Week 9

Question 1

List common symptoms of GI system

Answer 1

Nausea
Vomiting
Stomach pain
Diarrhea
Constipation
Rebound pain - Blumberg’s sign: is a clinical sign in which there is pain upon removal of pressure rather than application of pressure to the abdomen.
Heartburn
Bloating
Anorexia- an eating disorder characterized by restriction of food intake leading to low body weight
Dysphasia- a condition that your ability to produce and understand spoken language
Bleeding

Question 2

Common conditions of GI system

Answer 2

hiatal hernia/ hernia in other regions
GERD: a digestive disorder that occurs when stomach contents leak back into the esophagus
Peptic Ulcers: a sore in the lining of the stomach or the first part of the small intestine, also known as the duodenum
Gastric Cancers
Gastritis
Colitis: An inflammatory reaction in the colon, often autoimmune or infections
Celiac: An immune reaction to eating gluten, a protein found in wheat, barley, and rye
IBD (Chron’s and Ulcerative colitis): Inflammatory Bowel Disease: ongoing inflammation of all or part of the digestive tract
IBS (irritable Bowel Syndrome): An intestinal disorder causing pain in the belly, gas, diarrhea, and constipation
Diverticulosis: A condition in which small, bulging pouches develop in the digestive tract
Obstructive disorders (hernia, intussusception)
Appendicitis
Peritonitis: inflammation of the membrane lining the abdominal wall and covering the abdominal organs
Rectal fissures and hemorrhoids

Question 3

What does black fecal matter mean

Answer 3

Blood in the upper GI system

Question 4

What does bright red fecal matter mean

Answer 4

lower GI system bleed

Question 5

What are risk factors of the GI system?

Answer 5

H pylori => GERD
IBS > females
Celiac > in person with AID
Generalized risk factors: smoking, obesity, poor diet, alcoholism and other health conditions (DM), prolonged use of NSAIDs and other medications, genetics

Question 6

Case ex: Patient is a 46-year-old male. You are currently treating him for right knee pain that occurred after a fall. One his second day of treatment he states he is not comfortable lying flat because of his heartburn. He reports recently finishing breakfast and his symptoms are often worse for a few hours after eating.

Answer 6

GERD
Ask further

Question 7

Common symptoms of hepatic system

Answer 7

Jaundice (yellowing of the skin and sclerae)
Ascites
Right scapular pain
Dark colored urine
Clay colored poop
Weight/muscle loss
Mild brain fog
Gastritis
Testicular atrophy
Tremors

Question 8

Common conditions of the hepatic system

Answer 8

Hepatitis A, B, C
Cirrhosis
Fatty Liver
Pancreatitis
Cholelithiasis

Question 9

Where does liver/gallbladder pain commonly radiate to?

Answer 9

right scapula

Question 10

What are the risk factors of the hepatic system?

Answer 10

Alcoholism
Unsafe
sex practices
Unsafe food practices (not as common in USA) Exposure to blood
Obesity
DM 2
Tattoos

Question 11

Ex case: Patient is a 78-year-old female reporting to therapy with a chronic history of neck pain. She has a history of alcoholism as well as liver disease. She is rather petite, but you do notice her abdomen is often protruding further than it should for her size.

Answer 11

Jaundice “looks yellow”, cirrhosis, ascites

Question 12

ex case: 56-year-old patient presents to the clinic during his third week of treatment for right shoulder pain. He mentions to you that he just finished lunch at What-a-burger. Today he seems to have increased irritation with all exercises, and nothing really takes the pain away. You ask him if he has noticed an increase in pain in the right shoulder after eating. He thinks for a minute and replies “yes, I do think my shoulder hurts more, mostly after lunch”. You discover he has a lot of fast food for lunch.

