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Medcon Rehab IV > GI Disease (ALL) > Flashcards

GI Disease (ALL) Flashcards

1
Q

GI System areas to be covered:

NOTICE SIDES OF EA. ORGAN!!!

A
  • Mouth
  • Esophagus
  • Gallbladder
  • Pancreas
  • Liver
  • Small/Large Intestines
  • Rectum
  • Anus
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2
Q

Liver side + Gallbladder

A

RIGHT

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3
Q

Stomach side

A

Left

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4
Q

Spleen side

A

LEFT

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5
Q

Pancreas side

A

RIGHT

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6
Q

Appendix side (McBurney’s Point)

A

RIGHT SIDE

Landmarks: ASIS + Umbilicus→ right in bw!!!

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7
Q

S/S GI Disease

A

Nausea, vom, dysphagia, achalasia (diff for food/liquid to pass to stomach), heartburn

Constipation, fecal incont, abd pain, GI bleed, anorexia

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8
Q

NORMAL ANATOMY OF UPPER GI

Great pic!!!

A

KNOW IT….LABEL IT!

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9
Q

Normal Anatomy of Upper GI

A
  • To Be Covered:
    • heartburn, substernal pain, diff or pain swallow
    • role of diaphragm and intrabdom pressure on sx’s
    • lower esophageal sphincter (@ bottom of esophagus)
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10
Q

NORMAL Anatomy pic vs.

A

Hiatal Hernia

  • Notice the Hiatus “hole” and how it is LARGER w/ the stomach protruding thru!!!
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11
Q

Hiatal Hernia

A
  • Stomach passes thru diaphragm into thoracic cavity
  • Age & gender
  • KNOW diaphragm and intraabdom pressure→ as diaphragm raises w/ INhale==== HIGHER intraabdom pressure!
  • Dx:
    • Ultrasonography, barium swallow w/ fluroscopy
  • Mgmt:
    • symptom control
    • sx mgmt
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12
Q

Sx for Hiatal Hernia and GERD

Recreates what?

A

Fundoplication

Lower Esophageal Sphincter (LES)

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13
Q

Gastroesophageal Reflux Disease (GERD)

A
  • LES opens spontaneously for pds of time, OR does not close properly→ allows stomach contents to rise UP INTO esophagus
  • *inflamm of esophagus
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14
Q

GERD Mgmt:

A
  • Pharmacological, lifestyle mods, elevate HOB, avoid reclining and vigorous activities 1-3hrs after eating
  • ID and avoid food/bev triggers, sx
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15
Q

Sx’s of _______ and ______ VERY SIMILAR

A

Hiatal hernia and GERD

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16
Q

Pharma Interventions for GERD

3:

A
  1. Proton Pump INhibitors (PPIs)
  2. Histamine 2 receptor blockers
  3. Antacids
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17
Q

GERD Pharma Interventions

Proton Pump Inhibitors (PPIs)

A
  • Acid suppression
  • Shut off acid pump, blocking acid prod.
  • ***FIRST LINE OF TX

EX: Prilosec OTC

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18
Q

GERD first line of tx:

A

PPIs

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19
Q

GERD Pharma Interventions

Histamine 2 receptor blockers

A
  • Acid reduction via prevention of acid secretion
  • ***Long-term relief

EX: Zantac, Pepcid AC

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20
Q

GERD Loooong-term relief

A

Histamine 2 receptor blockers

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21
Q

GERD Pharma Interventions

Antacids

A
  • Acid reduction via acid neutralization
  • **Acid production/secretion remains SAME
  • ***Short-term/IMMEDIATE relief

EX: TUMS, Pepto-Bismol

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22
Q

SHORT-TERM/IMMEDIATE GERD relief

A

Antacids !!!

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23
Q

Hiatal Hernia

PT Implications/Guidelines:

Whats a GREAT INTERVENTION TO USE???? You can also modify it to seated since they should NOT be in supine?????

A

Shaker head lift***

  • Supine/Seated/Elevated HOB
    • Chin tuck→ head lift & hold OR
    • Chin tuck→ head lift & repeated motions for reps
  • Bennies:
    • Swallow help & neck flexor strengthening
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24
Q

Shaker Head Lift

Think…..

