Week 7- GI Flashcards
What are the primary organs of digestion?
- oral cavity
- pharynx/larynx
- esophagus
- stomach
- small intestine(duodenum, jejunum, ilium)
- large intestine
What are the 3 main functions of the stomach?
- mechanical
- exocrine
- endocrine
What are some accessory organs of digestion?
- teeth
- tongue
- salivary glands
- liver
- gallbladder
- pancreas
- What is in the RUQ?
- What is in the RLQ?
- What is in the LUQ?
- What is in the LLQ?
- RUQ: liver, gallbladder, colon, kidney, duodenum, small intestine
- RLQ: ascending colon, caecum, appendix, small intestine
- LUQ: stomach, spleen pancreas, kidney, colon, jejunum
- LLQ: descending colon, colon, sigmoid colon, small intestine
- When evaluating a patient whos chief complaint is due to a GI condition, make sure to investigate _____ patterns.
- In patients who may not have a GI diagnosis, but have pain patterns that may not match the MOI, be alert for GI conditions.
pain
What are some common symptoms of GI dysfunction?
- N/V/D
- Hemoptysis (coughing up blood)
- Incontinence/Diarrhea
- Heartburn (reflux)
- Abdominal pain
- Dysphagia
- Jaundice
- Color changes in stool/urine
- Hematochezia
- Melena
What are some disorders that can also adversely affect the GI system?
- Medical hx
- Substance use disorder
- Food intolerance
- Thyroid dysfunction
- DM
What are some diagnostic studies that may be seen in patients with GI issues? (6)
- Laparoscopy
- Barium swallow
- Endoscopy
- ERCP
- GI bleeding screens
- Upper GI series
- What is a laparoscopy?
- It can be _________ or _________.
- Insertion of laparoscope into abdominal cavity using small incision and local anesthetic.
- diagnostic or therapeutic
- What is a barium swallow test?
- It is used to ID pathologic conditions of the ___________.
- What is the modified barium swallow study used to diagnose?
- Patient swallows barium liquid while x-ray images examine swallowing and peristalsis of esophagus.
- esophagus
- dysphagia
What is a endoscopy?
Insertion of endoscope into digestive tract.
What is a ERCP?
Uses endoscopy and fluoroscopy to diagnose and treat gallbladder, biliary system, pancreas, and liver problems.
What are GI bleeding scans?
Used to determine the presence and/or source of GI bleeding.
What is a Upper GI series used for?
Used to identify disorders of the esophagus, stomach, and duodenum.
What are some lab tests for liver function/biliary tests?
- ALT
- ALP
- AST
- albumin
- bilirubin
- ammonia
What are some lab tests for pancreatic function?
- lipase
- amylase
- sweat test
GI CONDITIONS
GI CONDITIONS
Dysphagia:
- What is dysphagia?
- It can be either ____pharyngeal or _____phageal.
- How is it diagnosed?
- What are the causes?
- How do we treat it?
- Difficulty swallowing
- oropharyngeal or esophageal
- MBSS, endoscopy, CT, or MRI
- Caused by neurological conditions (stroke, TBI), dementia, myasthenia gravis
- Treat through airway protection and nutritional support.
GERD:
- What is GERD?
- What are the SxS?
- How is it treated?
- Backflow of gastric acid into esophagus.
- heartburn and regurgitation
- diet modification, weight loss, PPIs, H2 blockers, Nissen fundoplication
PUD:
- What is PUD?
- What are the causes?
- What are the SxS?
- How is it treated?
- Ulceration in the stomach or duodenum
- h.pylori infections and NSAIDs
- hungerlike sensation, nocturnal pain
- lifestyle modification, PPIs, antibiotiics, no NSAIDs/aspirin
Dumping Syndrome:
- What is Dumping Syndrome?
- Can result from a number of GI __________ including gastrectomy, gastric bypass surgery, PUD surgery, Nissen fundplication.
- Early DS occurs within ____ minutes of a meal and involves palpitations, tachycardia, flushing, diaphoresis, syncope, and abdominal symptoms.
- Late DS occurs __-__ hours after meal and the SxS are consistent with _____________.
- What are the treatments?
- Enhanced gastric emptying interrupts normal digestive sequence
- surgeries
- 30 minutes
- 1-3 hours, hypoglycemia
- dietary changes and medications
Dumping Syndrome (DS) occurs due to rapid transition and absorption of food from the _______ to the ________.
stomach to intestine
- GI Hemorrhage can be divided into _____ and _____.