Answer 12

gallbladder

Question 13

Common symptoms of the renal system

Answer 13

Flank pain
Pain in the inner thighs, labia/scrotum
Changes in bladder habits: 1) Frequency 2) Consistency 3) Presence of blood 4) Pain with urination
Edema
Elevated BP

Question 14

Common conditions of the renal system

Answer 14

UTI
Kidney infections
Kidney stones
Chronic kidney disease
Incontinence
IC “interstitial cystitis”

Question 15

Risk factors of the renal system

Answer 15

UTI= female>males
hygiene, hydration

Kidney Stones=Male>females
genetic component

Kidney Disease:
DM, HTN, polycystic disease, lupus,

chronic UTIs

Incontinence= female>males
giving birth

IC=females>males
other autoimmune or inflammatory
conditions

Question 16

Ex case: Patient presents to therapy for generalized weakness. She reports she is on dialysis three days a week and can come to therapy the other two days. She has moved up on the transplant list and is eager to get her life back. She wants to get strong enough to dance at her grandsons wedding two months from now.

Answer 16

Therapy on other 2 days, arm sensitivity, blood pressure, energy levels, hydration

Question 17

Common symptoms of the female reproductive system

Answer 17

Pain in the lower abdomen/vulva/vagina/back

Pain with menstruation

Pain with vaginal penetration

Cyclical pain

Changes in menstrual cycle
increased/heavy bleeding, amenorrhea

Nonlactating nipple discharge

Excessive breast tenderness

Question 18

Common conditions of the female reproductive system

Answer 18

Endometriosis: painful menstruation, decrease fertility; A disorder in which tissues similar to the tissues that lines the uterus grows outside the uterus in places where it doesn’t belong. Dx: mircroscopic surgery and ultrasound

uterine fibroids: increased miscarriage; non cancerous growth in the uterus that can develop during a women’s childbearing
years

Ectopic pregnancy: A pregnancy where the fertilized egg grows outside the uterus

Ovarian cyst: A solid or fluid-filled sac or pocket (cyst) within or on the surface of the ovary

PID (pelvic inflammatory disease): an inflammation of the upper genital tract due to an infection in women

POP (Pelvic Organ Prolapse): is characterized by descent of pelvic organs from their normal positions into the vagina

Menopause:
1 year and 12 months of duration, can cause a
polycystic ovarian disease: A hormonal disorder causing enlarged ovaries with small cysts on the outer edges

Breast conditions
Infection and inflammation
Mastitis: a painful infection of the breast tissue, blocked mild duct or bacteria entering the breast

Question 19

Risk factors for the female reproductive system

Answer 19

Smoking
Obesity
STI=unprotected sex
Genetic components (endo, fibroids)
POP=pregnancy, surgery

Question 20

Ex case: Patient is a 20-year-old female presenting to your clinic for chronic low back pain. The pain has come and gone for a few years but with the heavier course schedule at school she is sitting more and noticed an increase in pain. This is the third week of treatment; she had been progressing well. Today the patient is in more pain and is not as motivated to complete her exercises. When you ask her how she is doing she reports she is on her menstrual cycle. She states that the pain always gets worse, that she has very heavy cycles and often must spend the first two days in bed (which today is day three). She is concerned she has endometriosis as her older sister just got diagnosed.

Answer 20

Sexually active?

Question 21

Common symptoms of male reproductive system

Answer 21

Pain in the lower abdomen/scrotum/penis

Pain with erection/ejaculation

Changes/difficulty/pain with urination

Scrotal edema

Changes in sexual function: inability to achieve an erection. inability to orgasm

Question 22

Conditions of the male reproductive system

Answer 22

Prostatitis: Swelling of the small walnut-sized gland (prostate) the produces seminal fluid

BPH- Benign prostatic hyperplasia: to an enlargement of the prostate gland in the male reproductive system

Orchitis:a condition that causes inflammation of one or both testicles

Epididymitis: a coiled tube located on the back of the testicle, responsible for storing and maturing sperm, becomes inflamed, usually due to a bacterial infection, often associated with sexually transmitted infections like chlamydia or gonorrhea, leading to pain, swelling, and tenderness in the scrotum.

