Gastrointestinal System Flashcards
(99 cards)
1
Q
Common signs and symptoms of GI disease
A
nausea & vomiting, diarrhea, anorexia, constipation, dysphagia, heartburn, abdominal pain, GI bleeding, achalasia, bowel incontinence
2
Q
3 types of GI bleeding
A
Hematemesis - spitting up blood
Melena - black stool
hematochezia - bloody stool
3
Q
Achalasia
A
inability to relax smooth muscles of GI tract; feeling of fullness in sternal region
4
Q
Diarrhea
A
Neurogenic: irritable bowel syndrome
Muscular: alcohol, muscular incompetence
Mechanical: obstruction
Other: diet (food additives), laxative medications, infection, strenuous exercise
5
Q
Constipation
A
Neurogenic: IBS, MS, PD
Muscular: inactivity, back pain/injury
Mechanical: obstruction
Other: diet (lack of fiber), pain medication
6
Q
GI conditions of esophagus
A
- hiatal hernia
- GERD
- scleroderma esophagus
- neoplasms
- varices
- tracheoesophageal fistula (only seen in peds)
7
Q
Hiatal Hernia
A
- enlargement of cardiac sphincter
- stomach protrudes through this opening in the diaphragm into thoracic cavity
8
Q
hiatal hernia signs/symptoms
A
- midline/sternal pain 30-60 min after eating; increases w/ tight clothing or lying down
- may also produce difficulty/pain in swallowing
9
Q
Treatment of hiatal hernia
A
antacids, elevating upper body in supine
10
Q
hiatal hernia: PT management
A
treat - be aware of condition
shaker head lifting exercises and education regarding reduction of intra-abdominal pressure
Avoid: full supine position for exercise and valsalva maneuver
11
Q
GERD
A
inflammation of esophagus
may be result of irritating fluids: infectious agents, chemical irritants, physical agents (NG tube; radiation), gastric juices
12
Q
Treatment of GERD
A
acid-supresing inhibitor drugs (PPIs); antacids or histamine blockers; lifestyle modifications
13
Q
PT management of GERD
A
- weight loss
- educate on avoiding supine and lying after meal, increase fluid intake between meals - dilute gastric acids
- screen to rule out angina
- exercise may aggravate symptoms
- low-impact exercise may decrease symptoms
14
Q
Adenocarcinoma is most frequently seen in what population?
A
- most frequently seen in middle-aged white men
15
Q
Squamous cell
A
- common in blacks, associated w/ ETOH/tobacco use
16
Q
Causes for esophageal cancer
A
- Vit A and zinc make esophagus more vulnerable to neoplastic changes
- food/drink remain in esophagus
- alcohol and tobacco
- site of metastasize from liver or lung
- if esophagus is primary site, will not metastasize bc kills pt before it can metastasize
17
Q
symptoms of esophageal neoplasm/cancer
A
- dysphagia w/ or w/o pain
- heartburn when lying down
- anorexia
- weight loss
- hoarseness
- cough/recurrent pneumonia
- bleeding
18
Q
Esophageal CA treatment and prognosis
A
Treatment: surgery, radiation or chemo if unable to resect
Prognosis: poor due to advanced stage at diagnosis
survival rate is < 10 months
19
Q
PT management esophageal neoplasm/CA
A
- be aware of lymph node changes during upper quarter screening (enlarged and painless)
- if pt not receiving chemo, consider low-level aerobic activity to increase immune system function
20
Q
Esophageal Varices
A
dilation of veins in lower 1/3 of esophagus
liver disease –> portal HTN –> varies
21
Q
Esophageal Varices signs/symptoms
A
- painless and massive hematemesis w/ or w/o melena (black stool)
- postural tachycardia and profound shock d/t blood loss
22
Q
Treatment of Varices
A
pharmacologic or endoscopic; TIPS: trans-jugular intrahepatic portosystemic shunt
- usually good candidates for liver transplant
23
Q
PT management of Varices
A
- Refer to physician
- avoid valsalva maneuver
- watch for asterixis signaling developing hepatic encephalopathy
- assess fluid retention (LE) and presence of ascites
24
Q
Tracheoesophageal fistula
A
- abnormal pathway between esophagus and trachea
- aspiration risk –> need surgical repair
- only seen in peds
25
GI conditions of stomach
- gastritis
- peptic ulcer disease (PUD)
- gastric cancer
26
Gastritis
inflammation of stomach lining
27
acute gastritis
often occurs in conjunction w/ serious illness, physiologic stress, medication/NSAID use
28
chronic gastritis
Type A: less common; associated w/ pernicious anemia
| Type B: more common; bacterial infection (Helicobacter pylori)
29
Acute gastritis risk factors w/ NSAIDs
- over 65
- Hx of ulcer disease
- using NSAIDs > 3 months
- high dose or multiple NSAIDs
- concurrent corticosteroid therapy
30
Symptoms of Acute gastritis
epigastric pain; feeling of abdominal dissension; appetite loss; nausea; occult GI bleeds
Less common: heartburn, low-grade fever, vomiting
31
Treatment of acute gastritis
removal of predisposing factors
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symptoms of chronic gastritis
possibly asymptomatic; may experience pain, indigestion after eating
33
PT management of acute gastritis
monitor for signs for pts using NSAIDS
| - educate proper use, side effects and risks of NSAID use
34
Peptic ulcer disease
- break in protective gastric mucosa or duodenal mucosa exposing submucosal areas to gastric secretions
- Average age: 50s
- Referred pain at T8 level - gastric; T10 - duodenal
- Helicobacter pylori infection most common risk factor for developing PUD
35
stress ulcers
- ischemic etiology
- develop in response to prolonged psychological or physiologic stress ( ICU pts)
- very few symptoms; painless until perforation/hemorrhage occur
36
PUD symptoms
epigastric pain (burning, gnawing, cramping, aching); occurs in waves lasting several minutes; radiate T6-T10 level; related to secretion of acid and presence of food in stomach
nausea, appetite loss, possible weight loss
rosaria - integumentary sign of PUD
37
Treatment of PUD
Goals:
- relief of symptoms
- promotion of healing
- prevention of complications
- prevention of recurrences
- antimicrobials treat H. pylori
- antacids, PPIs, histamine-blockers
- surgical repair for perforation
38
PT management of PUD
- Exercise at least 3x/wk reduces risk of GI bleeding
| - closely monitor all-long term NSAID users/eldery
39
Signs of GI bleeding
pallor
activity intolerance
fatigue level
vital signs: signs of bleeding
low BP and tachycardia --> refer immediately, emergent condition!
