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Medical Conditions II > GI System > Flashcards

Flashcards in GI System Deck (139):
1

S/Sx GI Disease

-N/V
-diarrhea
-anorexia
-constipation
-dysphagia
-achalasia
-heartburn
-abdominal pain
-GI bleeding
-Bowel incontinence

2

Achalasia

-inability to relax smooth muscles of GI tract
-feeling of fullness in sternal region

3

hematemesis

-spitting up blood

4

melena

black stool

5

hematochezia

bloody stool

6

Causes of Diarrhea

-neurogenic: IBS
-Muscular: alcohol, muscular incompetence
-Mechanical: obstruction
-Other: diet, meds, infection, strenuous exercise

7

Causes of Constipation

-neurogenic: IBS, MS, PD
-Muscular: inactivity, back pain
-mechanical: obstruction
-Other: diet, meds

8

Aging and GI

-constipation, incontinence, diverticular disease
-wear/tear dental components
-decreased sensation and salivation
-decrease gastric motility, volume/acid content
-decreased blood flow and nutrient absorption
-decreased production of intrinsic factor (IF)

9

GI is an ____ organ

-endocrine

10

GI produces and secretes _____

hormones

-travel through portal system to organ of influence

11

Intrinsic Innervation

-enteric nervous system
-myenteric plexus
-submucsal plexus

12

Extrinsic Innervation

-parasympathetic and sympathetic nervous systems

13

Parasympathetic Innervation of GI

-from sacral segments of SC
-thoracic ganglia
-celiac, superior mesenteric, inferior mesenteric ganglia

14

Sympathetic Innervation of GI

-nonadrenergic fibers from prevertebral sympathetic ganglia

15

Vagus Nerve

-sensory and motor fibers

16

Gastrointestinal conditions: Esophagus

-hiatal hernia
-GERD
-Scleroderma Esophagus
-Neoplasms
-Varices
-Tracheoesophageal Fistula

17

Hiatal Hernia

-enlargement of cardiac sphincter
-stomach protrudes thru opening into diaphragm into thoracic cavity

18

Hiatal Hernia may cause:

-midline/sternal pain (heartburn) 30 min after eating
-pain/difficulty with swallowing

19

Treatment of Hiatal hernia

-antacids
-elevating upper body in supine position
-avoid full supine
-avoid valsalva

20

GERD

-gastroesophageal reflux disease
-result of reflux of irritating fluids

21

GERD Treatment

-acid-suppressing inhibitor drugs (PPIs)
-antacids or histamine blockers
-lifestyle modifications

22

GERD PT Management

-exercise may aggravate
-decreased Sx with less strenuous exercise
-avoid supine

23

Esophageal Neoplasms

-2 types: squamous cell and adenocarcinoma
-more in middle aged white men
-squamous more in blacks

24

GERD may increase the risk of:

-adenocarcinoma via Barrett's esophagus (precancerous)

25

_____ mades esophageal mucosa more vulnerable to neoplastic changes

-vitamin A and zinc deficiencies

26

Food/drink remaining in esophagus may lead to _____

-ulceration/metaplasia

27

Sx of esophageal neoplasm

-dysphagia w/ or w/o pain
-heartburn in supine
-enlarged painless lymphnodes
-anorexia
-weight loss
-hoarseness
-cough/recurrent pneumonia
-bleeding

28

Esophageal Neoplasm Treatment

-surgery
-radiation
-chemo

poor prognosis/rapid metastasis

29

Esophageal Varices

-dilation of veins in lower 1/3 of esophagus
-liver disease-->portal HTN-->varices

30

Variceal bleeding usually manifests as ____

painless but massive hematemesis with or w/o melena

31

Esophageal Varices S/Sx

-postural tachycardia
-profound shock
-melena
-hematemesis
-asterixis
-ascitis

32

Esophageal Varices Treatment

-pharmacologic
-endoscopic
-liver transplant

33

Esophageal varices PT management

-avoid valsalva
-watch for asterixis
-assess fluid retention (ankles) and ascites