Testicular torsion: 2 small organs that are found outside the scrotum

ED (erectile disfunction): (Associated with age, ex: at 50 50% of men will have it)
the inability to achieve or maintain an erection that’s satisfactory for sexual activity:
Physical health, Psychological issue, Aging, Substance use
Other conditions: multiple sclerosis, spinal cord injuries, nerve damage from pelvic operations, and chronic sleep disorder

Question 23

Risk factors for the male reproductive system

Answer 23

STI
Age
UTI
Obesity
DM
Alcohol
Smoking

Question 24

Ex case: 72-year-old male presents to clinic for the first time. He complains of low back pain affecting daily activities. Because you are a stellar PT, you ask about relationships as well as his sex life. He reveals that he has had difficulties maintaining an erection and at times there is some pain with ejaculation deep in the groin area.

Answer 24

check prostate

Question 25

sexual trauma

Answer 25

4/5 women and 4/10 men

Question 26

GI upper tract structures and goal

Answer 26

upper GI tract: the 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 27

GI lower tract structures and goal

Answer 27

lower GI tract: the 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 28

Describe the process of ingestion to elimination

Answer 28

1) Mastication of food breaks down the food to create a bolus that is then swallowed. Saliva lubricates food and provides enzymes for digestion. In 10 seconds the food is passed from the mouth through the esophagus to the stomach.
2) Depending on the composition, food will remain in the stomach about 1–4 hours. Stomach motility churns the food into small particles for delivery to the small intestine via the pyloric sphincter. Exocrine secretions from the stomach mucosa help to dilute and dissolve food; gastric acid assists in dissolving and denaturing the components of food.
3) Food passes into the small intestine with the delivery of exocrine secretions from the biliary system and the pancreas. The pancreas produces numerous enzymes that assist in digestion as well as HCO3−, which neutralizes acid from the stomach. The gallbladder delivers stored bile to the intestine. Bile is important for lipid assimilation.
4) Food moves through the small intestine within 7–10 hours. All significant absorption of nutrients occurs in the small intestine.
5) Food then passes through the large intestine, from the cecum to the sigmoid colon, over a period of 12–24 hours. The large intestine are responsible for fluid and electrolyte transport and fermentation of undigested carbohydrates. Storage of fecal waste occurs in the distal large intestine; elimination of fecal waste typically occurs within 1–3 days after ingestion of a meal.

Question 29

Pathology + signs and symptoms of GI system

Answer 29

Food goes in, nutrients are absorbed, waste goes out. If only it were that simple! The GI system is very complex and many hormonal, enzymatic, muscular and neural connections are required for things to move smoothly (pun intended). In complex systems there is a lot of room for error.

Signs and symptoms:

Most common of all GI symptoms include nausea, vomiting, diarrhea, constipation, anorexia, dysphagia, achalasia, heartburn, abdominal pain.

Question 30

Constipation

Answer 30

slow transit vs obstructed defecation: slow transit develops when there is a lack of effective peristalsis present. This is more challenging to impact as a PT. Obstructed defecation can include the muscles of the pelvic floor and dyssynergia or anismus can be present. Often patients are sent to therapy for muscle coordination training.

1) Management of Constipation: slow transit often requires patients to become more active as well as assess their diets. Typical Western diets are low in water, low in fiber and high in processed foods. Many bodies cannot digest these foods effectively. Therefore the food moves through our digestive system very slowly.

2) Management of Constipation: Obstructive disorders are often treated with education on proper toileting positions (squatty potty). Placing the knees higher than the hips can assist in relaxing the pelvic floor muscles. Balloon training, placing an inflated rectal balloon in the patients rectum and retraining the external sphincter to relax as the patient attempts to expel the balloon

Question 31

Gastrointestinal bleeding

Answer 31

this is a serious condition, possibly a medical emergency. Where the blood is coming out, vomiting or stool, what color it looks like, bright red, dark, coffee grounds, will guide you to the next provider.

