Week 7 Flashcards
1
Q
What is the pathophysiology of a bowel obstruction?
A
A blockage prevents the content of the intestine from passing normally through the digestive tract. The cause of this can be inside or outside the intestine
2
Q
What are some of the causes of a bowel obstruction inside the intestine?
A
A tumor or swelling
3
Q
What are some of the causes of a bowel obstruction outside the intestine?
A
The adjacent organs or area of tissue to pinch, compress or twist a segment of the bowel
4
Q
Where does a bowel obstruction occur?
A
In the small or large bowel
5
Q
A bowel obstruction can be total or partial. What determines what type of obstruction present?
A
It depends on whether any intestinal content can pass through the obstructed area
6
Q
What does the obstruction of the small intestine present with?
A
Cholic, abdominal pain and vomiting.
7
Q
What does the obstruction of the large intestine present with?
A
Distention and absolute constipation
8
Q
What are the common causes and risk factors of a small bowel obstruction?
A
- Adhesions: bands of scar tissue that may form after abdominal or pelvic surgery
- Hernias caused by a breakthrough of the weakened abdominal wall (2nd most common cause of an obstruction in the USA)
- Inflammatory diseases(chromes disease or a fistula)
- Tumors (rare, usually spreads to the small bowel from the colon, reproductive organs, breast, lungs or skin)
9
Q
____ is the leading risk factor for small bowel obstruction in the USA
A
Earlier abdominal surgery is the leading risk factor for small bowel obstruction in the USA
10
Q
What are the signs and symptoms of a small bowel obstruction?
A
- Cramping and abdominal pain
- Nausea and vomiting
- No gas passing through the
rectum - Abdominal bloating or tenderness
- Rapid pulse and rapid breathing
- Upper epigastric distension
- Constipation
- Lack of appetite
11
Q
What is constant abdominal pain a sign of?
A
Maybe a sign os bowel strangulation
12
Q
__ is the most common cause of a large bowel obstruction in the USA
A
Adhrsions is the most common cause of a large bowel obstruction in the USA/developed countries
13
Q
____ is the most common cause of obstruction
A
Adenocarcinoma of the colon is the most common cause of obstruction
14
Q
About half of all large bowel obstructions are caused by ____
A
About half of all large bowel obstructions are caused by colorectal cancer
15
Q
How does undiagnosed colon or rectal cancer cause large bowel obstruction?
A
It may cause a gradual narrowing of the large intestines in our passageway.
16
Q
Before the large bowel becomes obstructed, what does the pt feel?
A
Intermittent constipation
17
Q
What is volvolus?
A
An abdominal twisting of a segment of the bowel around itself. This typically produces a closed loop bowel with a pinched bowel, which leads to a bowel obstruction
18
Q
In what population is a volvolus most common?
A
People over 65, in western countries, often with a history of chronic constipation
19
Q
What are the common causes of large bowel obstruction?
A
- Colorectal cancer
- Volvolus
- Diverticular disease
20
Q
What is a colonstricture?
A
A scar that encircles the colon, which narrows the intestine gradually as it ages, which will eventually cause a closed colon
21
Q
What are the signs and symptoms of large bowel obstruction?
A
- Lower abdominal bloating/distension - Lower abdominal cramping and pain, which can be vague and mild, or sharp and severe depending on the cause - Constipation - Diarrhea - Possible rectal bleeding
22
Q
What are the red flags for immediate medical referral in a pt with a possible large bowel obstruction?
A
- Intense and/or constant abdominal pain
- Vomiting
- Bloating
- Blood in the stool
23
Q
What are the checklist items that must be screened when there is a suspicion of a GI system abnormality?
A
• Nausea • Vomiting • Swallowing difficulties • Indigestion, heartburn • Food intolerance • Bowel dysfunction – Color of stool – Shape, caliber of stool – Constipation – Diarrhea – Difficulty initiating – Incontinence
24
Q
What are swallowing difficulties/dysphagia typically a result of?
