OTH: GI System Flashcards
Upper GI contains
Mouth, esophagus, stomach
Middle GI contains
Small intestine (duodenum, jejunum, ileum)
Lower GI contains
Large intestine (cecum, colon, rectum)
What are the accessory organs of the GI system?
Salivary glands, liver, pancreas
Neural control is achieved by ___. The ___ and ___ plexuses extend length of GI wall. ____ (mediated by __ N.) reflexes control secretions and motility of GI tract.
ANS
sympathetic and parasympathetic
Vasovagal (Vagus)
Major GI hormones include
Cholecystokinin, gastrin, secretin
N+V: nausea signals stimulation of ___ vomiting center. Can be triggered by food, drugs, ___oxia, shock, inflammation of __ __, distention, irritation of __ __, __ sickness. Prolonged vomiting leads to __ and ___ imbalance, resulting in ___ aspiration and mucosal/GI damage.
Medullary
Hypoxia, abdominal organs, GI tract, motion sickness
Fluid and electrolyte, pulmonary
Diarrhea: Dehydration, ___ imbalance, dizziness, thirst, weight __. Triggers: ___ organisms ( ____, rotavirus, ____), dysentery, ___ enteropathy, ___ ___ syndrome, ____thyroidism, neoplasm, diverticulitis
Electrolyte, loss
Infectious (E. Coli, Salmonella), diabetic, irritable bowel, hyper
Constipation: From diet lacking in ___ and ___, inadequate ___ consumption, __ age, ___ lifestyle, drugs (___and ___ meds). ____thyroidism, diverticula disease, __ __ syndrome, __, __ (2 NM conditions), tumors, __ obstruction, rectal __
Bulk, fiber, fluid
Increasing age, sedentary, CCB and anticholinergics
HYPOthyroidism, IBS, PD, SCI
Bowel, lesions
What is obstipation? Who gets this?
Intractable constipation- fecal impaction, likely inability fart, retention of hard dry stools in rectum/colon
- post-op pts, long-term opiates, SCI
(Needs to be removed)
RED FLAGS: constipation can cause ___ pain, tenderness in ___, ___, __ regions
Abdominal, anterior hip, groin, thigh
Constipation may develop as result of __ __ and __ (i.e. LBP)
Muscle guarding
Splinting
Dysphasia can result from CNS lesions (3 listed), strictures, ___ scarring, swelling, __, and __
stroke, PD, Alzheimer’s
Esophageal
CA, scleroderma
What is achalasia?
Lower esophageal sphincter fails to relax (food gets trapped in esophagus)
Abdominal pain can result from (3 listed)
Visceral pain in epigastric, periumbilical, lower abdomen —> what spinal levels are these associated with?
- Inflammation 2. Ischemia 3. Mechanical stretching
Epigastric: T3-T5 symp distribution
Periumbilical: T10 sympathetic
Lower abdomen: T10-L2 sympathetic
RED FLAGS: Referred GI pain patterns —> where?
- Esophagus
- Midthoracic spine (nerve roots)
- Visceral pain from liver, diaphragm, pericardium
- Visceral pain from colon, appendix, pelvic viscera
- Midback
- Esophageal
- Shoulder
- Pelvis, low back, sacrum
What is heartburn? What increases it?
Painful burning sensation, reflux
From increased abdominal pressure: pregnancy, tight clothing, bending over, lying down after large meal
4 causes of GI bleeds
- Erosive gastritis
- Peptic ulcer
- Prolonged use of NSAIDs
- Chronic alcohol
How do you determine occult blood?
Stool sample lab test
Inflammation of liver from viral or bacterial infection, chemical agents (alcohol, drugs, toxins)
Hepatitis
autoimmune hepatitis, ___ cirrhosis, metabolic disorders (___ disease) are all causes of hepatitis
Biliary, WILSONNNNNN’s
Hepatitis A: __ __ hepatitis
Transmission: ?
Acute or chronic?
Prevention?
Acute infectious
Oral-fecal routine (contaminated food/water, person-to-person)
ACUTE (mild—> severe)
Prevention: hand hygiene, sanitation, immunization
Hepatitis B: ___ hepatitis
Transmission?
How long does it last?
Prevention?
Serum
Blood, body fluids, body tissues, blood transfusion, oral/sexual contact with contaminated person, contaminated needles
Mild (few weeks)- chronic (yrs)
Prevention: disposable needles, screen blood donors, health care worker pxns, immunization (EDUCATION)
Hepatitis C?
Transmission? What is most common?
Acute or chronic?
Same transmission as B (body fluids)
Needle sharing most common
Can be acute OR chronic
Hepatitis D
How do you get it?