Question 32

Hiatal hernia

Answer 32

in this condition a portion of the stomach passes through the diaphragm into the thoracic cavity. Several theories exist as to why this occurs. The main symptoms are regurgitation. If the hernia is sliding, heartburn may also be present post prandial.

Question 33

Name these

Answer 33

1) normal
2) sliding hiatus hernia
3) paraesophageal hiatus hernia

Question 34

Gastroesophageal reflux disease

Answer 34

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. Heartburn is the main symptom in this patient population. Often patient are provided with proton pump inhibiting drugs (PPI). Dietary modification can often resolve symptoms, but are more challenging for some patients.

Management of patients with GERD: be mindful of positions that may be uncomfortable, especially after a meal, supine and/or prone. Exercising after a meal can also be uncomfortable for patients.

Question 35

Gastritis

Answer 35

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

Question 36

Peptic ulcers

Answer 36

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.

One pathogenesis is the use of NSAIDs. In normal functioning bodies there is a balance between mucosal insults and mucosal defenses. Prostaglandins help to inhibit stomach acid. If a deficiency exists in prostaglandins, gastric ulcers can occur. NSAIDs can lead to this deficiency.
Management: diagnosis typically occurs based on symptoms with endoscopy typically used to confirm diagnosis. Treatment often includes stopping the irritating substances (NSAIDs), possible addition of proton pump inhibiting drugs (PPI)

Question 37

Gastric cancers

Answer 37

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.
Signs and Symptoms: weight loss and early satiety are often the first signs, with the disease progressing to advanced stages often before warning signs. With treatment including resection as well as radiation and or chemotherapy the 5 year survival rate is only 20%.

Question 38

Intensive maladaptive disorders

Answer 38

Celiac Disease- 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. Being it is autoimmune mediated it is more common in persons with other autoimmune diseases or genetic syndromes. Chronic inflammation and malabsorption of nutrients are the most common complications of the disease. Most common symptoms from patients with Celiac disease include 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.

IgA antibodies can assist in the diagnosis as well as serologic testing and biopsies of the small intestines.
Treatment is the avoidance of all gluten containing grains
Prognosis for those who follow the diet is good

Question 39

Intestinal vascular disease

Answer 39

Vascular Diseases: Intestinal Ischemia-is a result of decreased blood supply to the bowels. A life threating event is acute mesenteric ischemia where occlusions occur in the visceral branches of the abdominal aorta. The superior mesenteric artery is the most commonly involved.

Symptoms: abdominal pain, followed later by blood in the stool, nausea vomiting, fever, back ach and shock. Most common in persons over 50 years of age.
Testing: angiography, CT angiography or MRI angiography
Treatment: with thrombotic diseases, exploratory surgery is preferred, where necrotic tissue can be removed as well as perforated bowels.

Question 40

Inflammatory Bowel Diseases: (IBD)

Answer 40

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.

Question 41

Crohn disease

Answer 41

Any age; 10-30 yr most common
20%-25%
Equal in women and men
Increased; early detection best means of prevention
Any segment; usually small or large intestine
Common
Entire intestinal wall (all layers) involved

Question 42

Ulcerative colitis

Answer 42

Any age; 10-40 yr most common
20%
Equal in women and men
Increased; preventable with bowel resection
Rectum and left colon
Mucosal layers involved; submucosal involvement only in severe cases

Question 43

Antibiotic Associated Colitis

Answer 43

antibiotics can reek havoc on the natural biome of our gut. Often, several days to months after completing a round or antibiotics patients can suffer from diarrhea. Clostridium difficile is a common form of colitis that is associated with antibiotic use. This condition can also lead to reactive arthritis, often in the the larger lower extremity joints

Question 44

Irritable bowel syndrome

Answer 44

as per the Mayo clinic-(IBS) is a common disorder that affects the stomach and intestines, also called the gastrointestinal tract. Symptoms include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both. IBS is a chronic condition that you’ll need to manage long term.

