GI Flashcards
What is included in the upper GI?
mouth pharynx esophagus stomach duodenum
What is included in the lower GI?
small intestine
large intestine
rectum/anus
What are the accessory organs of the GI system?
teeth tongue salivary glands liver gall bladder pancreas
List the diagnostic studies for GI, hepatic, biliary, pancreatic, and splenic systems (7)
Laparoscopy Barium swallow Modified barium swallow study Endoscopy Endoscopic retrograde cholangiopancreatography (ERCP) GI bleeding scan (scintigraphy) Upper GI series
Describe a laparoscopy and what it is used for
- insertion of a laparoscope into the abdominal cavity
- uses a small incision and local anesthetic
- can be diagnostic or therapeutic
Describe a barium swallow study and what it is used for
- patient swallows barium liquid while XR and fluoroscopic images examine swallowing and peristalsis of esophagus
- used to ID pathologic conditions of the esophagus (propulsion of liquid through esophagus into stomach)
Describe a modified barium swallow study and what it is used for
- used to diagnose dysphagia
- analyzes oral, pharyngeal, and upper esophagus
Describe endoscopy
insertion of endoscope into digestive tract (esophagus, stomach, small intestines)
Describe ERCP and what it is used for
Endoscopic retrograde cholangiopancreatography
- uses endoscopy and fluoroscopy to diagnose and treat gall bladder, biliary system, pancreas, and liver problems
Describe what GI bleeding scans (scintigraphy) are used for
to determine the presence/source of GI bleeding
Describe what an upper GI series is used for
to identify the disorder of the esophagus, stomach, and duodenum
What is a small bowel series used for?
to visualize the jejunum and ileum
What are the common lab values associated with the liver?
ALT ALP AST albumin bilirubin ammonia
What are the common lab values associated with pancreatic function?
lipase
amylase
sweat test
Name the different health conditions that affect the GI system (15)
- Dysphagia
- GERD
- PUD
- Dumping syndrome
- Upper GI bleed
- Lower GI bleed
- Diverticular disease
- Hiatal hernia
- Abdominal hernia
- Crohn’s disease
- Ulcerative colitis
- Morbid obesity
- Encephalopathy
- Cholecystitis
- Cholelithiasis
Describe dysphagia, its causes, diagnosis, and treatment
difficulty swallowing (oropharyngeal or esophageal) Dx: - MBSS - endoscopy - CT - MRI Causes: - neurological conditions (stroke/TBI) - dementia - myasthenia gravis Tx: - airway protection - nutritional support
Describe GERD, its SxS and treatment
backflow of gastric acid into the esophagus SxS: - heartburn - regurgitation Tx: - diet modification - weight loss - PPIs - H2 blockers - Nissen fundoplication
Describe PUD, its causes, SxS, and Tx
ulceration in the stomach or duodenum Cause: - H. pylori infection - NSAIDs SxS: - hunger-like sensation - nocturnal pain Tx: - lifestyle modifications - PPIs - antibiotics - no NSAIDs/aspirin
Describe Dumping Syndrome, its causes, the types, and treatment
enhances gastric emptying and interrupts normal digestive sequence Causes: - GI surgeries (gastrectomy, gastric bypass surgery, PUD surgery, Nissen fundoplication) Types: - early DS - late DS Tx: - dietary changes - medication
Describe Early Dumping Syndrome
occurs within 30 minutes of a meal SxS: - palpitations - tachycardia - flushing - diaphroesis - syncope - abdominal symptoms like cramping and bloating
Describe Late Dumping Syndrome
occurs 1-3hrs after a meal
SxS:
- consistent with hypoglycemia
Describe upper GI bleed and its causes
bleeding that occurs in the stomach, esophagus, or duodenum Causes: - ulcers - gastric erosion - gastric/esophageal varices
Describe a lower GI bleed and its causes
a bleed that occurs in the colon and anorectum Causes: - IBS (diverticulitis) - ischemic colitis - anal and rectal lesions (hemorrhoids) - ulcerate polyps - colorectal cancer
What are the SxS of a GI bleed?
- hematemesis
- hematochezia
- melena
How is a GI bleed treated?
- IV fluids
- blood transfusions
- management of causative factors
Describe the SxS and treatment for diverticular disease
SxS: - LLQ pain - polyuria - fever - elevated WBCs - constipation - NV Tx: - diet modification - clear liquids - IV fluids - pain meds - antibiotics - surgery (abscess drainage, colectomy)
Describe a hiatal hernia, its SxS, and treatment
a protrusion of abdominal structures upward through the esophageal hiatus SxS: - heartburn-like pain - dysphagia - chest pain - dyspnea - hoarsness Tx: - behavior modifications - eating small/frequent meals - bland food with high fiber - acid-reducing medications - laparoscopic repair
Describe an abdominal hernia, its SxS and treatment
a protrusion of bowel that is classified by location of protrusion SxS: - abdominal distension - NV - position changes with increased abdominal pressure (laughing, coughing) - pain - paresthesia Tx: - monitor asymptomatic cases - symptomatic --> surgical repair - possible temporary colostomy
Describe Crohn’s disease
an idiopathic inflammatory bowel disease that can occur anywhere in the GI system
- most common in the terminal ileum and proximal colon
What are the causes of Crohn’s disease?