40
Gastric Cancer
- > 90% of all malignant stomach tumors
- chronic H. pylori infection is strong risk factor
- no good detection of stomach cancers - usually not found til late stage
Treatment: surgical
Site of pain: epigastric or back
41
paraneoplastic acanthosis
- seen in gastric adenocarcinoma
- diffuse thickening of the skin w/ grey, brown or black pigmentation
- usually in body folds
42
Virchow's nodes
enlargement of L supraclavicular nodes seen in gastric cancer
43
GI conditions of intestines
- intestinal ischemia
- botulism
- inflammatory bowel disease (IBD)
- antibiotic-associated colitis
- irritable bowel syndrome (IBS)
- diverticular disease
- neoplasms
- malabsorption syndrome
- obstructive disease
44
malabsorption syndrome
group of syndromes marked by decreased absorption/excessive loss nutrients in stool
- celiac disease
- cystic fibrosis
- crown's disease
- chronic pancreas
- pernicious anemia
- short-gut syndrome
45
maldigestion
failure of chemical process of digestion
46
malabsorption
failure of intestinal mucosa to absorb digested nutrients
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digestive defects
cystic fibrosis: absent pancreatic enzymes
| - lactase deficiency
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absorptive defects
primary: celiac disease
secondary: inflammatory disease of bowel
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Malabsorption syndrome conditions common in PT
- gastroenteritis d/t NSAID use
- fibrosis d/t progressive systematic sclerosis or radiation
- exocrine deficiency of pancreas d/t DM
- short-gut syndrome following extensive resection of bowel or congenital shortening of small bowel
50
Symptoms of malabsorption syndrome
early: weight loss, fatigue, depression, abdominal bloating
possible: steatorrhea; nocturne; dermatitis herpetiformis
common: explosive &/or chronic diarrhea, abdominal cramps, indigestion, flatulence
later: muscle wasting, bone mineral density changes, low BP, abdominal dissension, pernicious anemia (poor uptake of Vit B12)
51
malabsorption of calcium, Vit D, proteins
causes osteoporosis, bone pain from compression fx and skeletal deformities
52
electrolyte imbalance and low calcium
cause muscle spasms
53
intestinal ischemia
- occur acutely from embolic occlusions of abdominal aorta visceral branches
- occur secondary to arteriosclerotic changes
- presents w/ crampy or steady epigastric periumbilical pain BUT may refer to thoracolumbar junction w/ exertion
54
blood supply to intestines
celiac, superior and inferior mesenteric arteries
55
PT management of intestinal ischemia
Screen back pain for:
- CAD risk factors
- PVD/PAD
- other PMH - recent surgery (abdominal), hx of blood clots
56
Botulism
most cases result from ingestion of Escherichia coli, campylobacter, listeria, salmonella
57
Botulism symptoms
prolonged bloody diarrhea, dehydration, weight loss, fever, nausea, severe abdominal pain
58
inflammatory bowel disease
Crohn's disease and ulcerative colitis
both are idiopathic; affect Gi tract's ability to distinguish foreign entities from body's antigens
possible genetic link and immunologic mechanism
59
Crohn's disease
affects all layers of intestine and is characterized segments of affected intestine w/ normal areas in-between ("skip" areas)
60
ulcerative colitis
affects mucosa and submucosa in continuous pattern (no "skips")
61
Treatment of IBD
diet/nutrition; palliative or specific medication; occasionally surgical excision
62
PT management IBD
- watch for referred pain to lumbar region
- screen LBP, hip, SI pain of unknown origin
- be aware of low bone mineral content and prevalence of osteoporosis
- pt's may be dehydrated; watch for vascular depletion
63
Antibiotic-Associated Colitis
long use of antibiotics decrease colonies of normal GI bacteria, leads to colonization of yeast, colds and C-diff
C-diff replaces normal GI flora; releases toxins damaging intestinal mucosa
64
C-diff symptoms
voluminous, watery diarrhea; abdominal cramps/tenderness, fever
65
Treatment of C-diff
- must use lavage to remove spores
- stop antibiotics; probiotics, immunoglobulins, IV fluids
- very hard to get rid of
66
reactive arthritis
acute, aseptic inflammatory arthropathy arising after infectious process, at site remote from primary infection
- may be result of C-diff
67
Prevention of C-diff spreading
- wash hands with soap and water
- clean room surfaces w/ bleach or EPA approved spore killing disinfectant