Only a small number of people with IBS have severe symptoms. Some people can control their symptoms by managing diet, lifestyle and stress. More-severe symptoms can be treated with medication and counseling.

IBS doesn’t cause changes in bowel tissue or increase your risk of colorectal cancer.

Question 45

Diverticular Disease

Answer 45

According to the NIH: Diverticulosis is a condition that occurs when small pouches, or sacs, form and push outward through weak spots in the wall of your colon. When diverticulosis causes symptoms, bleeding, inflammation, or complications, doctors call this condition diverticular disease.

Symptoms: Symptoms of diverticular disease may include constipation, diarrhea, abdominal pain, or bloating. Diverticulitis most often causes abdominal pain, which is usually severe. Experts are not sure what causes these conditions.
Diagnosis: To diagnose diverticular disease, doctors review your medical history, perform a physical exam, and order tests. Your doctor may notice pouches in your colon wall while performing tests for other reasons. If you don’t have symptoms related to these pouches, your doctor may diagnose diverticulosis.
Treatment: Your doctor will recommend diverticular disease treatments based on whether you have chronic symptoms, diverticulitis, or complications. Treatments may include high-fiber foods, medicines, or surgery to remove part of your colon, called a colectomy.
Diet and lifestyle changes: If you have chronic symptoms of diverticular disease or if you had diverticulitis in the past, your doctor may recommend eating more foods that are high in fiber. Good sources of fiber include whole grains, fruits, and vegetables.

Question 46

Obstructive Disorders

Answer 46

Adhesion: number 1 cause of obstruction. These can be caused from scar tissue, endometriosis or infections. This tissue can impair the bowels ability to slide
Intussusception: telescoping of the bowels, if left untreated the bowels can become ischemic. There is a connection in children and the rotavirus vaccine. In adults it is often the result of lesions suck as diverticulum.
Volvulus: torsion or loop of the intestines. This can cause kinks in the bowels and lead to ischemia.
Hernia: a hernia is a weakening of the abdominal wall where a portion of the bowels pushes through. These can be acquired or congenital and there is a hereditary predisposition to them. Obesity, pregnancy and heavy weightlifting increase the risk. These can occur through out the abdominal wall with inguinal being the most common.

Question 47

The Appendix ​

Answer 47

appendicitis is inflammation of the appendix that can result in necrosis of the tissue or perforation. Often acute appendicitis has no known cause. Its peak incidence is 15-19 with males>females. Symptoms of acute appendicitis abdominal pain, difficulty eating, nausea, vomiting, low grade fever, tenderness at McBurney point, rebound pain to the peritoneal cavity.

Question 48

The peritoneum

Answer 48

peritonitis is inflammation of the lining of the walls of the peritoneal cavity. This can be caused by an acute infection, or from trauma and surgery. Patients with peritonitis will have decreased peristalsis with intestinal distension and gas. Severe abdominal pain with a rigid feel may be present. Pain is often referred to the shoulders and thoracic area and nausea, vomiting and high fever may be present. Left untreated this can lead to multi-organ failure. Diagnosis is often through a CT scan.

Question 49

Rectal

Answer 49

Rectal fissures: an ulceration or tears of the lining of the anal canal. This often occurs with excessive stretching such as in childbirth or large hard bowel movements. After the tearing the tissue is frail and weak and susceptible to retearing

Hemorrhoids: varicose veins in the mucosa between the rectum and the anus. Common symptoms are burning and itching as well as bleeding. Typical treatment is conservative with diet for good bowel health and aerobic conditioning. If they are severe, or fail conservative treatment, then surgical management may be required.

