1. Syncope (passing out) 2. hypotension 3. pallor 4. diaphoresis 5. Tachycardia

GI Disorders Flashcards by Meg Heil

Function of the GI tract (4)

Digestion
o physical breakdown and chemical alterations of food stuff to allow absorption along GI tract
o Involves GI motility, pH changes, biological detergents and enzymes
Absorption
o Direct movement of nutrients across the intestinal lining
Excretion
o Food residue, hydrophobic molecules (drugs bacteria and dead cells)
Host defense
o Largest lymphoid organ in the body with extensive surface area
o Gut microbiome
o

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Function of the esophagus

-Fibromuscular tube connecting the throat with the stomach
-Food passes by peristaltic contractions
Sphincters: bundles of muscle that control entry/exit
o Upper esophageal sphincter
o Lower esophageal sphincter

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Explain GERD and contributing factors

Reflux of gastric contents into the esophagus causes heartburn
contributing factors:
1. incompetent lower esophageal sphincter
2. impaired gastric emptying
3. Hiatal hernia
4. Alcohol abuse
more common in children with developmental delays

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Complications of GERD

Regurgitation/malnutrition
Esophagitis- inflammation of the esophagus
Barretts Esophagus
-Transformation of the normal esophagus squamous epithelium to columnar epithelium “pre malignant”
-Increased risk of developing esophageal cancer
Respiratory compromise: Associated with asthma and COPD

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Function of the Stomach

Reservoir function: controlled release of chyme into small intestine
mechanical digestion: gastric motility peristalsis
chemical digestion: digestive enzymes continue digestion of protein and fats
Hydrochloric acid: chemical digestion activates digestive enzymes; immune defense
Intrinsic Factor (IF): binds vitamin b12 for absorption

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If there is an issue with intrinsic factor in the stomach what happens? Where is intrinsic factor produced

individual will become vitamin b12 deficient
intrinsic factor is produced in the parietal cells

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Cell types within the stomach allow for what?

alot of cell types in the stomach secrete mucus to protect the stomach from its own acidity

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Define Gastritis and acute causes

Gastritis: inflammation of the inner lining of the stomach
excessive acid production> gastric defense
ex: NSAID, ASA, ETOH
Stress induced
ex: common in critical illness

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Define Peptic Ulcer Disease

increased acid secretion and digestive enzymes that erode the gastric mucosa
Helicobacter pylori infection: infection leading to PUD

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Complications of PUD

Hemorrhage, peroration, peritonitis, scarring
defined by site of origin

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15% of long term ___ users develop peptic ulcer disease

NSAID
Asprin, ibuprofen and cox2 inhibitors

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What are the risk with NSAID/Asprin

pain relief with GI bleeding risk blocks both COX1 and COX2

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What are the risks with COX2 inhibitors

pain relief with decreased GI bleed risk but Increased MI/CVA risk

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GI Bleed Red Flags

Syncope (passing out)
hypotension
pallor
diaphoresis
Tachycardia

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Coffee ground emesis/ black tarry stools indicate what type of GI bleed

UGIB
not good

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Blood in stool indicates what type of GI bleed

LGIB

What examination items would you include for a pt who has a PMH including GIB

review the H & H values- look for trends slow decrease in value recognize that the blood volume is less and less oxygen carrying capacity
normal RBC around 13-17 male
female 12-15

Function of the small intestine

mixes and grinds (segmentation) and propels (peristalsis) contents
digests and absorbs nutrients
secretes regulatory hormones

mainly absorbs nutrients!!!!

