Test 4: GI, GU, and Reproductive

Question 1

What is included in the upper GI tract?

Answer 1

mouth, pharynx, esophagus, stomach and duodenum

The goal of the upper GI tract is the ingestion of food, as well as the start of digestion

Question 2

What is included in the lower GI tract?

Answer 2

small and large intestines and anal canal

The lower GI’s role is digestion and absorption of nutrients (small intestines) and water and electrolytes (large intestines), as well as aid in the removal of waste.

Question 3

Gastrointestinal Bleeding

Answer 3

black stool = bleed in upper GI

red stool = bleed in lower GI

Question 4

Hiatal Hernia (pathology, symptoms, diagnostics, medical management, and PT implications)

Answer 4

Pathology: a portion of the stomach passes through the diaphragm into the thoracic cavity. Several theories exist as to why this occurs.
- Sliding hiatus hernia: stomach and gastroesophageal junction are displaced up into the thorax
- Paraesophageal (rolling) hiatal hernia: gastroesophageal junction stays below the diaphragm but part of the stomach pushes through thorax

Symptoms: The main symptoms are regurgitation. If the hernia is sliding, heartburn may also be present post prandial.

Diagnostics: endoscopy, barium swallow, or esophageal manometry

Treatment: symptom control, proton pump inhibitors (PPIs)

PT implications:
- supine should be avoided
- any positions with valsalva maneuver or intraabdominal pressure should be avoided

Question 5

Gastroesophageal reflux disease (GERDs) (pathology, symptoms, diagnostics, medical management, and PT implications)

Answer 5

Pathology: In this condition gastric contents enter into the esophagus. In some people little damage to the esophagus occurs, where in other erosion and even cancer can develop. Prevalence is high, 10-20% of US adults report having GERD. Obesity is linked to GERD. Might be due to H. pylori (bacteria)

Symptoms: Heartburn is the main symptom in this patient population.

Diagnostics: based on symptoms, might use endoscopy

Treatment: Often patient are provided with proton pump inhibiting drugs (PPI). Dietary modification can often resolve symptoms, but are more challenging for some patients

PT Implications:
- Exercise might worsen symptoms
- Supine position should be done before meals and avoided just after eating
- For sleeping, instruct left side sleeping because right side sleeping makes it easier for acid to go up into the esophagus

Question 6

Gastritis (pathology, symptoms, diagnostics, medical management, and PT implications)

Answer 6

Pathology: acute or chronic inflammation of the stomach. NSAIDs are one main culprit for gastritis, in therapy often patient self medicate with this class of drug, as it is marketed as a safe over the counter pain reliever. However long term use can lead to chronic gastritis. H. Pylori and food choices can also cause this.

Symptoms:
- stomach heaviness
- stomach pain
- nausea/vomiting
- heartburn

Question 7

Peptic Ulcers (pathology, symptoms, diagnostics, medical management, and PT implications)

Answer 7

Pathology: A peptic ulcer is an erosion of the stomach or duodenum lining. Many causes exist, and the damage can be on the surface to as deep as the muscular lining. The prevalence in the USA is 3.3% and is decreasing with the onset of treatment of H. pylori. Along with H. pylori, NSAIDs and aspirin use are among the leading causes.

Symptoms: None specific to PUD (Maybe bleeding)

Diagnostics: Endoscopy

Treatment: Stopping irritating substances (NSAIDs), addition of proton pump inhibiting drugs (PPIs)

Question 8

Gastric Cancers (pathology, symptoms, diagnostics, medical management, and PT implications)

Answer 8

Pathology:
- various types of gastric cancers are prevalent. Gastric adenocarcinoma is is the most common form of stomach cancer, which is the second most common cause of cancer deaths. Most of these can be divided into two types, intestinal and diffuse. Intestinal type is often related to the environment and foods where the diffuse is seen in younger patients with a worse prognosis.
- Risk factors include H. pylori, Epstein-Barr virus as well a smoking. Diet modification with increased fresh fruits and vegetables can decrease the risk.

Symptoms: weight loss and early satiety are often the first signs, with the disease progressing to advanced stages often before warning signs.

Diagnostics: endoscopy

Treatment: resection as well as radiation and or chemotherapy the 5 year survival rate is only 20%.

Question 9

Celiac Disease

Answer 9

Pathology: most common of the maladaptive diseases. This is an immune mediated disorder where by exposure to gluten in the digestive tract triggers the response. Approximately 1% of the population is affected with celiac. More common in people with autoimmune diseases

Symptoms: GI disturbances, bloating, diarrhea, weight loss and abdominal pain. Along with GI symptoms, patients with Celiac can also have skin conditions and irritations. Long term manifestations can include cancers.

Diagnostics:
- IgA antibodies can assist in the diagnosis as well as serologic testing and biopsies of the small intestines.

Treatment:
- Treatment is the avoidance of all gluten containing grains

Question 10

Inflammatory Bowel Diseases (Chron’s and ulcerative colitis)

Answer 10

Pathology: these include inflammatory diseases of the bowels, most commonly Chron’s Disease and Ulcerative Colitis. Chron’s diseases is a chronic life long inflammatory condition that affects any segment of the intestines (often the ilium and colon) followed by normal regions. Ulcerative Colitis is also a chronic inflammatory condition but affects the mucosa of the colon.

Symptoms: abdominal pain, bloody stool, diarrhea, abdominal mass, anorexia

Diagnostic: Colonoscopy

Treatment: 5-aminosalicylate drugs and glucocorticoids