Question 50

Liver physiology

Answer 50

> 500 digestive, endocrine, excretory and hematologic functions
Production of bile
Important roles in the production of hemoglobin
Production of key clotting factors
Elimination of toxins through a process that supports the immune system

Question 51

Pancreas physiology

Answer 51

exocrine and endocrine gland
Exocrine: Digestion, with the excretion of digestive enzymes and pancreatic juices
Endocrine functions: glucagon and insulin are secreted for the regulation of carbohydrate metabolism

Question 52

Gallbladder physiology

Answer 52

acts as a reservoir for bile which plays an important role in the emulsification, absorption and digestion of fats

Question 53

liver disease

Answer 53

Jaundice: a symptoms of liver disease, it is characterized by yellowing of the skin and sclerae. This occurs with either over production or malfunction in bilirubin metabolism. Bilirubin is the byproduct in the breakdown of hemoglobin. If this is present patients need to be tested for liver disease and function.
Cirrhosis of the liver occurs with chronic inflammation. Normal tissue is lost and replaced by fibrotic tissue. Although many drugs and diseases will lead to cirrhosis, alcohol and hepatitis C are the most common. Overall mortality rate is fairly high. Ascites is very common with cirrhosis.
Portal Hypertension: Increases in hepatic sinusoidal pressure. This is often related to cirrhosis. This can begin to flow blood back towards the stomach and esophagus. This can lead to varices and bleeding that can be life threatening in nature.
Hepatic Encephalopathy: a condition that can occur with persons with hepatic diseases, and includes various neuropsychiatric symptoms, motor disturbances and coma. Persons managing hepatic encephalopathy are also at greater risk for internal bleeding and care must be in place to avoid falls.
Ascites: abnormal accumulation of fluid with in the peritoneal cavity. Often, as in cirrhosis, portal hypertension is the culprit to the fluid accumulation. Sodium, fluid restriction, diuretics are all utilized in the treatment/management. Remember to elevate the head of the table when treating patients with ascites as breathing can be challenging in a fully supine position.

Question 54

Alcohol related liver disease

Answer 54

over 40% of deaths related to cirrhosis are alcohol related. Men > Women. Fat accumulation in the liver will occur with over 90% of heavy drinkers, but only a small percentage will develop cirrhosis. Patients are often asymptomatic for a very long time, until the disease has progressed, or if specific liver tests are being completed.

Nonalcoholic fatty liver is a growing condition in the USA due to insulin resistance and obesity. This condition is thought of as manifestation of metabolic syndrome. NAFLD can often be managed with lifestyle changes.

Question 55

Hepatits

Answer 55

1. Hepatitis A: Spread through ingestion of contaminated food or water. It usually causes an acute infection that the body can clear on its own, and there is a vaccine available.
   
   2. Hepatitis B: Transmitted through bodily fluids, such as blood or sexual contact. It can be acute or chronic, with some cases leading to liver damage. There’s also a vaccine for Hepatitis B.
   3. Hepatitis C: Mainly spread through blood-to-blood contact (e.g., sharing needles). Often becomes chronic and can lead to liver cirrhosis or cancer. While there’s no vaccine, it can often be cured with antiviral medications.
   4. Hepatitis D: Requires Hepatitis B to be present for infection, as it’s an incomplete virus. This co-infection can lead to severe liver disease. The Hepatitis B vaccine indirectly prevents Hepatitis D.
   5. Hepatitis E: Typically spread through contaminated water, like Hepatitis A. It is usually acute and self-limiting, but it can be dangerous for pregnant women. There is a vaccine in some countries but not widely available.

Question 56

Diabetes Mellitus

Answer 56

the pancreas acts as and endocrine gland, producing the hormones insulin and glucagon as well as an exocrine gland producing digestive enzymes. The islets of Langerhans are the cells that are responsible for producing hormones. defects in this process lead to DM. More is covered on this topics in a later section.

Question 57

Pancreatitis

Answer 57

serious inflammation of the pancreas. This can be acute of chronic, where acute is often mild and reversable, chronic tends to be recurrent and persisting. Most symptoms of acute are stomach pain, nausea and vomiting, with pain in the right upper quadrant and radiating pain to the back. Chronic, causes changes in the pancreas that are no longer reversable most often caused by alcohol abuse.