- With small GI bleeds we may not see intervention, however, severe bleeds are a medical emergency that can cause ___________ instability leading to hypovolemic shock.
- UGIB and LGIB
- hemodynamic
Upper GI Bleeds (UGIB):
- Where do they occur?
- Generally caused by ______, gastric erosion, and gastric/esophageal varices.
- esophagus, stomach, or duodenum
- ulcers
Lower GI Bleeds (LGIB):
- Where do they occur?
- Caused by _____, ischemic colitis, anal and rectal lesions, (hemorrhoids), ulcerate polyps and colorectal cancer.
- colon and anorectum
- IBS (diverticulitis)
What are the SxS of UGIB and LGIB?
- hematemesis
- hematochezia
- melena
What is the treatment of UGIB and LGIB?
-IV fluids, blood transfusions, management of causative factors
Diverticular Disease:
- What is the difference between diverticulosis and diverticuliltis?
- What are the SxS?
- What is the treatment?
- Diverticulosis is the presence of diverticula (can be asymptomatic). Diverticulitis is inflammation and infection of the divertculi.
- LLQ pain, polyuria, fever and elevated WBC, constipation, N/V
- diet modification, clear liquids, IV fluids, pain meds, antibiotics, surgery
Hiatal Hernia:
- What is a hiatal hernia?
- What are the SxS?
- What is the treatment?
- Protrusion of abdominal structures upward through esophageal hiatus.
- heartburn-like pain, dysphagia, chest pain, dyspnea, hoarseness
- Behavior modifications, eating small/frequent meals, bland food with high fiber content, acid-reducing meds; laparoscopic repair
Abdominal Hernia:
- What is a abdominal hernia?
- What are the SxS?
- What is the treatment?
- protrusion of bowel that is classified by location of protrusion
- abdominal distension, N/V, position changes with increased abdominal pressure (laughing, coughing), pain, paresthesia
- monitor asymptomatic cases, Surgical repair for symptomatic, possible temporary colostomy
What are 4 common areas for abdominal hernias?
- Inguinal
- Femoral
- Umbilical
- Epigastric
With a hernia, if the contents can be replaced within the surrounding musculature it is called ___________. If you can’t replace the contents, it is ___________.
reducible
-irreducible
A ____________ hernia has compromised circulation and can be fatal.
strangulated hernia
Irritable Bowel Syndrome (IBS):
- IBS is characterized by ___________ pain and altered _______ movements.
- The diagnostic criteria includes that SxS persist for at least ___days/month in the past 3 months associated with _________ criteria.
- Can increase or decrease GI motility, which can result in what?
- abdominal pain and altered bowel movements
- 3 days/month, Rome IV
- diarrhea, constipation, or both
What are the Rome IV criteria for IBS? (4)
- recurrent abdominal pain
- pain relieved by defacation
- changes in stool frequency
- changes in stool form or appearance
What are 2 idiopathic inflammatory bowel diseases?
- Crohn’s Disease
- Ulcerative Colitis
Crohn’s Disease:
- Idiopathic _________ bowel disease (IBD).
- Where can it occur in the GI system?
- What are the SxS?
- What are the causes?
- What is the treatment?
- inflammatory
- anywhere in the GI system (most common terminal ileum, proximal colon)
- RLQ pain/mass, diarrhea, weight loss, fatigue, low grade fever
- genetics, immune dysregulation, infectious agents, psychological issues, environmental factors
- corticosteroids, antibiotics, immunosuppressants, nutritional support
What are some complications that can result from uncontrolled Crohn’s Disease?
intestinal obstruction, inflammation of membranes, arthritis, ankylosing spondylitis, gallstones, B12 deficiency, thromboembolism
Ulcerative Colitis:
- Idiopathic ________ bowel disease (IBD).
- Where does it occur?
- What are the SxS?
- What are the causes?
- What is the treatment?
- inflammatory
- mucosal layer of rectum and proximal colon
- lower abdominal pain relieved by defecation, bloody stools, diarrhea, incontinence, nocturnal defecation, fatigue, wt loss, dehydration
- similar to Crohn’s Disease
- anti-inflammatory meds, immunosuppressants, biologics, diet modification, surgery, monitoring for colon cancer
Crohn’s Disease and Ulcerative Colitis Similarities:
- Both are the main forms of _________ _______ ________.
- Both characterized by __________ of digestive tract.
- Both often develop in teenagers and young adults(___-___ years and ___-___ years).
- Both affect men and women __________.
- Symptoms are similar.
- Causes are _________, but both diseases have similar types of contributing factors such as environmental, genetic, and inappropriate response to immune system.