A

Hiatal hernia intervention!!!

25
Hiatal Hernia **PT implications/guidelines**
* **AVOID:** * Flat/supine * Valsalve * **Educate:** * MINIMIZE **intraabdom. pressure** * **\*\*\*Shaker head lift!!!**
26
GERD ## Footnote **PT implications/guidelines:** **ALL (then broken down w/ ?'s)**
* Elevate HOB * Left S/L to **prevent regurgitation/aspiration** * Exercise rx to avoid body agitation activities, strenuous exercise * Post-op pulm mgmt/pos'ing * polypharm * **Screening ?'s:** * READ BOOK!!!
27
GERD ## Footnote **PT IMPLICATIONS:** **LEFT sidelying….why?**
Stomach on **left side!** ## Footnote **LESS likely to go back up into esophagus!!**
28
GERD ## Footnote **PT implications** **Exercise rx…. why?**
Strenuous exercise can irritate/cause sx's!!!
29
Gallbladder ## Footnote **FACTS:**
* Reservoir for **bile** * Stores/concentrates **bile** during **fasting pds** * Contracts to **expel bile** into **duodenum** in resp to **arrival of food→** Signaled by release of **_cholecystokinin_**
30
Cholelithiasis aka
Gallstone Disease
31
Cholelithiasis (Gallstone Disease) ## Footnote **which system?**
Biliary
32
Cholelithiasis (Gallstones) ## Footnote **FACTS:**
* **Gallstones→** CHO or bile salts * **INCd incidence:** * Older adults, Native Am's, obesity/post-gastric-bypass/rapid wt loss, women under 50 (role of estrogen) * **Influences:** * diet, **esp. FATS**
33
Acute Cholecystitis aka
Inflamed Gallbladder
34
Acute Cholecystitis aka Inflamed Gallbladder ## Footnote **What is it?**
Impaction of **gallstones** in **cystic duct** * Obstructs **bile flow** * Painful **distention** of gallbladder
35
Acute Cholecystitis aka **Inflamed Gallbladder** ## Footnote **S/S:**
* **Sever pain→** R. subcostal region * **Steady pain→** R. upper abdomen (incs rapidly and **lasts** 30mins→hrs esp after eating) * **Referred pain→** midback bw scap, R. shoulder, R. upper trap, R. subscap * **Fever, INCd WBC #**
36
Acute Cholecysitits aka Inflamed Gallbladder ## Footnote **Sx Procedures:**
KNOW: **Cholecystectomy** * Laparoscopic cholecystectomy * **referred pain up to 48hrs** * Lithotripsy * the **sound waves one**
37
Biliary Disease ## Footnote **PT Implications + Exercise Guidelines**
**Physical activity may _prevent_ symptomatic _cholelithiasis_ (gallstones)** * 30 mins of **endurance activity/day** * **5d/week**
38
Biliary Disease ## Footnote **PT Implications** **Post-op Cholecystectomy interventions:**
Chest PT, breathing retraining, exercise activity, wound splinting **\*\*Remember they just had stomach cut open!!!**
39
Label this Image!
1. Liver 2. Gallbladder 3. Stomach 4. Pancreas 5. Duodenum 6. Colon
40
Liver = POWERHOUSE ## Footnote **FACTS**
* \> 500 functions! * **Key organ w/ gut in nutrient absorption/metabolism\*** * 500-1500 mL bile/day * **Produces clotting factors** * Sole source→ **albumin, plasma PROs** * Conversion/excretion **bilirubin→** too much = jaundice * Stores vitamins * Reduces toxins in body
41
Hepatic (Liver) Disease Symptoms: ## Footnote **ALL**
* GI Sx's * **Edema, ascites (distended stomach)** * **RUQ abdom pain** * Lt/clay color stool * Skin changes→ jaundice, bruising, spider angioma, **palmar erythema** * dark urine * hepatic failure * Portal HTN * **elevated pressure in _portal venous system_** * _Portal vein_→ major vein leading to liver * most common cause→ cirrhosis (scarring) liver
42
Hepatic (Liver) Disease Symptoms ## Footnote **Neuro involvement**
Confusion, sleep disturbs, mm tremors, hypERactive reflexes, **Asterixis (flapping tremor)→** literally what it sounds like!
