GI System Flashcards
S/Sx GI Disease
- N/V
- diarrhea
- anorexia
- constipation
- dysphagia
- achalasia
- heartburn
- abdominal pain
- GI bleeding
- Bowel incontinence
Achalasia
- inability to relax smooth muscles of GI tract
- feeling of fullness in sternal region
hematemesis
-spitting up blood
melena
black stool
hematochezia
bloody stool
Causes of Diarrhea
- neurogenic: IBS
- Muscular: alcohol, muscular incompetence
- Mechanical: obstruction
- Other: diet, meds, infection, strenuous exercise
Causes of Constipation
- neurogenic: IBS, MS, PD
- Muscular: inactivity, back pain
- mechanical: obstruction
- Other: diet, meds
Aging and GI
- constipation, incontinence, diverticular disease
- wear/tear dental components
- decreased sensation and salivation
- decrease gastric motility, volume/acid content
- decreased blood flow and nutrient absorption
- decreased production of intrinsic factor (IF)
GI is an ____ organ
-endocrine
GI produces and secretes _____
hormones
-travel through portal system to organ of influence
Intrinsic Innervation
- enteric nervous system
- myenteric plexus
- submucsal plexus
Extrinsic Innervation
-parasympathetic and sympathetic nervous systems
Parasympathetic Innervation of GI
- from sacral segments of SC
- thoracic ganglia
- celiac, superior mesenteric, inferior mesenteric ganglia
Sympathetic Innervation of GI
-nonadrenergic fibers from prevertebral sympathetic ganglia
Vagus Nerve
-sensory and motor fibers
Gastrointestinal conditions: Esophagus
- hiatal hernia
- GERD
- Scleroderma Esophagus
- Neoplasms
- Varices
- Tracheoesophageal Fistula
Hiatal Hernia
- enlargement of cardiac sphincter
- stomach protrudes thru opening into diaphragm into thoracic cavity
Hiatal Hernia may cause:
- midline/sternal pain (heartburn) 30 min after eating
- pain/difficulty with swallowing
Treatment of Hiatal hernia
- antacids
- elevating upper body in supine position
- avoid full supine
- avoid valsalva
GERD
- gastroesophageal reflux disease
- result of reflux of irritating fluids
GERD Treatment
- acid-suppressing inhibitor drugs (PPIs)
- antacids or histamine blockers
- lifestyle modifications
GERD PT Management
- exercise may aggravate
- decreased Sx with less strenuous exercise
- avoid supine
Esophageal Neoplasms
- 2 types: squamous cell and adenocarcinoma
- more in middle aged white men
- squamous more in blacks
GERD may increase the risk of:
-adenocarcinoma via Barrett’s esophagus (precancerous)
_____ mades esophageal mucosa more vulnerable to neoplastic changes
-vitamin A and zinc deficiencies
Food/drink remaining in esophagus may lead to _____
-ulceration/metaplasia
Sx of esophageal neoplasm
- dysphagia w/ or w/o pain
- heartburn in supine
- enlarged painless lymphnodes
- anorexia
- weight loss
- hoarseness
- cough/recurrent pneumonia
- bleeding
Esophageal Neoplasm Treatment
- surgery
- radiation
- chemo
poor prognosis/rapid metastasis
Esophageal Varices
- dilation of veins in lower 1/3 of esophagus
- liver disease–>portal HTN–>varices
Variceal bleeding usually manifests as ____
painless but massive hematemesis with or w/o melena
Esophageal Varices S/Sx
- postural tachycardia
- profound shock
- melena
- hematemesis
- asterixis
- ascitis
Esophageal Varices Treatment
- pharmacologic
- endoscopic
- liver transplant
Esophageal varices PT management
- avoid valsalva
- watch for asterixis
- assess fluid retention (ankles) and ascites
Stomach Conditions
- Gastritis
- Peptic Ulcer Disease (PUD)
- Gastric Cancer
Gastritis
- inflammation of stomach lining (gastric mucosa)–not whole wall
- most common stomach disorder
- 2 types: A and B
Gastritis Type A
- associated with pernicious anemia
- less common