A
A loss of coordinated local muscle activity or a mechanical obstructive disorder
25
What are the disorders that can result in muscle incoordination, resulting in swallowing difficulties/dysphagia?
* Myasthenia gravis
* Multiple sclerosis
* Amyotrophic lateral sclerosis
* Parkinson's disease
26
What are the disorders that can result in a mechanical obstruction, resulting in swallowing difficulties/dysphagia?
```
• Tumors
• Thyroid goiter
• Osteophytes of the cervical
spine
• Aortic aneurysm
```
27
What is the onset, progression, ability to swallow solid food/liquids, ability to swallow cold substances, and bolus passage of dysphagia caused by motor incoordination?
• Onset: Gradual onset
• Progression: Slow
• Swallowing solid foods vs. liquids: Equal difficulty
• Swallowing cold substances: Worsening of swallowing
difficulties
• Bolus passage: Facilitated by repeated swallowing. Valsalva
maneuver, throwing back head and shoulders
28
What is the onset, progression, ability to swallow solid food/liquids, ability to swallow cold substances, and bolus passage of dysphagia caused by mechanical obstruction?
* Onset: Faster onset
* Progression: Faster
* Swallowing solid foods vs. liquids: More difficulty swallowing solids
* Swallowing cold substances: Swallowing difficulties not affected by temperature
* Bolus passage: Can be accompanied by regurgitation
29
What are the symptoms that fall under the category of dyspepsia/heartburn?
Indigestion, and Heartburn
30
The use of what type of drugs has been associated with dyspepsia/heartburn?
NSAIDs
31
In what part of the body does a pt with dyspepsia/heartburn feel their symptoms?
Retrosternally in the epigastric region
32
What are the questions to ask a pt, when there is a suspicion for dyspepsia/heartburn?
* How long have you had these symptoms?
* Do you know what is causing them?
* Are they constant or intermittent?
* How are you treating the symptoms?
* Are there any associated symptoms such as fatigue, weakness or shortness of breath
33
Many OTC medications for heartburn/dyspepsia are designed to treat what?
They are designed to treat the symptoms of heartburn, not the actual problem, so increasing the dose will not help the condition
34
What are the self- management options that a pt can take to treat heartburn/dyspepsia?
```
Antacids:
• Milk of Magnesia
• Alu-Tab
• Tums
• Maalox
Histamine (H2) antagonists
• Tagamet
• Zantac
• Pepcid AC
```
35
Where is the referral site of a gallbladder disorder?
The mid thoracic or right scapula region
36
____ is associated with the provocation of symptoms can be a warning sign of underlying pathology of the GI system
*Food intolerance* is associated with the provocation of symptoms can be a warning sign of underlying pathology of the GI system
37
What are the foods that can stimulate gallbladder activity and may result in the precipitation of gallbladder symptoms?
* Cheese
* Chocolate
* Citrus fruits
* Nuts
* Red wine
38
What does melena represent?
GI bleeding most likely from the upper GI structures, such as the esophagus, stomach, and duodenum
39
What are the important follow-up questions that a physician should ask a pt who complains of melena?
* How long have you been having black, tarry stools?
* Have you felt lightheaded?
* Have you had any nausea, vomiting, diarrhea, fatigue, lightheadedness, abdominal or back pain, or sweats associated with these stools?
40
What is the role of the PT in the management of melena?
Check the pt's HR and BP, in preparation to produce important info for the physician who will need it to determine the urgency of the situation
41
In addition to melena, light grey or pale stools can be associated with what?
Obstructive Jaundice
42
What are the questions that should be asked when a pt reports obstructive jaundice ?
* How long have you noticed the light, pale colored stools?
* Have you noticed an atypical color (e.g., dark) of your urine?
* Have you noticed any associated symptoms, such as fatigue, fever, chills, unexplained weight change, or nausea?
43
What questions are included in the screening of the lower GI system?
