Week 10- GI System 1 Flashcards
Includes mouth, esophagus, stomach, and duodenum
Upper GI tract
The upper GI tract aids in the…
Ingestion and digestion of food
Consists of the small and large intestines
Lower GI tract
___________ accomplishes digestion and absorption of nutrients
Small intestine
____________ absorbs water and electrolytes, storing waste products of digestion until elimination
Large intestine
Function completely independently of the CNS and have its own psycho-neuroses
Enteric nervous system
True or false: The enteric nervous system is based on a mind-body connection
True
This makes up the mind-body connection of the enteric nervous system
Emotions, brain functions, GI functions
Gut immune system has _____% of the body’s immune cells
70-80
True or false: The development and expression of the gut is dependent on systemic immunity
False
(independent)
True or false: Reduction of normal bacteria in the gut after antibiotic treatment or in the presence of infection may interfere with the nutrients available for immune function in the GI tract
True
Signs and symptoms of GI disease
-Nausea
-Vomiting
-Diarrhea
-Constipation
-Dysphagia
-Achalasia
-Heartburn
-Abdominal Pain
-Ischemic pain
-GI Bleeding
-Fecal incontinence
-Referred pain
SLIDE 6-9
Most common GI problems in older adults
Constipation, incontinence, and diverticular disease
True or false: Alimentary organs like all muscular structures, never lose some tone with age and still manage to perform almost as well in age as in youth
False
(they do lose some)
Changes within the alimentary tract include decreases in…
-Gastric motility
-Blood flow
-Nutrient absorption
-Volume and acid content of gastric juice
Esophageal hiatus of the diaphragm becomes enlarged, allowing the stomach to pass through the diaphragm into the thoracic cavity
Hiatal hernia
True or false: A hiatal hernia can be congenital or acquired
True
90-95% of hiatal hernias are _________
Sliding hernias
The remaining hiatal hernias (5-10%) are __________
Rolling/para-esophageal hernias
The stomach and gastroesophageal junction are displaced upward into the thorax
Sliding hernia
The gastroesophageal junction stays below the diaphragm, but all or part of the stomach pushes through into the thorax
Rolling/para-esophageal hernias
-5 per 1000 people
-Increases w/ age (60% in people > 60 y/o)
-Women > men
Hiatal hernia
Causes of increased intraabdominal pressure
-Lifting
-Straining
-Bending over
-Prolonged sitting or standing
-Chronic/forceful cough
-Pregnancy
-Ascites
-Obesity
-Congestive heart failure
-Lower fiber diet
-Constipation
-Delayed bowel movement
-Vigorous exercise
Symptoms of hiatal hernia
-Heartburn
-Reflux
Heartburns can occur _____ minutes after a meal and are posture related
30-60
Heartburn contributes to incompetence of the ___________ allowing acid into the esophagus
Lower esophageal sphincter (LES)
This contributes to GERD
Reflux
Reflux is associated with ___________ pain
Substernal
Regarding hiatal hernias, avoid flat supine position and any exercises requiring the ______________
Valsalva maneuver
True or false: A client with hiatal hernia does not have to be warned against activities that cause increased intraabdominal pressure or receive safe lifting instructions before discharge
False
(they have to be warned)
The consequences from the reflux (backward flow) of gastric contents into the esophagus accompanied by a failure of anatomic and physiologic mechanisms to protect the esophagus
GERD
GERD can be…
Erosive or non-erosive
GERD occurs in ____% of adults and _________ with age
10-20
Increases
Causes of GERD
-Decreased pressure of LES or alteration in esophageal acid clearance
-Gastric contents near junction
In healthy people, three factors to remain healthy esophagus…
-Anatomic barriers between the stomach and the esophagus
-Mechanisms to clear the esophagus of stomach acid
-Maintaining stomach acidity and acid volume
True or false: People with GERD have consistently low pressure of the LES or altered protective mechanisms due to the causes
True
_____________ should be distinguished and evaluated before chest pain is assumed to be related to GERD
Cardiac chest pain
Adults > ____ y/o are more likely to have atypical symptoms
70
Atypical symptoms of GERD
Dysphagia
Vomiting
Respiratory difficulties
Weight loss
Anemia
Anorexia with or without heartburn or acid regurgitation
3 extra-esophageal manifestations
Asthma
Cough
Laryngitis
Treatment for GERD
Lifestyle modifications
Medications
Surgery
Lifestyle modifications for GERD
Avoid aggravating food, smoking cessation and encouraged to reduce alcohol consumption, weight loss and elevation of the bed etc.