- inflammatory bowel diseases
- inflammation
- 15-35 years and 55-70 years
- equally
- unknown
Crohn’s Disease and Ulcerative Colitis Differences:
- Ulcerative Colitis is limited to the ______, while Crohn’s Disease can occur anywhere between the ______ and ______.
- With Crohn’s Disease, there are _______ parts of the intestine mixed in-between inflamed areas. With Ulcerative Colitis, the inflammation is __________ within the colon.
- Ulcerative Colitis affects the ___________ layer of the colon while Crohn’s Disease affects ______ layers.
- colon, mouth and anus
- healthy, continuous
- innermost layer, all layers
Morbid Obesity:
- Chronic disease characterized by excessive body fat and BMI of ____ or higher.
- Many comorbidities linked with morbid obesity!
- What are the conservative treatments of morbid obesity?
- What are the surgical treatments of morbid obesity?
- Better outcomes associated with patients involved in _________ program.
- Closely monitor exercise _________ with BP, HR, RR.
- _____ inspection also key.
- Be aware of weight limits for equipment.
- 30 or higher
- weight loss (goal: 10% reduction), diet modification, meds, behavior mgmt, increased physical activity.
- gastric bypass, gastric banding, gastroplasty, gastrectomy
- exercise
- tolerance
- skin inspection
What are 2 liver and biliary disorders?
- Encephalopathy
- Cholecystitis
Encephalopathy:
- May be caused by acute and chronic _____ disease.
- Impaired _______ status and __________ dysfunction occurs over hours to days.
- Altered __________. (ammonia intoxication, changes in cerebral blood flow)
- Treatment includes reducing ________ levels, correcting _________ imbalance, antibiotics, nutritional support, and liver transplant.
- liver
- mental status and neuromuscular dysfunction
- consciousness
- ammonia levels, correcting electrolyte imbalance
Cholecystitis:
- Cholecystitis is commonly associated with obstructions by ___________.
- What is cholecystitis?
- What is cholelithiasis?
- S/S include _____ pain that may radiate to R shoulder, abdominal rebound sign (________ sign), ________, N/V, fever.
- What does treatment of cholecystitis involve?
- gallstones
- Cholecystitis: acute or chronic inflammation of the gallbladder
- Cholelithiasis: gallstone formation
- RUQ pain, Murphy’s sign, jaundice
- laparoscopic cholecystectomy (gallbladder removal)
MANAGEMENT OF GI CONDITIONS
MANAGEMENT OF GI CONDITIONS
When looking at pharmacological management of GI disorders, we are either looking at meds to control ______ _____ secretion or meds to normalize GI __________.
- gastric acid secretion
- GI motility
Abdominal Surgical Approaches:
- ____________ is open surgery of the abdomen to explore and/or repair issues; many different types of incisions, “midline” is the standard cut.
- __________ is when short, narrow tubes (trochars) are inserted into abdomen through small (<1cm) incisions; surgical tools inserted through trochars to perform surgery. High resolution cameras provide visual of area of interest.
- Laparotomy
- Laparoscopic
Is a laparotomy or laparoscopic less invasive, and has faster recovery time.
Laparoscopic
GI Surgical Procedures “-ectomies”:
- ___________ is removal of appendix.
- ___________ is removal of gallbladder.
- ___________ is resection of portion of colon, usually involves a colostomy or iliostomy.
- ___________ is removal of part or whole stomach.
- ___________ is removal of spleen.
- Appendectomy
- Cholecystectomy
- Colectomy
- Gastrectomy
- Splenectomy
Colostomy:
- What is a colostomy?
- Is it temporary or permanent?
- Make sure pouch is securely closed before patient __________.
- Keep covered for patient _________.
- Empty bag if full.
- Procedure that reroutes stool from diseased colon to external bag.
- Can be temporary or permanent.
- interventions
- dignity
General PT Considerations for GI:
- _________ to decrease tension on surgical site.
- ______ knees while HOB lowered to decrease tension.
- ______ can aggravate dysphagia and GERD.
- ______ during mobility/coughing.
- Increased ________ likely.
- Be aware of _________ restrictions.
- sidelying
- flex knees
- supine
- splinting
- fatigue
- dietary
If a patient has varices (dilated blood vessels), they may rupture with increased _______ pressure. Avoid __________ effects (coughing).
- intraabdominal
- valsalva
Ascites (fluid accumulation in the abdomen) hinders effective ___________ and restricts adequate _________.
- coughing
- ventilation
