GI ISH Flashcards
NSAIDS and type of Pain consideration
Always Consider NSAIDS in scenarios because they cause ulceration and damage gastric mucosa lining. (e.g OA patient with deep boring pain in abdominal/mid bacl…)
Where is an umbilical hernia and what are contraindications
Umbilicus
Contradiction with strong abdominal contractions (e.g vasalva, situps, BL SLR)
Deep Diaphragm is indicated for these patients
Where is the hiatal hernia
into esophagus
Contraindications same as other
Where is inguinal hernia
Inguinal ligament
Contraindications
Skin turgor test
Pinch skin and look for recoil, if it takes long time then dehydrated
What is common side effect of too many NSAIDS
Gastric lining degradation and ulceration due to damaged prostaglandin synthesis of gastric mucosa
Coffee-ground emesis
Vomited blood that touched stomach acid (peptic ulcer)
Hematamesis
Bright red blood (ingested)
Melena
Black tarry stools due to upper GI
Hematochezia
Rectal related bleeding seen in stools (marron color)
GI bleeding indications
low hematocrit
low hemoglobin
Fecaal blood test
Causes of GI bleeding
Trauma
peptic ulcer (heliobacter pylori
NSAID
alcohol
Gastric ulcer pain time
30-90 min after eating
duodenal/pyloric ulcers
pain 2-4 hrs after b/c distal to stomach later in digestion
Gerd and hiatal hernia positioning
Avoid flat supine and prone
do left sidelying
schedule PT before meals or at least 1.5 hr after
Melena (dark-colored stools)
due to upper GI tract
Gerd considerations
Backflow of acid and contents from stomach
Causes heartburn, sharp stabbing pain, hoarseness and coughing, damage to tissues
Caused by NSAIDS, smoking, alcohol, other meds, hematamesis (vomited red blood)
Related to other respiratory and GI issues, leads to further damage of esophagus if untreated
Made worse with recumbency, supine b/c gravity is NOT holding contents down in these positions
Exercise can induce sx, tight clothing, constipation
Left sidelying is ideal
Flow of GI
Upper: mouth to esophagus to stomach (Left) to
Lower: small intestines:duodenum to jujenum to ilium t
then large intestine:ascending, transverse, descending, signmoid, rectum, anus
Pancreas (Left)
Gallbladder and Liver (Right)
secrete digestive enzymes (gland organs)
Stomach
Grinds food with secretion of hydrochloric acid, secretions from gland orhans
*Gastritis, peptic ulcer
Duodenum (small intestine)
Neutralizes acid*
Jujenum (small intestine)
Absorbs nutrients, water, electrolytes
ilium (small intestine)
Absorbs bile and waist
Large intestine
Cont to absorb water, and electrolytes, then eliminated undigested food/feces
Gallbladder
R side
Produces bile to assist with digestion in duodenum
Liver
R side
Produces bile for absorption of and maintenance of nutrients (proteins, fats, lipids)
Related to RBC and vitamin K
Pancreas
L side
Secretes insulin to regulate blood glucose levels (Insulin signals for cellular uptake)
and bicarbonate, other
General considerations for GI disease
- vomiting, diahhreah, weight loss can cause electrolyte imbalances
- Orthostatic hypotension due to imbalance
- Muscle cramping due to imbalance
- Dysphagia
- Back pain shoulder pain due to GI ulcer, bleeding
- Kehrs sign means unwanted blood or air in the abdominal cavity
- Avoid Valsalva
Gastritis considerations
Stomach
Inflammation of gastric mucosa of stomach
- Nausea, vomiting, may be asymptomatic
- may be acute due to NSAIDS, alcohol, infection (REMOVE STIMULUS)
- May be chronic due to H pylori/peptic ulcer (treat with meds proton pump inhibitor and antibiotics)
- If blood in stools, refer out
- Avoid aspirin, blood thinners due to bleeding
- Take food with meds
Proton pump inhibitors end in zole
Peptic ulcer disease considerations
Stomach
- Imbalance, stomach acid related
- NSAIDS or h pylori infection (peptic ulcer)
- Long list of GI sx dependent on location and severity of ulcer
- meds to intervene
- Back pain may be due to ulcer on back of stomach or duodenum
- Epigastric pain b/c stomach is upper
- Mid thoracic pain* radiating to RUQ, R shoulder pain due to blood in peritoneal cavity
Constipation vs diarrhea
Constipation means difficulty emptying due to hard stools
Diarrhea refers to abnormal frequency and/or volume of stools
Malabsorption Syndrome
- Lack of absorbing nutrients
- Many causes (think Chrons, celiac, cystic fibrosis, Addison’s disease, aids, etc.)
- Weight loss, chronic diarrhea, anemia fatigue, bloating, bone pain, oil-covered stools
PT-related - increased risk osteoporosis, weight loss, energy loss, muscle spasms, lack of protein , neuropathy
Hiatal hernia
Stomach protrudes through the diaphragm into the esophagus, causing heartburn,
Irritable bowel syndrome
Think of it as general condition. All around GI symptoms. Severity may vary, but not a disease.
Usually triggered and regulated by psychosocial/stress, diet, strengthening immune system, less caffeine, etc.
Exercise and breathing exercises are good
This can be anyone
Diverticulitis
Inflamed pouches that branch off from intestine
1/4 of people have diverticula but not infalmed
Treat with increased deitary fiber (20-35 g) per day *
Exercise (in remission periods) and breathing is good
Avoid too much abdominal pressure
may have tenderness in L Lower abdomen*
Appendicitis
Consider McBurney point, rebound tenderness, psoas sign, pain that goes from belly button to LRQ
Hepatitis A, B. C Consideration
Sx - fever flu, jaundice, dark urine, enlarged spleen and lover
- usually viral or due to other virus
- Acute treated medically
- Chronic may require transplant
Healthcare worker considerations if come in contact with blood of someone with disease, require immunoglobulin therapy
- pt will require rest and energy conservation during PT
- Type A requires enteric precautions
- Always standard precautions
Cirrhosis of liver
Typically due to alcohol or hepatitis C
Scar tissue lays down in liver
Sx Ascites,* LE edema, * jaundice, * gallstones, spider anginoma, oliguria (decrease urine), RUG pain, Rhabdomyolysis. light-great stools
Process can be treated but not reversed
Report any blood loss
Avoid excessive exercise and valsalva maneuver
- Cholecystitis and 2. Cholelithiasis
- Inflammation and 2. gallstones
Gallstones in the cystic duct
- most common sx is RUQ pain if lodged into cystic duct, and inter scap region
- Jaundice, fever, etc.
Treatment to break up stones or if no stones then will resolve with meds
Exercise and precautions of surgery occurs
INFLAMMATORY bowel disease
Autoimmune, systematic, ulcerative colitis
Related to reactive arthritis b/c autoimmune
Peritonitis
Inflammation of walls of the abdominal cavity
Rebound test
All hernias
Avoid strong abdominal contraction and valsalva
D breathing is good
Pancreatitis
Epigastric pain and referred to L side
Bluish discoloartion, tachycardia, GI sx
Colorectal cancer
Rectal bleeding (hematochezia, maroon color stool), back, abdominal, sacral pain, general GI sx, weight loss, fever
Pernicious anemia
Lack of gastric intrinsic factor (IF)
= less absorption of B12.
Due to malabsorption related issues, gastrititis
If above L1
Spastic and hyperreflexia but reflexes intact so can use digital stimulation for bowel
If below L1
Flacid and areflex so will require manual removal, stool softeners and laxatives may help
If too much acetaminophine
Pancreatitis