Medications for GERD
Nonprescription antacids, H2 blockers, and proton pump inhibitors (PPIs)
True or false: People with GERD may have trouble exercising, because some types of physical activity can worsen symptoms
True
Strenuous exercise inhibits both ________ and _________ emptying
Gastric
Small intestine
GERD induced by strenuous exercise is common among _________
Athletes
Avoid _________ meals or ________ foods (or other triggers) immediately before exercising to avoid or minimize exercise-related GERD
High-calorie
Fatty
________ position should be scheduled before meals and avoided just after eating.
________lying is better.
Supine
Left
A break in the lining of the stomach or duodenum of 5 mm or more owing to a number of different causes
Peptic ulcer disease (PUD)
Types of PUD ulcers
Gastric
Duodenal
Stress
Occur in response to significant physiologic stress (e.g., severe trauma, surgery, extensive burns, brain injury)
Stress ulcers
Most common causes of PUD
NSAIDs
Low-dose aspirin
H. pylori bacterial infection
Risk factors for PUD
Psychologic stress
Diet
Caffeine
Tobacco use
Alcohol consumption
Mucous and bicarbonate layer, an epithelial barrier, prostaglandins, and adequate mucosal blood flow
Mucosal defenses
Acid, pepsin, alcohol, bile salts, drugs
Contributing mucosal insults
If there is an imbalance between mucosal insults and mucosal defenses, an _________ can form
Ulcer
There are symptoms or physical findings specific/sensitive for PUD. Many people with NSAID-induced PUD have pain at diagnosis.
False
(no symptoms or physical findings, they do NOT have pain)
PUD is often discovered because of __________ or is noted on _______
Bleeding
EGD
The classic symptom of PUD, when present, is _________ pain described as…
-Epigastric
-Burning, gnawing, or cramping near the xiphoid or radiating to the back
PUD pain may be relieved with _________ or occur at ________
Eating
Night
PUD complications
-Bleeding
-Perforation
-Penetration
-Gastric outlet obstruction
PUD PT implications
-Monitoring symptoms and vital signs
-Referred pain patterns
-Moderate exercise training reduces the risk of GI bleeding
Perforate and hemorrhage cause __________
Back pain
Ulcer pain radiates to the…
Mid-thoracic back and right shoulder pain
True or false: PUD MSK symptoms may recur after discontinuing NSAIDS, owing to the masking effects of these drugs
True
_________ exercise training reduces the risk of GI bleeding
Moderate
A polygenic disease with complex interactions between gut microbiota, host immunity, and intestinal mucosal response
Inflammatory bowel disease
A chronic, lifelong inflammatory disorder that can affect any segment of the intestinal tract, although most commonly it affects the ileum and/or colon
Crohn disease
A chronic inflammatory disorder of the mucosa of the colon, typically involving the rectum, which can then advance proximally in a continuous manner to involve the entire colon
Ulcerative colitis
SLIDE 47-49
Joint involvement ranging from _________ to _________ is the most common extra-intestinal finding in IBD
Arthralgia
Acute arthritis
___________ associated with IBD is usually continuous and symmetric
Arthritis
Arthropathies are divided into __________ and __________ involvement
Peripheral
Axial
PT implications for IBD
-Periumbilical pain, referred pain to the corresponding low back, and lower right quadrant pain
-Psoas abscesses
-Joint problems: migratory arthralgia, monarthritis, polyarthritis, or sacroiliitis
-Any time a client presents with low back, hip, or sacroiliac pain of unknown origin, the therapist must screen for medical disease
-High prevalence of osteoporosis
-Hydration and nutrition
-Psychologic factors and ANS