34

Stomach Conditions

-Gastritis
-Peptic Ulcer Disease (PUD)
-Gastric Cancer

35

Gastritis

-inflammation of stomach lining (gastric mucosa)--not whole wall
-most common stomach disorder
-2 types: A and B

36

Gastritis Type A

-associated with pernicious anemia
-less common

37

Gastritis Type B

-bacterial infection
-more common

(Helicobacter pylori)

38

Acute Gastritis

-often with serious illness (physiologic stress) or meds (NSAIDs)

39

Risk factors with NSAID use:

->65
-Hx of ulcer disease
-NSAIDs >3 months
-high dose of multiple NSAIDs
-concurrent corticosteroid therapy

40

S/Sx Acute Gastritis

-epigastric pain
-abdominal distention
-appetite loss
-nausea
-occult GI Bleeds

-heartburn
-low-grade fever
-vomiting

41

S/Sx Chronic Gastritis

-asymptomatic
-pain/indigestion after eating

42

Acute Gastritis PT Management

-watch for Gastritis in people taking NSAIDs
-edu about side effects, risks, proper use of NSAIDs

43

PUD

-peptic ulcer disease
-break in gastric mucosa or duodenal mucosa

44

Pepsin

-proteolytic enzyme
-principle component of gastric juice
-catalyst in chemical breakdown of protein

45

S/Sx of PUD

-symptomless until perforation/hemorrhage occur
-epigastric pain (burning, gnawing, cramping, aching)
-nausea
-appetite loss
-weight loss
-occur in waves
-radiate to back (steady T6-T10 pn with duodenal perforation)

46

Risk factor of PUD

-Helicobacter pylori infection (90% of all ulcers)
-NSAIDs

47

S/Sx PUD related to:

-secretion of acid presence of food in stomach

48

PUT Treatment Goals

-relief of Sx
-promote healing
-prevent complications
-prevent recurrence

49

_____ ulcers heal faster than _____ ulcers

duodenal faster than gastric ulcers

50

PUD Treatment

-antimicrobials for H. pylori
-antacids, PPIs, histamine blockers
-diet mod
-surgery for perforation
-ex's to decrease risk of GI bleeding (moderate)

51

Signs of GI bleed

-pallor
-activity intolerance
-fatibue level
-vital signs: RR, HR increased

52

Most Common Gastric Cancer

-adenocarcinoma
-(90% of all malignant tumors of stomach)

53

Gastric Cancer Risk Factors

-H. pylori

54

Treatment of Gastric Cancer

-surgical

55

S/Sx Gastric Cancer

-epigastric pn
-back pain
-paraneoplastic acanthosis
-left supraclavicular lymph node enlarged (Virchow's)
-umbilical nodule

56

Paraneoplastic Acanthosis

-diffuse thickening of skin with grey/brown/black pigmentation
-found in body folds

57

Virchow's Node

-left supraclavicular lymph node
-commonly involved with gastric cancer

58

Intestinal Conditions

-malabsorption syndrome
-intestinal ischemia
-botulism
-inflammatory bowel disease (IBD)
-irritable bowel syndrome (IBS)
-diverticular disease
-neoplasms
-obstructive disease

59

Malabsorption Syndrome

-group of syndromes marked by decreased intestinal absorption/excessive loss of nutrients in stool

60

Causes of Malabsorption Syndrome

-Celiac Disease
-Cystic Fibrosis
-Crohn's Disease
-Chronic Pancreatitis or Pancreatic Carcinoma
-Pernicious Anemia
-Short-Gut Syndrome

61

Maldgestion

-failure of chemical process of digestion

62

Malabsorption

-failure of intestinal mucosa to absorb digested nutrients

63

Digestive Defects

-Cystic Firbosis: absent pancreatic enzymes
-Lactase Deficiency

64

Absorptive Defects

-primary (celiac disease)
-secondary (inflammatory disease bowel)