What is prognosis?
Dependent on having Hep B
Poor prognosis- pts often with fulminant liver failure
Sx of hepatitis: initial stage (___)- low grade fever, anorexia, N+V, diarrhea, fatigue, malaise, headache, ___ tenderness, myalgia, arthralgia
Preicteric
Abdominal
What is second stage of hepatitis? (2 names)
Jaundice/icteric
What are symptoms of jaundice?
Fever, jaundice, enlarged liver with tenderness, abatement of earlier symptoms, dark or amber colored urine
What are the elevated lab values of hepatitis?
Hepatic transaminases, bilirubin
Chronic HBV and HCV may lead to what?
Chronic liver infection (necrosis, cirrhosis, failure)
Viral hepatitis is leading cause of ? Common reason for what?
Liver CA
Liver transplant
Cirrhosis is a result of ?
Chronic hepatitis
Cirrhosis sx?
___, ___ edema, ____ contracture, ___ erythema, angiomas, ___megaly, ____megaly, ____(abdominal)
Jaundice Peripheral Dupuytren’s Palmar Hepatomegaly, splenomegaly Ascites
Tx?
Lasix, paracentesis to drain fluid
Late complication of cirrhosis may be __ __
Hepatic encephalopathy
What are 3 other changes (neuro) with cirrhosis?
Personality changes, intellectual impairment, slurred speech
What is asterixis?
Liver flap- myoclonus of hand with wrist in extension, seen with late cirrhosis, characteristic of hepatic encephalopathy, drug OD, WILSON’s disease
What is lactulose (cirrhosis)
Increase in BM and excrete ammonia in stool
What is cholelithiasis?
Gallstones present in gallbladder
What does cholelithiasis lead to?
If block common bile duct, biliary colic can occur
cholelithiasis/gallstones pain radiates to where?
RUQ pain with radiation to R SCAP
What is cholecystitis?
Partial or complete obstruction of common bile duct resulting in inflammation of gallbladder
Where is pain/where is it referred with cholecystitis? Other symptoms?
Pain in RUQ, radiates to R scap
N+V, low grade fever
What is Murphy’s sign? What does it indicate?
Palpate near R subcostal margin as pt takes deep breath
Pain indicates cholecystitis
3 causes of acute pancreatitis
- Gallstones
- Alcoholism
- Substance abuse
Acute pancreatitis pain- where? Radiates where?
Acute band-like pain radiating to back, worse in supine
Symptoms of acute pancreatitis?
PXN for pt?
Hypotension, tachycardia, N+V
NPO**
Chronic pancreatitis is pain where?
Epigastric and LUQ
Sx of chronic pancreatitis? (6)
- Anorexia
- N+V
- Constipation
- Flatulence
- Wt loss
- Steatorrhea
What is GERD?
Reflux of gastric contents from stomach —> esophagus, causes heart burn
Why does GERD occur?
Failure of lower esophageal sphincter to regulate food flow from esophagus into stomach from increased gastric pressure
Over time, gastric acids (ph ?) damages esophagus. Heartburn is common ___ after eating and lying down at night.
<4
20-30 min
RED FLAGS: Atypical GERD pain may present as ____ pain. May sometimes be mistaken for ___ with ___ pain. Respiratory symptoms may include (3).
Head/neck
heart attack, chest
1. Cough 2. Hoarseness 3. Irritation
Complications of GERD? (2)
Strictures
Barrett’s esophagus (precancerous)
PT interventions for GERD? (2)
- Positional changes from full supine to more upright
2. Contraindication: Valsalva (when is it ever not…)
Hiatal hernia: protrusion of ___ upward through ___, or displacement of stomach ___ junction upward into ___.
Stomach, diaphragm
Gastroesophogeal, thorax
Sx of hiatal hernia?
Heartburn from GERD
Gastritis of the stomach: from 5 causes
- Severe burns
- NSAIDs
- corticosteroids
- Allergy
- Infection
Symptoms of gastritis? 3
Anorexia, N+V, pain
Chronic gastritis: from ____ (bacteria), __ CA, ___ anemia, autoimmune disease (__ and __)
H. Pylori
Stomach
Pernicious
thyroid, addson’s
Pts taking NSAIDs long-term should be monitored for what?
Stomach pain, bleeding, N+V
What is peptic ulcer disease?
Ulcerative lesions of upper GI tract
Causes of peptic ulcer disease? (5)
- H. Pylori
- Aspirin
- NSAIDs
- Excess secretion of gastric acids
- Stress
Sx of peptic ulcer disease:
___ pain, __, __, __ (3 sensations), hemorrhage, dizziness, weakness, ____ ___
Epigastric
Gnawing, burning, cramping
Circulatory shock
Pain from peptic ulcer is located where? Radiates where?