Question 58

renal system physiology

Answer 58

Disposes toxic waste products and unnecessary fluid

Regulates metabolic processes

Acid-base/electrolyte balance

Lower GU system transports the fluid and waste and stores it until it is convenient to dispose of

Question 58

Cholelithiasis

Answer 58

gallstones, 20 million persons a year female>male, increased risk with age. This occurs when stones form in the bile. They only become symptomatic when they move into the cystic ducts. Genetics also plays a role in the risk factor. Right upper quadrant pain is often the most noted sign. Transabdominal ultrasound is utilized for assessment and diagnosis. Some patients will have resolution of symptoms, some will need the gallbladder removed.

Question 59

Kidney physiology

Answer 59

Located retroperitoneal at T11-L3
Regulate BP with fluid balance and renin
Formation of red blood cells
Filter nitrogenous waste products in the form of ammonia, uric acid or urea

Question 60

Urinary tract physiology

Answer 60

Function: Storage of urine and elimination of urine
Micturition
Innervation from parasympathetic, sympathetic and somatic nervous system

Question 61

Urinary tract infection

Answer 61

very common in all persons. Females typically have less complicated conditions than males and children. It is common for them to reoccur. Women and older adults are most at risk. By 24 years of age 33% of women will have been treated for at least 1 UTI. This is due to the shorter length of the urethra and the position close to the vagina and rectum. Vaginal intercourse also increases the risk as bacteria may be introduced into the vagina. In older adults the use of incontinence products increases the risk. Persons with DM may also have increased risk due to glycosuria. Other conditions that increase the risk are interstitial cystitis and overactive pelvic floor muscles. Most UTIs are caused from fecal matter with e. coli being the number one organism and staph close behind.
Symptoms include: dysuria, frequency, urgency, nocturia, fever, chills, malaise, urine may be cloudy, smelly or have blood present and pain with both urination and intercourse may present themselves.
Prevention is key: drinking plenty or water, urinating post intercourse, wiping front to back, changing pads often, proper genital hygiene, if possible avoid spermicidal agents, take a probiotic.
Diagnosis is made with urinalysis. Treatment is often antibiotics based on the bacteria present.

Question 62

Pyelonephritis

Answer 62

this is either infection of the kidney or chronic inflammation of the kidney. This is often spread from a UTI infection that moves up the tract to the kidneys. The main organisms are the same as UTIs.

Question 63

Cystic diseases

Answer 63

a renal cyst is a cavity of fluid. This can be dangerous in that is can allow for these regions to lead to degeneration of renal tissue. Some cysts are small and other large, there are several different categories. The incidence depends on the type, with polycystic kidney disease being most common and affecting 0.1% of the population. One of the main symptoms other than pain is the development of end stage renal disease.

Question 64

Renal Calculi

Answer 64

kidney stones, the third most common urinary tract disorder. These are often made up of calcium and can very in size and shape. They occur in up to 5% of adults Men>Women. Pain is severe and debilitating. Diet modifications including proper hydration can help with prevention of stones. Diagnosis is made often via CT scans. Treatment is often pain management while the patient passes the stone with the possibility of shockwave lithotripsy to fragment the calcium stone. If large enough a patient may have to undergo a ureteroscopy.

Question 65

CKD: Chronic Kidney disease

Answer 65

It is very common in the US, many people with this condition are not aware that they have it, even if they have a more severe later stage of the disease process
Prevalence: 1:7 adults or 15% USA
Disease process: kidney function slows and toxins build in the body, Disease process leads to elevated BP, anemia, weakened bones, nurse damage and decreased nutritional health over time the disease process leaved to kidney failure. When this occurs patients will often need to utilize dialysis while awaiting a kidney transplant.