Questions about bowel function, including:
- Characteristics of the stool
- Constipation
- Diarrhea
- Difficulty initiating a bowel movement
- Incontinence
44
What is the question to ask a pt in regard to the lower GI system?
Have you recently noted any problems or difficulties with bowel function?
45
What is hematochezia?
The passage of bright blood red stools, which usually originates in the left side of the colon or anorectal area
46
What are the questions that should be asked when a pt complains of hematochezia?
* How long have you noticed bright red blood in your stools?
* Is the red blood mixed within the stools (red streaks) or not?
* Are there any associated symptoms, such as difficulty in initiating bowel movements or a feeling of lightheadedness or fatigue?
47
What should the PT do when a pt answers questions regarding hematochezia in the positive?
Check BP and HR
48
What may be indicative of a colon carcinoma, and what should you ask your pt in regards to this?
Stool unusual shapes may be suggestive of a colon carcinoma.
Ask your pt "Have you noticed any unusual shape of your stool
recently, such as pencil like in diameter, flat and ribbon-like?
49
What are the potential causes of constipation?
* Impaired motility, Inadequate dietary fiber
* Inactivity
* Diverticulitis
* Hypothyroidism
* Hypercalcemia
* Scleroderma
* Neurologic dysfunction
* Multiple sclerosis
* Spinal cord injury
* Psychosocial dysfunction
* Depression
* Situational stress
* Anxiety
50
What are the potential causes of diarrhea?
* Infectious agents
* Laxative abuse
* Colon cancer
* Irritable bowel syndrome
* Crohn's disease
* Ulcerative colitis
* Diabetic enteropathy
51
What are the questions to ask a pt when there is a suspicion of dehydration and in order to determine the severity?
• How many episodes do you have each day?
• How long have you had diarrhea?
• Do you ever have periods of diarrhea alternating with periods of constipation?
• Is the diarrhea worse at certain times of the day?
• Do family members or companions have similar
symptoms?
• Do you have any associated symptoms, such as fever, chills, nausea, vomiting, confusion, or abdominal pain or distention?
52
What are the signs and symptoms of dehydration?
* Thirst and dry mouth
* Postural hypotension
* Rapid breathing
* Rapid pulse (higher than 100 beats/min)
* Confusion, irritability, lethargy
* Headache
53
___ is the 3rd leading cause of cancer in USA in women, and the 2nd in men
*Colorectal cancer* is the 3rd leading cause of cancer in USA in women, and the 2nd in men
54
What are the signs and symptoms of renal failure?
* Decreased urine output
* Nausea
* Vomiting
* Fatigue
* Increased BP
* SOB
55
What physiologic functions is the genitourinary system?
Urination and reproduction
56
What are the symptoms that are commonly associated with a dysfunction of the male reproductive system?
• Urethral discharge
• Sexual dysfunc:on
• Pain during intercourse,
ejaculation
57
What are the symptoms that are commonly associated with a dysfunction of the female reproductive system?
```
• Vaginal discharge
• Pain with intercourse
• Menstruation
– Frequency of periods
– Length of cycle
– Dysmenorrhea
– Blood flow
• Number of pregnancies and
deliveries
• Menopause
• Perimenopausal
– Postmenopausal vaginal bleeding or spotting
```
58
What are the symptoms that are commonly associated with a dysfunction of the urinary system?
```
• Color
• Flow
– Frequency
– Urgency
– Output
– Retention
– Dysuria
• Reduced caliber or force of urine stream
• Difficulty initiating urine stream
• Incontinence
```
59
What is dark color of urine an indication of?
Can be associated with hepatic or biliuary obstructive disease and acute exertional rhabdomyolysis
60
A pt presents to the clinic with shoulder pain, and weakness, and a report of dark urine. What is the possible diagnosis?
Acute exertional rhabdomyolysis
61
What is the medication that can lead to reddish color urine?
Pyridium
62
What are the questions to ask a pt when suspecting hematuria?
* How long have you noticed the red urine?
