GI Disease (ALL) Flashcards
GI System areas to be covered:
NOTICE SIDES OF EA. ORGAN!!!
- Mouth
- Esophagus
- Gallbladder
- Pancreas
- Liver
- Small/Large Intestines
- Rectum
- Anus
Liver side + Gallbladder
RIGHT
Stomach side
Left
Spleen side
LEFT
Pancreas side
RIGHT
Appendix side (McBurney’s Point)
RIGHT SIDE
Landmarks: ASIS + Umbilicus→ right in bw!!!
S/S GI Disease
Nausea, vom, dysphagia, achalasia (diff for food/liquid to pass to stomach), heartburn
Constipation, fecal incont, abd pain, GI bleed, anorexia
NORMAL ANATOMY OF UPPER GI
Great pic!!!
KNOW IT….LABEL IT!
Normal Anatomy of Upper GI
- 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)
NORMAL Anatomy pic vs.
Hiatal Hernia
- Notice the Hiatus “hole” and how it is LARGER w/ the stomach protruding thru!!!
Hiatal Hernia
- 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
Sx for Hiatal Hernia and GERD
Recreates what?
Fundoplication
Lower Esophageal Sphincter (LES)
Gastroesophageal Reflux Disease (GERD)
- LES opens spontaneously for pds of time, OR does not close properly→ allows stomach contents to rise UP INTO esophagus
- *inflamm of esophagus
GERD Mgmt:
- Pharmacological, lifestyle mods, elevate HOB, avoid reclining and vigorous activities 1-3hrs after eating
- ID and avoid food/bev triggers, sx
Sx’s of _______ and ______ VERY SIMILAR
Hiatal hernia and GERD
Pharma Interventions for GERD
3:
- Proton Pump INhibitors (PPIs)
- Histamine 2 receptor blockers
- Antacids
GERD Pharma Interventions
Proton Pump Inhibitors (PPIs)
- Acid suppression
- Shut off acid pump, blocking acid prod.
- ***FIRST LINE OF TX
EX: Prilosec OTC
GERD first line of tx:
PPIs
GERD Pharma Interventions
Histamine 2 receptor blockers
- Acid reduction via prevention of acid secretion
- ***Long-term relief
EX: Zantac, Pepcid AC
GERD Loooong-term relief
Histamine 2 receptor blockers
GERD Pharma Interventions
Antacids
- Acid reduction via acid neutralization
- **Acid production/secretion remains SAME
- ***Short-term/IMMEDIATE relief
EX: TUMS, Pepto-Bismol
SHORT-TERM/IMMEDIATE GERD relief
Antacids !!!
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?????
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
Shaker Head Lift
Think…..
Hiatal hernia intervention!!!
Hiatal Hernia
PT implications/guidelines
-
AVOID:
- Flat/supine
- Valsalve
-
Educate:
- MINIMIZE intraabdom. pressure
- ***Shaker head lift!!!
GERD
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!!!
GERD
PT IMPLICATIONS:
LEFT sidelying….why?
Stomach on left side!
LESS likely to go back up into esophagus!!
GERD
PT implications
Exercise rx…. why?
Strenuous exercise can irritate/cause sx’s!!!
Gallbladder
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
Cholelithiasis aka
Gallstone Disease
Cholelithiasis (Gallstone Disease)
which system?
Biliary
Cholelithiasis (Gallstones)
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
Acute Cholecystitis aka
Inflamed Gallbladder
Acute Cholecystitis aka Inflamed Gallbladder
What is it?
Impaction of gallstones in cystic duct
- Obstructs bile flow
- Painful distention of gallbladder
Acute Cholecystitis aka Inflamed Gallbladder
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 #
Acute Cholecysitits aka Inflamed Gallbladder
Sx Procedures:
KNOW: Cholecystectomy
- Laparoscopic cholecystectomy
- referred pain up to 48hrs
- Lithotripsy
- the sound waves one
Biliary Disease
PT Implications + Exercise Guidelines
Physical activity may prevent symptomatic cholelithiasis (gallstones)
- 30 mins of endurance activity/day
- 5d/week
Biliary Disease
PT Implications
Post-op Cholecystectomy interventions:
Chest PT, breathing retraining, exercise activity, wound splinting
**Remember they just had stomach cut open!!!
Label this Image!
- Liver
- Gallbladder
- Stomach
- Pancreas
- Duodenum
- Colon
Liver = POWERHOUSE
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
Hepatic (Liver) Disease Symptoms:
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
Hepatic (Liver) Disease Symptoms
Neuro involvement
Confusion, sleep disturbs, mm tremors, hypERactive reflexes, Asterixis (flapping tremor)→ literally what it sounds like!
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
Alcohol-Related Liver Disease
3 things:
- Fatty liver infiltrate
- fatty tissue infiltrates liver
- Alcoholic hepatitis
- inflamm of liver
- Alcoholic cirrhosis (scarring)
Alcohol-Related Liver Disease
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!!!
Hepatic Disease
BIG 2 THINGS TO LOOK FOR AND WHAT TO DO ABOUT IT!!!
- Jaundice→ refer to physician
- Ascites→ refer to physician
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
When you see Malabsorption** Syndrome…..**
THINK……
Intestines + Rectum***
Malabsorption Syndrome
- Group of disorders characterized by reduced intestinal absorption of dietary components OR excess. loss of nutrients in stool
- Maldigestion vs. Malabsorption
- Includes:
- Celiacs
- CF
- IBD
- Crohn’s, ulcerative colitis
- Includes:
Malabsorption Syndrome
2 components
Reduced intestinal absorption of dietary components
OR
Excess loss of nutrients in stool
Malabsorption Syndrome
Malabsorption 2 components
Maldigestion vs Malabsoprtion
- Under this umbrella:
- Celiacs
- CF
- IBD
- Crohn’s, Ulcerative colitis
Malabsoprtion vs. Maldigestion
What’s the Difference? (all first)
- Malabsorption:
- Food fully digested
- Not adequately absorbed by intestines
- Celiacs, IBD
- Maldigestion:
- Deficiencies of enzymes or specific defects in the GI tract
- CF→ pancreatic enzymes absent, Lactose intolerance
Food fully digested, NOT adequately absorbed by intestines
Ex’s: Celiacs, IBD
Malabsorption
Deficiencies of enzymes or defects in GI tract
CF, Lactose intolerance
Maldigestion
Ex’s of Malabsorption
Celiacs, IBD
Ex’s of maldigestion
CF, lactose intolerance
Malabsorption Syndrome
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
Malabsorption Syndrome
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
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
