-predominant
3. mixed
33
Diverticular disease -
outpouchings (diverticula) in the wall of the colon or small intestine
34
Diverticulosis -
diverticula present but uncomplicated
35
Diverticulitis -
An infected & inflamed diverticula
36
How is diverticular disease treated?
Antibiotic
37
First symptom of GI disease?
Nausea (NOT a disease but a symptom)
38
Nausea -
sensation of unease and discomfort in the upper stomach often accompanied by an involuntary urge to vomit
39
Emesis -
- vomiting
| - The involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose
40
Vomiting can be caused by what?
concussions, meningitis, intestinal blockages, appendicitis and brain tumor
41
Resulting complications due to N&V?
- Dehydration due to fluid and electrolyte imbalances
- Pulmonary aspiration of vomitus
- Mucosal tear at the gastroesophageal junction (Mallory-Weiss syndrome)
- Presents with hematemesis (vomiting of blood)
- Rupture of the esophagus
- Malnutrition
42
Diminished appetite or aversion to food?
Anorexia
43
T/F Anorexia is a nonspecific symptom
True
44
Causes of anorexia:
- May be associated with N&V, diarrhea
- Cancer patients may suffer from it
- Voluntary food restriction
- Often caused by psychological issues
45
Anorexia can result in what?
- heart disease
- renal disease
- hypokalemia
- hypotension
- orthostatic hypotension
46
Cachexia -
Involuntary weight loss: Weight loss occurs despite getting adequate nutrition or a high number of calories
47
Cachexia is primarily associated with what?
Cancer
48
Cachexia is also associated with what?
1. ↑ metabolic rate
2. ↑ sympathetic drive
3. ↑ protein degradation
49
Cachexia results in:
1. Loss of strength secondary to loss of muscle mass
2. Malnutrition
3. Weight loss
50
T/F Cachexia, anorexia, and wasting are the same.
False, cachexia not the equivalent of anorexia and wasting
51
What is always measured in patients with cachexia?
BMI
52
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 activities
53
Constipation may occur because of:
- Age
- Diet
- Dehydration
- Side effects of medications (opioids)
- Inactivity/prolonged bed rest
- Acute or chronic diseases of the digestive system
- Underlying organic disease
- lesions or structural abnormalities within the colon that narrow the intestines and/or rectum,
- slow-transit alimentary canal – transit is slow
defecatory disorders/defective reflex
- Low back pain (LBP) → constipation (muscle guarding, splinting
54
Dysphagia -
- difficulty swallowing
55
Dysphagia caused by:
- Neurological (CVA’s)
- mechanical obstruction
- trauma
56
Achlasia -
- Failure of the smooth muscle fibers to relax so lower esophageal sphincter fails to open when needed
- Accumulation of food in the esophagus
57
Heartburn, Indigestion -
- Burning sensation in the esophagus usually at the midline below the sternum
- sphincter between the stomach and esophagus doesn't work as well -> Acidic stomach contents move into the esophagus
58
What might contribute to Heartburn, Indigestion?
Hiatal hernia
59
Mechanical abdominal pain -
Stretching of the wall of a hollow organ or the capsule of a solid organ
60
Inflammatory abdominal pain -
Occurs by the release of prostaglandins, histamine, serotonin, bradykinin, which in turn stimulate sensory nerves
61
Referred abdominal pain -
- unpleasant sensation localized to an area separate from the site of the causative injury or other painful stimulation
- Arises when visceral pain fibers and pain fibers from the skin synapse on the same second order pain fibers
62
Gall bladder refers pain where?
to the top of the right shoulder
63
Stomach problems may refer pain where?
to the spine between the shoulder blades
64
Intestinal dysfunction may refer pain where?
to the middle or low back
65
Ischemic abdominal pain -
- Metabolites are released in the area of ischemia resulting the generation of pain.
- Abdominal fullness cramps, or pain often occurring within 30 minutes of eating and last 1-3 hours
- May progressively worsen
66
Hematemesis -
- The vomiting of blood
| - Is always an important sign
67
If hematemesis is red, where is the origin of injury?
injury is esophageal in origin
68
If hematemesis has appearance of coffee grinds, where is the origin of injury?
- Indicates the presence of coagulated blood
| - injury is in the stomach in origin
69
Hematochezia -
- Unaltered red blood passed rectally
- If the blood appears red = Usually lower colon or rectum
- Often secondary to hemorrhoids
70
Melena -
- Passing of dark, tarry stools
- Caused by bleeding from any intestinal site
- Tumors, ulcers, inflammation
71
T/F Acute GI bleeds are potential emergencies
True
72
S&S of acute GI bleed:
- Blood loss can be large
- Anemia
- Result in hypovolemia (lightheadedness, fainting)
- Tissue hypoxia
73
GI disease: Implications for the PT
1. Body fluid loss-diarrhea, vomiting
2. Electrolyte imbalance (↓ K+)
3. Hypovolemia
- Orthostatic hypotension (↓ blood volume)
- Tachycardia
- Pallor
74
What 3 GI problems most commonly seen in older adults?