65

Types of Malabsorption Conditions Seen in PT

-gastroenteritis due to NSAID use
-Fibrosis due to progressive systemic sclerosis or radiation
-exocrine deficiency of pancrease due to DM
-Short-gut syndrome following extensive resection of bowel

66

Early Symptoms of Malabsorption Syndrome

-weight loss
-fatigue
-depression
-abdominal bloating
-steatorrhea
-nocuria
-dermatitis herpetiformis

67

Common Symptoms of Malabsorption Syndrome

-explosive &/or chronic diarrhea
-abdominal cramps
-indigestion
-flatulence

68

Later Symptoms of Malabsorption Syndrome

-muscle wasting
-bone mineral density changes
-low BP
-abdominal distention
-pernicious anemia
-clubbed fingers

69

Malabsorption Syndrome can result in:

-pernicious anemia
(poor uptake of Vit B12)

70

Aging of GI system can result in:

-decreased Intrinsic factor (IF) which promotes B12 absorption
-pernicious anemia

71

malabsorption of Calcium, vitamin D and proteins can cause:

-osteoporosis
-bone pain from compression Fx
-skeletal deformities

72

electrolyte imbalance and low Ca++ can cause

Mm spasms

73

Intestinal Ischemia caused by:

-embolic occlusions of abdominal aorta visceral branches
-arteriosclerotic changes

74

Intestinal Ischemia usually presents with:

-crampy or steady epigastric or periumbilical pain
-can refer to thoracolumbar junction with exertion

75

PT management of intestinal ischemia

-screen back pain pts for:
--CAD risk factors
--PVD/PAD
--recent surgeries
--Hx of blood clots

76

Botulism result from indigestion of:

-E. coli
-Camplyobacter listeria
-salmonella

77

GI Symptoms of Botulism

-prolonged bloody diarrhea
-dehydration
-wt loss
-fever
-nausea
-severe abdominal pain

78

Neurologic Sx of Botulism

-motor weakness
-paresthesias
-CN palsies

79

Treatment of Botulism

-antitoxin

80

IBD

-inflammatory bowel disease
-2 types (Crohn's disease, ulcerative colitis)

81

CD

-Crohn's Disease
-affects all layers of intestine with normal areas between (skip areas)

82

UC

-ulcerative colitis
-affects mucosa and submucosa in continuous pattern (no skips)

83

Cause of CD and UC

-idiopathic

84

CD and UC affect:

-GI tract's ability to distinguish foreign entities from body's antigens

85

Etiology of IBD

-genetic link
-immunologic mechanism
-run in families

86

Treatment of IBD

-diet/nutrition
-palliative
-medication
-surgical excision

87

IBD PT management

-watch for referred pn to LS
-screen all pt with low back/hip/SI pn with unknown origin
-aware of low bone mineral content/osteoporosis
-watch for dehydration/vascular depletion

88

Antibiotic-Associated Colitis

-long courses of antibiotics can decrease colonies of normal GI bacteria-->colonization of yeasts, molds and C. diff-->damage of intestinal mucosa

89

Symptoms of Antibiotic-Associated Colitis

-voluminous watery diarrhea
-abdominal cramps/tenderness
-fever

90

Clinical Complication of Antibiotic-Associated Colitis

-easily spread to other pts
-hand washing (C. diff)

91

Treatment of Antibiotic-Associated Colitis

-stop antibiotics
-use of meds
-IV fluids
-antibiotics just for C. diff
-probiotics
-immunoglobulins

92

Antibiotic-Associated Colitis: watch for

-reactive arthritis

93

reactive arthritis

-acute, aseptic inflammatory arthropathy after infectious process
-at site remote from primary infection

94

IBS

-Irritable bowel SYNDROME
-group of symptoms
-most common disorder of entire GI
-No inflammation