Gastritis Type B
- bacterial infection
- more common
(Helicobacter pylori)
Acute Gastritis
-often with serious illness (physiologic stress) or meds (NSAIDs)
Risk factors with NSAID use:
- > 65
- Hx of ulcer disease
- NSAIDs >3 months
- high dose of multiple NSAIDs
- concurrent corticosteroid therapy
S/Sx Acute Gastritis
- epigastric pain
- abdominal distention
- appetite loss
- nausea
- occult GI Bleeds
- heartburn
- low-grade fever
- vomiting
S/Sx Chronic Gastritis
- asymptomatic
- pain/indigestion after eating
Acute Gastritis PT Management
- watch for Gastritis in people taking NSAIDs
- edu about side effects, risks, proper use of NSAIDs
PUD
- peptic ulcer disease
- break in gastric mucosa or duodenal mucosa
Pepsin
- proteolytic enzyme
- principle component of gastric juice
- catalyst in chemical breakdown of protein
S/Sx of PUD
- symptomless until perforation/hemorrhage occur
- epigastric pain (burning, gnawing, cramping, aching)
- nausea
- appetite loss
- weight loss
- occur in waves
- radiate to back (steady T6-T10 pn with duodenal perforation)
Risk factor of PUD
- Helicobacter pylori infection (90% of all ulcers)
- NSAIDs
S/Sx PUD related to:
-secretion of acid presence of food in stomach
PUT Treatment Goals
- relief of Sx
- promote healing
- prevent complications
- prevent recurrence
_____ ulcers heal faster than _____ ulcers
duodenal faster than gastric ulcers
PUD Treatment
- antimicrobials for H. pylori
- antacids, PPIs, histamine blockers
- diet mod
- surgery for perforation
- ex’s to decrease risk of GI bleeding (moderate)
Signs of GI bleed
- pallor
- activity intolerance
- fatibue level
- vital signs: RR, HR increased
Most Common Gastric Cancer
- adenocarcinoma
- (90% of all malignant tumors of stomach)
Gastric Cancer Risk Factors
-H. pylori
Treatment of Gastric Cancer
-surgical
S/Sx Gastric Cancer
- epigastric pn
- back pain
- paraneoplastic acanthosis
- left supraclavicular lymph node enlarged (Virchow’s)
- umbilical nodule
Paraneoplastic Acanthosis
- diffuse thickening of skin with grey/brown/black pigmentation
- found in body folds
Virchow’s Node
- left supraclavicular lymph node
- commonly involved with gastric cancer
Intestinal Conditions
- malabsorption syndrome
- intestinal ischemia
- botulism
- inflammatory bowel disease (IBD)
- irritable bowel syndrome (IBS)
- diverticular disease
- neoplasms
- obstructive disease
Malabsorption Syndrome
-group of syndromes marked by decreased intestinal absorption/excessive loss of nutrients in stool
Causes of Malabsorption Syndrome
- Celiac Disease
- Cystic Fibrosis
- Crohn’s Disease
- Chronic Pancreatitis or Pancreatic Carcinoma
- Pernicious Anemia
- Short-Gut Syndrome
Maldgestion
-failure of chemical process of digestion
Malabsorption
-failure of intestinal mucosa to absorb digested nutrients
Digestive Defects
- Cystic Firbosis: absent pancreatic enzymes
- Lactase Deficiency
Absorptive Defects
- primary (celiac disease)
- secondary (inflammatory disease bowel)
Types of Malabsorption Conditions Seen in PT
- gastroenteritis due to NSAID use
- Fibrosis due to progressive systemic sclerosis or radiation
- exocrine deficiency of pancrease due to DM
- Short-gut syndrome following extensive resection of bowel
Early Symptoms of Malabsorption Syndrome
- weight loss
- fatigue
- depression
- abdominal bloating
- steatorrhea
- nocuria
- dermatitis herpetiformis
Common Symptoms of Malabsorption Syndrome
- explosive &/or chronic diarrhea
- abdominal cramps
- indigestion
- flatulence
Later Symptoms of Malabsorption Syndrome
- muscle wasting
- bone mineral density changes
- low BP
- abdominal distention
- pernicious anemia
- clubbed fingers