Posterior wall of stomach —> radiates to back and possibly R shoulder
Gastric/small bowel resection, CF, celiac, Chron’s, chronic pancreatitis, and pernicious anemia can all lead to
malabsorption syndrome
Red flags for malabsorption syndrome:
- ____ anemia
- Easy ____/___ due to decreased Vitamin _
- Muscle __ and __
- Bone loss, pain, predisposition for __
- __, tetany, ___
- spasms due to decreased ___
- Peripheral __
- Iron-deficiency
- Bruising/bleeding
- Weakness/fatigue
- Fx
- Neuropathy, paresthesias
- Electrolytes
- Edema
Inflammatory bowel disease (IBD)- from 2 chronic inflammatory intestine disorders ?
- Chron’s
2. Ulcerative colitis
Sx of IBD? What’s common in peds?
Abdominal pain, frequent attacks of diarrhea (that sucks), fecal urgency, wt loss
- stunted growth in peds
Symptoms of malabsorption syndrome: anorexia, wt loss, abdominal ___, pain and ___, ___, ___ (greasy poop)
Bloating, cramps, indigestion, steatorrhea
Deficiency of ___ enzyme with malabsorption syndrome
Pancreatic lipase
Chronic IBD can lead to __ and __
Anxiety, depression
IBD red flag: jt pain (reactive arthritis), skin rashes —> referral to where?
Low back
Complications of IBD include (2)
Intentional obstruction, corticosteroid toxicity
Nutritional deficiencies are common with IBD due to what?
Intentional absorption disrupted
Granulomatous inflammation anywhere in the GI. What type of lesions with this?
CHRON’S — skip lesions
Ulcerative and exudative inflammation of large intestine and rectum. What kind of lesions with this condition?
ULCERATIVE CHOLITIS: NO skip lesions
Ulcerative cholitis: 3 symptoms
Blood diarrhea, mucus, pus
IBS has abnormal increased motility of __ ?
Aka __, ___, __ colon
Large and small intestines
Spastic, nervous, irritable
Tx for IBS
Stress reduction, meds for anxiety, regular physical activity
Pouch like herniation of mucosal layer of colon
Diverticular disease
Where is diverticular disease common
Sigmoid colon
Sx of diverticular disease:
- Pain
- Cramping in ___
- N+V
- Slight __
- Increased __
- LLQ
- Fever
- WBC
Diverticular disease: pts may complain of ___ pain. What is important part of tx?
Back pain
Regular exercise
Appendicitis:
Inflammation of vermiform appendix: becomes swollen, gangrenous, perforated. Pain characteristics?
Abrupt onset, located epigastric or periumbilical area
What is Rebound Tenderness? Also called what? Used for what condition?
pain in response to depression of abdominal wall at site distant from painful area — aka blumberg’s sign
+Appendicitis, peritonitis
What is McBurney’s point? What does it indicate if positive?
Point tenderness at McBurney’s point: site of appendix, 1.5-2 inches above ASIS RLQ.
+ appendicitis
what is Rovsing’s sign? + is what?
pain RLQ with pressure on LLQ
+ appendicitis
What is psoas sign? + for what?
pain RLQ with hip extension from inflammation of peritoneum overlying psoas
+ appendicitis
What is obturator sign? + for what?
RLQ pain with R hip IR and flexion to 90 with 90 knee flexion
+indicative of inflammation of sheath of obturator N
+ appendicitis
What is merkle’s sign? + for what?
Pain in RLQ when pt drops from standing on toes to heels with jarring landing
+ appendicitis
WBC level indicative of appendicitis perforation? Tx?
Elevations in WBC >20,000 indicates surgery needed
Inflammation of peritoneum from bacterial infection
Peritonitis
Sx of peritonitis:
- Abdominal __
- Severe __ pain
- ___ from reflex guarding
- ___ ___ (test +)
- Decreased or absent __ __
- ___cardia
- Distention
- Abdominal
- Rigidity
- Rebound tenderness
- Bowel sounds
- Tachycardia
4 things found with peritonitis
- Fever
- Elevated WBC
- Electrolyte imbalance
- Hypotension
Peritonitis can lead to (4)
- Toxemia
- Shock
- Circulatory failure
- Resp distress
Tear/ulceration of lining of anal canal
Rectal fissure
Hemorrhoids: vericosities in ___/__ caused by vein congestion, internal or external. Symptoms?
Lower rectum/anus
Itching, pain