* Do you have a history of bleeding problems?
* What medications are you currently taking?
* Do you currently have or have you recently recovered from an upper respiratory infection or sore throat?
63
What may red urine d/t upper respiratory tract infection be associated with?
Acute glomerular nephritis
64
What are the questions to ask a pt when they complain red urine d/t upper respiratory tract infection?
• Have you noticed whether the urine starts red and then clears,
starts clear and then turns red, or is red throughout?
• Do you have any associated symptoms, such as items on the general health checklist,
including fever, weight loss, fatigue, or flank or abdominal pain?
65
True or False
Nocturia increases with age
True, Nocturia increases with age
66
What can urinary urgency/the intense an immediate sensation of the need to urinate be associated with?
Infection or irritation
67
What is dysuria, and when can it occur?
Pain on urination, it can occur with inflammation, infection, and sudden distention of a structure
68
What is polyuria and when can it be associated with?
Increased amounts of urine, which can be associated with diabetic conditions
69
What are the questions related to urinary flow that we can ask a pt?
• Have these changes occurred quickly or over a long period
of time?
• Have you been drinking more fluids (with an excessive thirst) than usual lately?
• What medications are you taking (diuretics)?
• Have you noticed that, despite the urge to urinate, you cannot start urination?
• After urine flow has stopped, do you experience the sensation of still needing to urinate?
• Do you have any associated symptoms, such as headaches or visual problems (possibly diabetes-related), or items on
the general health checklist, such as fever, nausea, and weight loss?
70
What are the common symptoms associated with obstructive disorders/urinary retention?
* Reduced force or urine
* Reduced caliber of urine flow
* Difficulty in starting urine stream
71
What is a disorder that true urinary retention is associated with?
Cauda equina syndrome
72
What are some red flags in pts with LBP that might be indicative of a genitourinary problem?
- Recent onset of urinary dysfunction
| - Retention, frequency or overflow incontinence and saddle anesthesia
73
What are follow up questions to ask a pt complaining of incontinence?
* Circumstances
* Causes
* Timing
* Frequency
* Volume of urine loss
74
When a pt complains of discharge, which may be associated with reproductive function, what are the follow up questions to ask?
* What is the frequency?
* Is it a continuous flow, spotting, or sporadic episodes?
* What is the color of the discharge?
* Is the discharge accompanied by an odor?
* Are there associated symptoms, such as pruritus (itching), local pain or inflammation, fever, nausea, or dyspareunia?
75
Why is the early treatment of UTIs and STDs important?
Untreated infections may increase the risk of developing an ectopic pregnancy, and may lead to infertility
76
What is dyspareunia?
Mechanical low back, SIJ, or hip pain during or after intercourse
77
True or False
Pain during intercourse that is associated with pelvic organ disease occurs regardless of the sex position
True, Pain during intercourse that is associated with pelvic organ disease occurs regardless of the sex position
78
What are the possible causes of erectile dysfunction?
```
• Spinal cord injury
• Herniated disk
• Postsurgical complica:ons
– Radical prostate
– Bladder
– Colon procedures
• Diabetes mellitus
• Medication side effects
• Psychogenic disorders
```
79
What are the items to assess in a pt in regard to menstruation?
```
• Frequency and length of
periods,
• Dysmenorrhea
– Loca:on
– Cycle
– Intensity
– Quality
– Duration
• Blood flow
```
80
What is dysmenorrhea?
Pain with menstraution
81
What are the questions to ask a pt in regards to menstruation?
```
• When was your last period?
• Was it a normal period for you (timing of the period compared with her normal cycle, pain pattern, blood flow)
• Have you experienced any
vaginal bleeding between
periods?
```
82
What are the common manifestations in pts during early pregnancy?
* Increased urinary frequency
* Breast tenderness
* Fatigue
* Weight loss (associated with nausea and vomiting)
* Heartburn
* Constipation
* Leukorrhea (white, yellowish vaginal discharge)