Explain Small Intestine segmentation

mixes and grinds breaks down food

Explain small intestine peristalsis

propels food bowel forward

Function of Large Intestine

main function of large intestine is reabsorption of water along with ions and some vitamins

What is the same and different about crohns disease and ulcerative colitis

Crohns Disease: inflammation that involves the entire bowel wall
pain in the lower right abdomen
Ulcerative Colitis: involves inflammation of the inner most lining of the bowel wall
pain is common in the lower left abdomen

Both involve joint pain and the medication taken suppresses the immune system thus these individuals are at a higher risk of infection

Common presentation of Crohns and Ulcerative Colitis

abdominal cramping, pain, diarrhea, obstruction, fatigue, malabsorption, leading to weight loss and malnutrition

What is IBS

o Disturbed bowel function without structural abnormalities
o Spasmodic motility pattern
o Malabsorption
o Nutrient deficiency and loose stools
o Etiology is unknown but IBS is believed to be related to colonic sensitivity
o Diagnosis of exclusion

Celiac Disease

Autoimmune disorder genetic predisposed people where ingestion of gluten damages the small intestine can lead to malabsorption and symptoms of bloating, diarrhea, gas and fatigue other issues include anemia, osteoporosis

Describe Hernia

Protrusion of an organ through the wall of the cavity that normally contains it Can lead to necrotic tissue or ischemia to the protruding tissue Doesn't necessarily need surgery

Describe Acute Abdomen/ Peritonitis and the Physical Exam

Sudden severe abdominal pain <24 hrs in duration often a medical emergency causes: appendicitis, cholecystitis, pancreatitis, ischemic bowel, AAA Physical Exam: identify location, palpation reveals rigidity; rebound tenderness; bowel sounds are usually diminished or absent

Colorectal Cancers

Progression often starts with benign polyp early detection; Colonoscopy common symptoms: bleeding; pressure/pain with deification; change in elimination associated with: family history, diet, age, exercise 3rd most common cancer 3rd leading cause of death

Common post operative compliations and what the PT role is?

pain pulmonary complications bleeding infection ileus: decrease motility/paralysis of the bowel bowel leakage: sepsis pt needs to be aware of pt changes in presentaion

Explain Pancreatitis

acute inflammation of the pancreas leads to inflammation and auto-digestion Causes: Alcohol abuse and gall stones

Common Signs and Symptoms of Pancreatitis

Severe abdominal pain, often radiating to the back nausea/vomiting symptoms worsen after eating foods relief with forward leaning can mimic LBP

Explain the importance of the liver in portal circulation

all GI veins go to the liver Thus if there is an issue with the liver and its function the veins will back up and increase in pressure causing portal hypertension causing the veins to expand leading to varices Varices can burst leading to Upper GI bleed

Explain the liver and its role in the first pass effect

The liver plays a role in detoxifying noxious compounds found in chemicals and drugs thus all the things pass by the liver for detoxification

Why does a pt with a liver disorder look swollen

If there is dysfunction of the liver then the liver is unable to produce albumen which makes it so that water isn't readily pulled into the capillaries as much so the water is pushed out into the intersitum. however the patient is actually extremely dehydrated and hypovolemic and hypotensive because the water was pushed out. pt should not be on a diuretic

Signs and Symptoms of Liver Dysfunction

Jaundice: excessive deposition of bile pigments Ascites: abdominal swelling/fluid in the peritoneum due to portal HTN and hypoalbuminemia

What is the difference between an aneurysm and a dissection?

aneurysm: ballooning/weakening of vessel wall ppl can have stable aneurysm for years Dissection: tear in the intimal layer medical emergency--> sharp pain instant blood accumulation

Clinical Presentation of ruptured/dissecting AAA

1. sudden abdominal or back pain 2. hypotension and tachycardia; sweating; clamminess; dizziness 3. N/V 4. Pulsating mass in abdomen

What are the Risk Factors and Complications of AAA

age, family hx, HTN, CAD, smoking, high cholesterol, male Complications thrombosis distal embolism dissection and rupture

Should a patient with a known aneurysm exercise?

high blood pressure--> pushing on already weakened walls typically yes but with restrictions HR: 90 bpm BP: SBP 150 duration and size of aneurysm