Week 9 Flashcards

Question

sexual trauma

Answer 1

4/5 women and 4/10 men

Answer 2

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.

Answer 3

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.

Answer 4

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.

Answer 5

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.

Answer 6

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

Answer 7

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.

Answer 8

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.

Answer 9

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

Answer 10

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.

Answer 11

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

Answer 12

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)

Answer 13

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%.

Answer 14

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

Answer 15

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.

Answer 16

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.

Answer 17

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

Answer 18

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

Answer 19

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

Answer 20

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.

Answer 21

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.

Answer 22

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.

Answer 23

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.

Answer 24

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.

Answer 25

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.

Answer 26

>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

Answer 27

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

Answer 28

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

Answer 29

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.

Answer 30

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.

Answer 31

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.

Answer 32

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.

Answer 33

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.

Answer 34

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

Answer 35

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.

Answer 36

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

Answer 37

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

Answer 38

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.

Answer 39

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.

Answer 40

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.

Answer 41

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.

Answer 42

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

Answer 43

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)

Answer 44

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

Answer 45

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

Answer 46

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.

Answer 47

dysfunction with the neurologic pathways.

Answer 48

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

Answer 49

Diabetes mellitus Pancreatitis Gall stones ETOH CA

Answer 50

1) acute cholecystitis 2) chronic cholecystitis 3) carcinoma

Answer 51

Cholangitis Cholecystitis Cholelithiasis

Answer 52

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