Screening: uACR Test measures the amount of protein that has leaked into the urine, kidney function test measures the glomerular filtration rate or GFR and reveals how well the kidneys are doing ar removing waste

Risk Factors: The main contributing factors that lead to kidney disease are diabetes and HTN however there are less common conditions that lead to kidney disease, these include glomerulonephritis- or damage to the glomerular, polycystic kidney diseases-which is inherited. Autoimmune diseases such as lupus can lead to kidney failure as well as other conditions that lend themselves to chronic strain on the kidneys such as kidney stones, chronic UTIS and kidney infections or even an enlarged prostate.

Treatment: early treatment is best: diet, exercise, medication lifestyle changes

Question 66

Stages of chronic kidney disease

Answer 66

Stage 1: kidney damage with normal kidney function (GFR 90 or higher)
Stage 2: kidney damage with mild loss of kidney function (GFR 89 to 60)
Stage 3a: mild to moderate loss of kidney function (GFR 59 to 45)
Stage 3b: moderate to severe loss of kidney function (GFR 44 to 30)
Stage 4: severe loss of kidney function (GFR 29 to 15)
Stage 5: kidney failure (GFR less than 15)

Question 67

Glomerular Diseases

Answer 67

these include a group of disease the damage the kidney’s filtering system. This is most often the common cause of ESRD.

Question 68

Incontinence (bladder and urethra)

Answer 68

Normal function of the bladder-Micturition is the process of bladder elimination, it is controlled through a series of neural circuits in the brain and spinal cord to coordinate the smooth muscle of the bladder and urethra with the voluntary control of elimination. Pelvic parasympathetic nerves: arise at the sacral level of the spinal cord, excite the bladder, and relax the urethra. Lumbar sympathetic nerves: inhibit the bladder body and excite the bladder base and urethra. Pudendal nerves: excite the external urethral sphincter. The bladder is located directly behind the pubic symphysis and below the uterus in females. Voluntary control of urine excretion is learned through inhibition of the reflex pathways, this typically occurs between the ages of 2-4.
Incontinence may be defined as involuntary urine loss.
Stress Incontinence: (most common): Leaks with laughing, coughing, sneezing, bending, lifting, changing positions. Weakening of the pelvic floor from pregnancy, childbirth, menopause or high impact activity. No Medications will help this! 53% of females over 20, 28% collegiate athletes.

Urge (Overactive Bladder):Frequent urination with strong and sudden urge to void. Can be caused by nerve damage: MS, Parkinson’s, CMT. 1/5 over 40 will experience OAB. Medications: block nerve impulses to bladder (Detrol, Ditropan, Oxybutynin, Sanctura, Enablex, Vesicare)

Overflow: Bladder does not empty completely, becomes so full it overflows. Common in men with prostate enlargement or hypotonic bladder or detrusor sphincter dyssynergia (incoordination voiding due to SCI MS)

Mixed: Combination of several types but most often urge and stress incontinence

Functional: Leaks when you cannot make it to the bathroom, Physical or mental disorder

Question 69

Painful Bladder Syndrome

Answer 69

complaints of suprapubic pain related to bladder filling. Often associated with other symptoms of increased frequency and without other obvious pathology. Interstitial cystitis is a subgroup of PBS. Although no risk factor have been identified, this condition often exists with fibromyalgia and IBS. Urinary frequency sas well as pain in the bladder, vagina suprapubic region and low back are common.

Question 70

Neurogenic bladder

Answer 70

dysfunction with the neurologic pathways.

Question 71

Function of the pancreas

Answer 71

1) production of digestive enzymes
2) secretes glucagon and insulin islets of langerhans

Question 72

Common pathologies of pancreas

Answer 72

Diabetes mellitus
Pancreatitis
Gall stones
ETOH
CA

Question 73

Name these

Answer 73

1) acute cholecystitis
2) chronic cholecystitis
3) carcinoma

Question 74

Common biliary conditions

Answer 74

Cholangitis
Cholecystitis
Cholelithiasis

Question 75

Functions of the liver

Answer 75

Filtration of GI circulation
Detoxification
Production of albumin
Regulates glucagon/glucagen balance
Production of clotting factors
storage of vitamins and minerals
Production of bile