Malabsorption Syndrome can result in:
-pernicious anemia
poor uptake of Vit B12
Aging of GI system can result in:
- decreased Intrinsic factor (IF) which promotes B12 absorption
- pernicious anemia
malabsorption of Calcium, vitamin D and proteins can cause:
- osteoporosis
- bone pain from compression Fx
- skeletal deformities
electrolyte imbalance and low Ca++ can cause
Mm spasms
Intestinal Ischemia caused by:
- embolic occlusions of abdominal aorta visceral branches
- arteriosclerotic changes
Intestinal Ischemia usually presents with:
- crampy or steady epigastric or periumbilical pain
- can refer to thoracolumbar junction with exertion
PT management of intestinal ischemia
- screen back pain pts for:
- -CAD risk factors
- -PVD/PAD
- -recent surgeries
- -Hx of blood clots
Botulism result from indigestion of:
- E. coli
- Camplyobacter listeria
- salmonella
GI Symptoms of Botulism
- prolonged bloody diarrhea
- dehydration
- wt loss
- fever
- nausea
- severe abdominal pain
Neurologic Sx of Botulism
- motor weakness
- paresthesias
- CN palsies
Treatment of Botulism
-antitoxin
IBD
- inflammatory bowel disease
- 2 types (Crohn’s disease, ulcerative colitis)
CD
- Crohn’s Disease
- affects all layers of intestine with normal areas between (skip areas)
UC
- ulcerative colitis
- affects mucosa and submucosa in continuous pattern (no skips)
Cause of CD and UC
-idiopathic
CD and UC affect:
-GI tract’s ability to distinguish foreign entities from body’s antigens
Etiology of IBD
- genetic link
- immunologic mechanism
- run in families
Treatment of IBD
- diet/nutrition
- palliative
- medication
- surgical excision
IBD PT management
- watch for referred pn to LS
- screen all pt with low back/hip/SI pn with unknown origin
- aware of low bone mineral content/osteoporosis
- watch for dehydration/vascular depletion
Antibiotic-Associated Colitis
-long courses of antibiotics can decrease colonies of normal GI bacteria–>colonization of yeasts, molds and C. diff–>damage of intestinal mucosa
Symptoms of Antibiotic-Associated Colitis
- voluminous watery diarrhea
- abdominal cramps/tenderness
- fever
Clinical Complication of Antibiotic-Associated Colitis
- easily spread to other pts
- hand washing (C. diff)
Treatment of Antibiotic-Associated Colitis
- stop antibiotics
- use of meds
- IV fluids
- antibiotics just for C. diff
- probiotics
- immunoglobulins
Antibiotic-Associated Colitis: watch for
-reactive arthritis
reactive arthritis
- acute, aseptic inflammatory arthropathy after infectious process
- at site remote from primary infection
IBS
- Irritable bowel SYNDROME
- group of symptoms
- most common disorder of entire GI
- No inflammation
IBS Cause
- abnormal intestinal contractions
- stress/serotonin levels
- women>men
IBS Treatment
- lifestyle/dietary changes
- medications
IBS Symptoms
=/>3 months
-relieved by bowel movement
IBS PT Management
- exercise (decrease stress and assist bowel function
- proper breathing/relaxation techniques
Diverticulosis
-uncomplicated disease
Diverticulitis
-disease with inflammation
Diverticula
- outpocketing in intestinal wall
- muscosa/submucosa herniates through muscular layers
Diverticular Disease Symptoms
- 80% asymptomatic
- passing fresh blood/clots
- urgency in defecation
- severe abdominal pain (left quadrant, mid-abdominal region-refer to back, pelvic pain)
- alternating constipation/diarrhea
- increase flatus
- fever
- anemia (due to blood loss)
Diverticular Disease Treatment
- dietary changes
- laxatives
- exercise
- may require antibioticcs
- NG Tube
- parenteral feedings
Neoplasms
- intestinal polyps
- adenocarcinoma
Intestinal polyps
- growth protruding into intestinal lumen from mucosa