1. Constipation
2. incontinence (inability to retain fecal material)
3. diverticular disease
75
How does aging affect taste bud function?
Decrease in taste bud function and sense of smell → ↓ interest in food and decreased appetite
76
How does aging affect salivary secretions?
- Decreased salivary secretions
| - Dental caries (cavities)
77
How does aging affect smooth muscle tone?
Loss of smooth muscle tone:
- Slower gastric emptying,
- decreased gastric motility, reduced nutrient absorption
78
Etiology of Fever Blisters/Cold Sores?
- the result of a viral infection (Caused by herpes simplex virus (HSV-1))
- Occur on or around one’s lips (are outside of the mouth)
- Often are grouped together
- Are very contagious
79
Canker sores -
occur inside the mouth and are not contagious
80
How is Herpes Simplex Virus Infection transmitted?
orally
81
Herpes Simplex Virus Infection initial infection -
- asymptomatic
| - virus lingers in the trigeminal nerve
82
Progression of Herpes Simplex Virus Infection -
- 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 immunocompromised patients
83
Oropharyngeal candidiasis -
- Fungal infection
- Candida Albicans normal inhabitant of the mouth
- Causes pathology when there is some impairment in the normal microflora balance of the mouth (DM, HIV, anemia, antibiotics or glucocorticoid therapy, disseminated cancer)
84
How can candida albicans spread in Oropharyngeal candidiasis?
- May spread in vulnerable patients into esophagus
| - Nasogastric tube may help spread the infection
85
Squamous Cell Carcinomas sites of origin?
- Cancers of oral cavity
| - Vermillion border of the lower lip, floor of the mouth, lateral border of the tongue
86
T/F Squamous Cell Carcinomas is often painless and therefore ignored
True
87
Squamous Cell Carcinomas is associated with:
- ETOH abuse
- Tobacco use (primarily smokeless tobacco)
- Poor oral hygiene, ill fitting dentures
88
Prognosis of Squamous Cell Carcinomas dependent on what?
Early detection
89
T/F Therapy for Squamous Cell Carcinomas is frequently extensive and is often debilitating.
True
90
Dysphagia -
- Difficulty in swallowing
- lack of pharyngeal sensation
- Inadequacy in the swallowing mechanism
91
Esophageal pain -
- Center of the chest,
- Pressing, or burning sensation
- Distinguish this pain from angina or other cardiac pain
92
Esophageal bleeding (Hematemesis) -
- Common sign of esophageal diseases
| - Tends to be red
93
Hiatal Hernia -
- A condition in which the upper portion of the stomach protrudes into the chest cavity through an opening of the diaphragm
OR The stomach and lower part of the chest slide up in to the thoracic cavity
OR the esophagus and stomach stay where they should be, but part of the stomach squeezes through the hiatus to sit next to your esophagus (Paraoesophageal hernia)
94
What % of adult population will have hiatal hernia?
15-20%
95
Hiatal Hernia symptoms:
- Esophageal pain
- GERD
- dyspnea
- may affect cardiac and cardiac function
96
What should patient avoid if they have hiatal hernia?
- Valsalva maneuvers in supine position
| - Avoid Coughing, vomiting, straining, or sudden physical exertion
97
Treatment of hiatal hernia?
Surgical repair, dietary modification
98
Gastroesophageal Reflux Disease (GERD) or Esophagitis -
- Inflammation of the esophagus secondary to retrograde flow of gastric juices
- Defect in the lower esophageal sphincter
99
Symptoms of GERD:
- Heart burn
- dysphagia
- frequent belching
- painful swallowing
100
T/F A hiatal hernia may weaken the LES and increase the risk for GERD
True
101
Causes of GERD:
- Obesity
- pregnancy
- smoking
- asthma medications
- calcium channel blockers
- antihistamines
- painkillers
- sedatives
- antidepressants
- body position
102
Aggravating factors of GERD:
1. supine posture
| 2. specific foods
103
How long can GERD symptoms last after eating?
2 hours
104
GERD: Implications for the PT
1. Avoid vigorous activities
2. Any intervention requiring a supine position should be scheduled before meals and avoided just after eating
3. For nocturnal reflux, encourage the individual to sleep on the left side with a pillow in place to maintain this position
4. Avoid activities that increase intra-abdominal pressure
5. Elevate head of the bed
6. Lifestyle modifications
7. Avoid caffeine, nicotine, alcohol, salicylates, and NSAIDs
8. Patient should wear loose clothing (increase abdominal pressure)
9. Patient should remain upright at least 3 hours after meals (limit reflux – acid move with gravity)
10. Should avoid meals near bedtime or nap time;
11. Losing weight, if obese
105
Symptoms of stomach pathologies:
- Epigastric pain: high in the abdomen, just below the sternum
- Hematemesis: Typically black, “coffee grounds”
- Melena: black tarry stools
- Frequent Vomiting
106
Gastritis -
Generalized inflammation of the protective lining of the stomach mucosa (lining of the stomach)
107
Acute gastritis -
hemorrhagic or acute erosive
108
Chronic gastritis -
less common, possibly an autoimmune disorder, long term inflammation
109
T/F Gastritis is common in severely ill individuals
True
110
Gastritis can cause what type of deficiency?