43
Cirrhosis (Scarring)
* **Chronic, progressive inflammation of liver** * progressive liver tissue damage * Fibrous bands, partition liver into irreg nodules * **\*Sx's:** * Wt loss, fatigue, **jaundice**, unable to met. drugs, hypOalbuminemia, ascites
44
**Alcohol-Related** Liver Disease ## Footnote **3 things:**
1. Fatty liver infiltrate 1. fatty tissue infiltrates liver 2. Alcoholic hepatitis 1. inflamm of liver 3. Alcoholic cirrhosis (scarring)
45
**Alcohol-Related** Liver Disease ## Footnote **PT Implications:**
* Susceptible to **infx's→ Universal Precautions (handwashing)** * Clotting dysf→ monitor bleed/bruising (Falls!) * Only 50% clients abusing alcohol ID'd by physician\*\*\* * NONE OF THEM SAY ANYTHING!!!
46
Hepatic Disease ## Footnote **BIG 2 THINGS TO LOOK FOR AND WHAT TO DO ABOUT IT!!!**
1. **Jaundice→ refer to physician** 2. **Ascites→ refer to physician**
47
Hepatic Disease **More PT Implications**
* Jaundice, Ascites→ refer to physician * **AVOID→** active, intense exercise in **active hepatic dis.** * **Clotting precautions, Universal precautions, Susceptible to infx's**
48
When you see **Mal**_absorption_** Syndrome…..** ## Footnote **THINK……**
Intestines + Rectum\*\*\*
49
Mal**absorption** Syndrome
* Group of disorders characterized by **reduced intestinal absorption of dietary components** OR **excess. loss of nutrients in stool** * Mal**digestion** vs. Mal**absorption** * Includes: * Celiacs * CF * IBD * Crohn's, ulcerative colitis
50
Malabsorption Syndrome ## Footnote **2 components**
Reduced intestinal absorption of dietary components OR Excess loss of nutrients in stool
51
Malabsorption Syndrome ## Footnote **Malabsorption 2 components**
Mal**digestion** vs Mal**absoprtion** * Under this umbrella: * Celiacs * CF * IBD * Crohn's, Ulcerative colitis
52
Mal**absoprtion** vs. Mal**digestion** What's the Difference? (all first)
* Mal**absorption:** * Food **fully digested** * Not adequately **absorbed** by intestines * Celiacs, IBD * Mal**digestion:** * Deficiencies of **enzymes** or specific defects in the **GI tract** * CF→ pancreatic enzymes absent, Lactose intolerance
53
Food fully digested, NOT adequately absorbed by intestines Ex's: Celiacs, IBD
Mal**absorption**
54
Deficiencies of enzymes or defects in GI tract CF, Lactose intolerance
Mal**digestion**
55
Ex's of Mal**absorption**
Celiacs, IBD
56
Ex's of mal**digestion**
CF, lactose intolerance
57
Malabsorption Syndrome ## Footnote **S/S** **Just recognize and ask _if they make sense and WHY_!!!**
* Wt loss, fatigue, depression, abdom bloating, bladder changes (nocturia), abdom cramps, indigestion, mm wasting/weakness\*, changes in BMD/Osteoporosis\*, low BP, parasthesias/neuro damage, dermatitis herpetiformis, infertility * **Bowel changes:** * steatorrhea (oily stools), explosive diarrhea, chronic diarrhea, flatulence
58
Malabsorption Syndrome ## Footnote **Tx, Dx**
* **Dx for various causes:** * blood tests, fecal fat analysis, biopsy small intestine mucosa * **Tx:** * avoid triggers (gluten, lactose) * probiotics * nutrition supps, **Total Parenteral Nutrition (TPN) in _extreme cases_**
59
Irritable Bowel Syndrome (IBS)
* **“Functional” disorder→** sx's NOT attributed to any identifiable bowel abnorm * abnorm intestinal contraction * **S/S:** * pain, bloating, passage of mucus, changes in stool form, stool freq changes, diff defecating, cramping

Medcon Rehab IV (18 decks)

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