- may be neoplastic (tumor) or non-neoplastic
- malignant or benign
Adenocarcinoma
-most relevant in colon and rectum
Adenocarcinoma Cardinal Sign
-bright-red blood from rectum
differentiate from diverticulosis
Adenocarcinoma Symptoms
- persistent stomach pain
- diarrhea
- constipation
- sometimes asymptomatic until metastasis occurs
Adenocarcinoma Prevention
- regular colonoscopy after 50 years
- decrease risk factors
- exercise
- daily aspirin/NSAID use >20 year
- sigmoidoscopy
- healthy diet
- no smoking/alcohol
Adenocarcinoma Treatment
- surgical removal of tumor (or portion of colon)
- radiation
Spread of cancer to prostate can refer pn to:
- sacral/lumbar spines
- vague, dull, achy
PT management of Adenocarcinoma
- simultaneous or alternating abdominal pain at same level as back pain
- associated GI symptoms
Adenocarcinoma Risk Factors
- age
- men
- adenomatous polyps
- UC/CD
- cancer elsewhere
- Family Hx
- Immunodeficiency disease
- sedentary
- tobacco
- low-fiber/high-fat/high-protein diets
Obstructive Disease Causes
- organic (ulcer, gallstone, viral infection, neoplasm)
- mechanical (actual block)
- functional (peristalsis, drug, electrolyte imbalance)
Obstructive Disease Progression
-obstruction–>distention–>constipation
Symptoms of Obstructive Disease
- cramping pain/tenderness in periumbilical area
- costitutional symptoms
- dehydration
- hypovolemia
- metabolic acidosis (w/n 24 hours of obstruction)
Paralytic Ileus
- functional obstruction
- after anterior lumbar fusion/abdomina surgery/immobilization
Obstructive Disease PT management
-get moving (within limitations by surgeon)
mechanical obstruction
- adhesions
- intussusception
- volvulus
- hernia
adhesions
-fibrous bands after abdominal surgery
intussusception
-telescoping of bowel in on itself
volvulus
-torsoin of an intestinal polyp, twisted on it’s mesentery
hernia
-abnormal protursion of part of an organ/tissue through structure normally containing it
Types of Hernias
- inguinal (direct/indirect) [sports hernia]
- femoral
- umbilical
- incisional (ventral)
Symptoms of Hernias
- intermittent/persistent bulge
- interm/persistent pain
- pn increases with change in position, valsalva maneuver, physical exertion
- pn relieved by stopping atcitity
- fever, tachycardia, vomiting, abdominal distention
Treatment of Hernias
-surgical repair (herniorrhaphy)
Appendicitis
- inflammation of vermiform appendix
- may progress to necrosis, perforation–>peritonitis
Cause of Appendicitis
- 1/2 are idipathic
- 1/3 due to obstruction
- infection elsewhere
- IBD (CD/UC)
- tuberculous enteritis
Symptoms of Appendicitis
- abdominal pain
- anorexia
- nausea
- vomiting
- low-grade fever (higher in children)
- TTP over McBurney’s point
- agg by valsalva, bend over
Treatment of Appendicitis
-surgical removal
PT management of Appendicitis
- refer to right hip, thigh, groin
- screening: palp of McBurney’s Point
- Blumberg Sign (rebound pn)
- local pn on coughing/valsalva
Peritonitis
-inflam of serous membrane lining abdominal cavity
Primary Peritonitis
-spontaneous
Secondary Peritonitis
-due to trauma, surgery, ulceration (contam by bowel contents)
Symptoms of Peritonitis
- rigid/board-like abdomen
- severe abdominal pn
- high fever
- nausea
- vomiting
- Blumberg Sign (rebound pn)
Treatment of Peritonitis
- surgical drainage/repair
- antibiotics
- supportive measures to correct fluid, electrolyte and nutritional disorders
Kehr’s sign
- left shoulder pain with splenic irritation
- associated with peritonitis due to blood, infectious fluids in abdominal cavity contacting spleen
Spleen refers to
-left shoulder
Liver refers to
-right shoulder