Can cause a vitamin B12 deficiency (lack of intrinsic factor; produced in the gastric mucosa and needed for B12 uptake in the gut )
111
Cause of gastritis:
- H pylori –associated chronic gastritis
- Decreased mucous production-decreased protection of the mucosa
- Associated with presence of a serious illness
- Chemical induced (NSAID’s aspirin)
- Stress induced gastritis/physiologic induced
- XRT
- ETOH abuse
- Common in severely ill
112
3 Risk factors for gastritis:
1. > 65 y/o
2. Long term NSAID use
3. Concurrent corticosteroid treatment
113
T/F Gastritis and stomach ulcers are the same.
False, Not a stomach ulcer - a deeper open sore in the lining of the stomach.
114
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 associated with eating
- Hematemesis
- Black, tarry stools (melena)
115
Gastritis: Implications for PT:
- Know which patients are on stomach injuring drugs and how much they are taking
- Be alert for symptoms (N&V, hematemesis)
- Encourage patients to only take meds as prescribed/per manufacturer recommendations
(With food (steroids with milk), Antacids)
116
Peptic ulcers -
- Breach in the protective mucosal lining exposing deeper layers (submucosal and muscularis) areas to injury by gastric secretions
- Peptic refers to pepsin (enzyme produced by stomach)
- Ulcers reach into muscularis layer, damaging blood vessels, causing hemorrhage
117
2 subtypes of peptic ulcers?
1. Gastric ulcer
| 2. Duodenal ulcers
118
Gastric ulcer -
- Affects the lining of the stomach
| - Middle and older-aged Americans are more likely to develop gastric ulcers
119
Duodenal ulcer -
- Found in the Duodenum
- 2-3 X’s more common than gastric ulcers
- More common in younger individuals
120
90% of peptic ulcers represent an infection by what?
H. pylori
121
What are risk factors for peptic ulcers?
- Lifestyle and psychologic stress are risk factors
- NSAID’s: Long term use of NSAID’s has deleterious effects on the entire GI tract.
- Reduced or loss of prostaglandin protection of the mucosa. These molecules:
1. Inhibit acid secretion
2. Enhancement of mucosal self protection mechanisms
122
Diagnosis of peptic ulcers based on what?
- Symptoms (bleeding, steady midline pain in thoracic spine, epigastric pain near xiphoid)
- Test for H. pylori
- Endoscopic examination of the stomach
123
Peptic ulcers: Pt implications:
1. Monitor symptoms
2. Monitor use of NSAID’s
3. Pay particular attention in older, aging adults
4. Signs of bleeding:
SP < 100 mm Hg
HR > 100bpm
> 10 mmHg drop in DP with a position change
124
Diarrhea & Dysentery -
- Increase in stool mass, frequency or fluidity
125
What is the ultimate problem of Diarrhea & Dysentery?
Problem: Excess loss of water
126
Gastric adenocarcinoma -
```
- cancer of mucus producing cells
Caused by: Chronic gastritis, H. pylori infection, dietary factors (western diet)
- High risk of metastasis-spreading
Dx: Endoscopy (screening)
Tx: Chemo &/or radiation
```
127
Colorectal Carcinomas -
- Cancer that begins in glandular mucus secreting cells
- Asymptomatic for years
- Screening test: Colonoscopy – visual screening of colon
- Often treated by resecting the tumor
128
Colorectal tumors Special implications for the physical therapist:
1. Hx. of corticosteroid treatment: bone demineralization, muscle weakness
2. Impaired posture: Adaptive shortening of the anterior abs (pain and surgical disruption → stooped posture, increased stress on lower back muscles
3. Removal of lymph nodes → increased risk of developing lymphedema
4. Mets: Prostate, lungs, liver
5. Ostomy management
129
Peritoneum/Peritonitis -
Inflammation of the serous membrane lining the walls of abdominal cavity
130
Causes of Peritoneum/Peritonitis -
Multiple causes: bacterial, chemical, surgery
131
Peritoneum/Peritonitis causes severe systemic effects -
- Circulatory alterations
- fluid shifts
- respiratory problems leading to fluid and electrolyte imbalances
132
T/F Peritoneum/Peritonitis has a high mortality rate, it is painful, the patient is usually hospitalized.
True
133
Patient positioning consideration for Peritoneum/Peritonitis:
1. Semi-Fowler position (angled in bed 15-45)
| 2. carry out position changes with care b/c of pain
