GI Disorders and Pelvic PT Considerations Flashcards
Upper GI
Difficulty swallowing
Nausea/vomit
Indigestion
Acid reflux
Lower GI
Severe pain in lower quadrant
Loss of bowel control
Change in stools
Systemic
Loss of appetite Unexplained weight loss Sever bloating Sudden loss of b/b control Night pain Night sweats
Cardiac
Chest tightness
Thoracic pain
Anatomy - rectum - function and from where to where
Storage
15-20 cm long
Starts at S3 at rectosigmoid junction and ends just below tip of coccyx
Anatomy - rectum - Ampula is what
Bottom 2/3 of rectum
Most distensible
Anatomy - rectum - what type of mm
smooth muscle
Anatomy - rectum - Sensation
Distension is sensed due to fascia surrounding rectum or receptors in rectal lining
If less than 15cm = gas
If more than 15 cm = stool
Anatomy - anus
3-4 cm long starting at levator ani mm
2/5 cm below coccyx
Pectinate line - 1.5-2 cm above anal verge
Anatomy - Anorectal mm
Muscular ring comprised of external anal sphincter and puborectalis
They contract simultaneously to kink off anorectal junction and aid in fecal continence
Puborectalis maintains anorectal angle at
90 degrees
Greater than 100 = fecal incontinence
Less than 80 or 90 = constipation
Anatomy - vascular supply - arteries
Superior, medial, inferior rectal arteries
Superior = above pectineal line
Inferior = below
Anatomy - Vascular supply - veins
Superior, medial, inferior rectal veins
Anatomy - vascular supply - Anal cushions
3 submucosal vascular plexes formed from anastamosis of veins
Hemorrhoids:
- internal - usually not P
- external - generally P
Anatomy - nerve supply
Autonomic
Spinal
Somatic
Anatomy - nerve supply - Autonomic
(visceral) Sensitive to stretch Above the pectineal line Sympathetics - L1-L3 Parasymp - S2-S4
Anatomy - nerve supply - spinal
S1, S2, S3
Supply striated muscle, travel in pudendal nerve
Anatomy - nerve supply - somatic
Pudendal nerve
S2-S4
Pain temp touch sensation
Below pectineal line
Anatomy - nerve supply - inferior rectal nerve
Sensory and motor below dentate line including EAS
Anatomy - nerve supply - perineal
Sensory and motor to perianal region
Physiology of defecation - define it
Final act of digestion with expulsion of solid, semi solid, or liquid material through anus
Defecation - normal
2-3 times a day to 2-3 times a week
Defecation - transit time
Variable - ranges from 1-4 days
50% of stamch is emptied in 2.5-3 hrs
Small intestine - 4 to 6 hrs
Colonic transit - 24 to 72 hours
Physiology of defecation - Colonic function “storage and mixing” - Ascending
Stores chyme
Mixes with mucus and bacteria to form feces
Physiology of defecation - Colonic function “storage and mixing” - Transverse
Contents change from liquid to semi solid
Physiology of defecation - Colonic function “storage and mixing” - transverse to descending
Absorption of water and electrolytes
Bacteria work to decompose fiber which nourishes the lining of the colon
Physiology of defecation - Colonic function “storage and mixing” - Descending
Transports stool to rectosigmoid colon for storage
Motility is irregular with bursts of propogated contractions
Physiology of defection - Rectal function
Distends from filling with stool
Stretch receptors signal sensory receptors for urge to defecate
Rectal compliance allows stretch receptors to initiate urge and peristalsis
Rectoanal inhibitory reflex and rectoanal excitatory reflex cause IAS to relax and EAS to contract
Respond to “call to stool”
EAS relaxation for passage of stool
Slight inc in abdominal pressure
Anorectal angle decrease and sphincters return to normal resting tone
Evacuation dysfunction defined by
frequency (goal 1/day)
Stool consistency and shape
Effort and time needed to evacuate (should be less than 1 min)
Feelings of incomplete emptying
Colon transit (slow/fast)
Colonic inertia and megacolon, megarectum
Sphincter/PFM function or dyssnergia
Constipation - Rome III criteria
Symptom based diagnosis
Must have at least 2 of the following symptoms for at least 6 months prior to diagnosis:
Defecation less than 3/wk
Straining or lumpy hard stools 25% of time (type 1 or 2)
Sensation of incomplete evacuation
Constipation - prevalence
Most common GI complaint in US Affects 1 in 6 individuals 2.5 million visits a year Women 2-3x more than men Only 22% discuss with doc $400 million spent on laxatives a year
Bristol Stool Chart
Types 1-3 are said to be indicators of constipation
Types 1 -7
Bristol Stool chart - type 1
Separate hard lumps, like nuts
Hard to pass
Bristol Stool Chart - type 2
sausage shaped but lumpy
Bristol Stool Chart - type 3
like a sausage but with cracks on its surface