- genetics
- immune dysregulation
- infectious agents
- psychological issues
- environmental factors
What are the SxS of Crohn’s disease?
- abdominal cramping
- RLQ pain/mass
- diarrhea
- weight loss
- fatigue
- low grade fever
What are the treatments for Crohn’s disease?
- corticosteroids
- antibiotics
- immunosuppressants
- nutritional support
What are some complications that may occur due to Crohn’s disease?
- intestinal obstruction
- inflammation of membranes
- arthritis
- ankylosing spondylitis
- gallstones
- vitamin B12 deficiency
- thromboembolism
Describe Ulcerative colitis and its causes
an idiopathic inflammatory bowel disease that occurs in the mucosal layer of the rectum and proximal colon
Causes:
- not well known but appear similar to crohn’s disease (genetics, immune dysregulation, infectious agents, psychological issues, environmental factors)
What are the SxS of ulcerative colitis?
- lower abdominal pain relieved by defecation
- bloody stools
- diarrhea
- incontinence
- nocturnal defecation
- fatigue
- weight loss
- dehydration
What are the treatments for ulcerative colitis?
- anti-inflammatory meds
- immunosuppressants
- biologics
- diet modification
- surgery
- monitoring for colon cancer
Describe morbid obesity and what should be monitored
a chronic disease characterized by excessive body fat and BMI of 30 or higher.
- many comorbidities are linked with morbid obesity
Monitor:
- exercise tolerance (BP, HR, RR)
- skin inspection
- weight limits for equipment
What are the different treatments for morbid obesity?
Conservative tx: - weight loss (goal: 10% reduction) - diet modification - medication - behavior management - increased physical activity (better outcomes) Surgical Tx: (BMI>40) - gastric bypass - gastric banding - gastroplasty - gastrectomy
Describe encephalopathy, its causes, symptoms, and treatment
Causes: - acute/chronic liver disease SxS: - impaired mental status and NM dysfunction that occurs over hours to days - altered consciousness (mild to coma) - ammonia intoxication - changes in cerebral blood flow Tx: - reduce ammonia levels - correct electrolyte imbalance - antibiotics - nutritional support - liver transplant
Describe cholecystitis, its symptoms, and treatment
acute or chronic inflammation of the gall bladder
SxS:
- RUQ pain that may radiate to R shoulder
- abdominal rebound tenderness (Murphy’s sign)
- jaundice
- NV
- fever
Tx:
- laparoscopic cholecystectomy
What is the only difference between cholecystitis and cholelithiasis?
Cholelithiasis is gallstone formation
and
cholecystitis is inflammation of the gall bladder
List the GI surgical procedures (8)
- laparotomy
- laparoscopy
- appendectomy
- cholecystectomy
- colectomy
- gastrectomy
- splenectomy
- colostomy
Describe a laparotomy
an open surgery of the abdomen to explore and repair tissues Standard incision: midline Used for: - situations involving multiple dense adhesions - grossly distended intestines - massive ascites - severe bleeding - blunt and penetrating trauma
Describe a laparoscopy
- a short, narrow tube is inserted into the abdomen through a small (<1cm) incision (trochar)
- surgical tools are inserted through the trochar to perform surgery
- high resolution provide visual area of interest
- less invasive, faster recovery time, shows better QOL outcomes
What is an appendectomy?
removal of the appendix
What is a cholecystectomy?
removal of the gall bladder
What is a colectomy?
resection of a portion of the colon
- usually involves a colostomy or ileostomy
What is a gastrectomy?
removal of whole or part of the stomach
What is a splenectomy?
removal of the spleen
What is a colostomy?
a procedure that reroutes stool from diseased colon to an external bag
What are the types of colostomy?
- end colostomy
- double barreled colostomy
- loop colostomy
What should be checked when working with a patient with a colostomy bag?
- make sure it is securely closed before interventions
- keep covered for pt dignity
- empty bag if full
What are PT considerations for GI issues?
- patient positioning for comfort
- increased fatigue is likely
- be aware of dietary restrictions
- Avoid Valsalva. (varices may rupture with increased abdominal pressure)
- ascites hinders effective coughing and restricts adequate ventilation
List the important positioning tips/techniques
- sidelying decreases tension on surgical site
- have pt flx knees while lowering HOB to decrease tension on abdomen
- supine may aggravate dysphagia and GERD
- splinting should be done during mobility/coughing