- isolate C-diff pts
68
IBS
most common disorder of GI system
- no inflammation present
- women>men early adulthood
- 3 mo abdominal pain and fatigue
69
Treatment of IBS
lifestyle changes, eliminate tobacco, alcohol, nicotine, caffeine, start healthier diet and exercise
70
Diverticulosis
uncomplicated disease
71
diverticulitis
disease with inflammation
72
diverticula
outpocketings in intestinal wall; mucosa/submucosa herniates through muscular layers
73
Diverticular Disease
- 80% asymptomatic
- pass fresh blood/clots and urgency in defecation
- tomatoes common for triggering (acidic w/ seeds)
74
Diverticular disease symptoms
severe abdominal pain in L quadrant or mid-abdominal region referring to low back; pelvic pain (women); alternating constipation/diarrhea; increased flatus; fever; anemia (blood loss)
75
diverticular disease treatment
dietary changes; laxatives; exercise; may require antibiotics; NG tube or parenteral feedings
76
intestinal polyps
growth/mass protruding into intestinal lumen from mucosa
| - may be neoplastic or non-neoplastic
77
adenocarcinoma of colon
leading cause of death in men, 3rd leading cause of death in women
- colonoscopies for prevention and early detection
78
adenocarcinoma risk factors
- increase age
- male
- adenomatous polyps
- ulcerative colitis or CD
- family hx
- immunodeficiency
- sedentary
- tobacco
- low fiber, high-fat or high protein diets
79
adenocarcinoma signs/symptoms
cardinal sign: bright red blood from rectum
symptom: persistent stomach pain, diarrhea, constipation
many cases asymptomatic until metastasis occurs
80
adenocarcinoma treatment
surgical removal of tumor; may accompany w/ radiation
81
PT management of adenocarcinoma
spread of cancer to prostate can refer pain to sacral or lumbar spine
- pt reports of vague, dull, aching
- watch for reports of simultaneous or alternating abdominal pain at same level back pain
- watch for associated GI symptoms
82
obstructive disease
organic, mechanical, functional causes
| obstruction, distension, constipation
83
obstructive disease symptoms
cramping pain/tenderness in periumbilical area; constitutional symptoms
- dehydration, hypovolemia and metabolic acidosis can develop w/in 24 hours of obstruction
84
PT management of obstructive disease
consider alternative methods of activity w/in limitations set by surgeon post op
85
adhesions
fibrous bands formed after abdominal surgery
86
intussusception
telescoping of bowel in on itself
87
volvulus
torsion of an intestinal loop, twisted on its mesentery
88
hernia
abnormal protrusion of part of an organ or tissue through the structure normally containing it
inguinal, femoral, umbilical, incisional(ventral)
89
hernia symptoms
intermittent or persistent bulge and pain; pain increases w/ changes in positions, Valsalva's maneuver or physical exertion; relieved by stopping precipitating activity; fever, tachycardia, vomiting, abdominal distention
90
Hernia treatment
surgical repair of defect (herniorrhaphy)
91
appendicitis
inflammation of vermiform appendix
may progress to necrosis, perforation -->peritonitis
significant complications from delayed diagnosis
92
appendicits symptoms
```
abdominal pain (RLQ); anorexia, nausea, vomiting, low grade fever
older adults little to no symptoms until perforation occurs
```
93
appendicitis treatment
surgical removal (prior to perforation)
94
PT management of appendicitis
screen w/:
- McBurney's point
- rebound tenderness (Blumberg)
- constitutional symptoms
- localization of pain on coughing or valsalva maneuver
95
Peritonitis
inflammation of serous membrane lining abdominal cavity
primary (spontaneous)
secondary (due to trauma, surgery or contamination by bowel contents)
96
Peritonitis symptoms
fluid/electrolyte imbalances and include severe abdominal pain, nausea, vomiting, high fever; rigid, board-like abdomen
positive Blumberg sign
97
Peritonitis treatment
surgical drainage, repair; antibiotics; supportive measures to correct fluid, electrolyte and nutritional disorders
98
Kerr's sign
L shoulder pain that occurs w/ splenic irritation
| associated w/ peritonitis d/t blood, infectious fluid in abdominal cavity containing spleen
99
PT management of peritonitis
monitor vitals
semi-Fowler's position (but for respiration exercises w/ less pain)
watch for signs of wound dehiscence
use safety measures in fever/infection produces confusion/disorientation