95

IBS Cause

-abnormal intestinal contractions
-stress/serotonin levels
-women>men

96

IBS Treatment

-lifestyle/dietary changes
-medications

97

IBS Symptoms

=/>3 months
-relieved by bowel movement

98

IBS PT Management

-exercise (decrease stress and assist bowel function
-proper breathing/relaxation techniques

99

Diverticulosis

-uncomplicated disease

100

Diverticulitis

-disease with inflammation

101

Diverticula

-outpocketing in intestinal wall
-muscosa/submucosa herniates through muscular layers

102

Diverticular Disease Symptoms

-80% asymptomatic
-passing fresh blood/clots
-urgency in defecation
-severe abdominal pain (left quadrant, mid-abdominal region-refer to back, pelvic pain)
-alternating constipation/diarrhea
-increase flatus
-fever
-anemia (due to blood loss)

103

Diverticular Disease Treatment

-dietary changes
-laxatives
-exercise
-may require antibioticcs
-NG Tube
-parenteral feedings

104

Neoplasms

-intestinal polyps
-adenocarcinoma

105

Intestinal polyps

-growth protruding into intestinal lumen from mucosa
-may be neoplastic (tumor) or non-neoplastic
-malignant or benign

106

Adenocarcinoma

-most relevant in colon and rectum

107

Adenocarcinoma Cardinal Sign

-bright-red blood from rectum
(differentiate from diverticulosis)

108

Adenocarcinoma Symptoms

-persistent stomach pain
-diarrhea
-constipation
-sometimes asymptomatic until metastasis occurs

109

Adenocarcinoma Prevention

-regular colonoscopy after 50 years
-decrease risk factors
-exercise
-daily aspirin/NSAID use >20 year
-sigmoidoscopy
-healthy diet
-no smoking/alcohol

110

Adenocarcinoma Treatment

-surgical removal of tumor (or portion of colon)
-radiation

111

Spread of cancer to prostate can refer pn to:

-sacral/lumbar spines
-vague, dull, achy

112

PT management of Adenocarcinoma

-simultaneous or alternating abdominal pain at same level as back pain
-associated GI symptoms

113

Adenocarcinoma Risk Factors

-age
-men
-adenomatous polyps
-UC/CD
-cancer elsewhere
-Family Hx
-Immunodeficiency disease
-sedentary
-tobacco
-low-fiber/high-fat/high-protein diets

114

Obstructive Disease Causes

-organic (ulcer, gallstone, viral infection, neoplasm)
-mechanical (actual block)
-functional (peristalsis, drug, electrolyte imbalance)

115

Obstructive Disease Progression

-obstruction-->distention-->constipation

116

Symptoms of Obstructive Disease

-cramping pain/tenderness in periumbilical area
-costitutional symptoms
-dehydration
-hypovolemia
-metabolic acidosis (w/n 24 hours of obstruction)

117

Paralytic Ileus

-functional obstruction
-after anterior lumbar fusion/abdomina surgery/immobilization

118

Obstructive Disease PT management

-get moving (within limitations by surgeon)

119

mechanical obstruction

-adhesions
-intussusception
-volvulus
-hernia

120

adhesions

-fibrous bands after abdominal surgery

121

intussusception

-telescoping of bowel in on itself

122

volvulus

-torsoin of an intestinal polyp, twisted on it's mesentery

123

hernia

-abnormal protursion of part of an organ/tissue through structure normally containing it

124

Types of Hernias

-inguinal (direct/indirect) [sports hernia]
-femoral
-umbilical
-incisional (ventral)

125

Symptoms of Hernias

-intermittent/persistent bulge
-interm/persistent pain
-pn increases with change in position, valsalva maneuver, physical exertion
-pn relieved by stopping atcitity
-fever, tachycardia, vomiting, abdominal distention

126

Treatment of Hernias

-surgical repair (herniorrhaphy)

127

Appendicitis

-inflammation of vermiform appendix
-may progress to necrosis, perforation-->peritonitis

128

Cause of Appendicitis

-1/2 are idipathic
-1/3 due to obstruction
-infection elsewhere
-IBD (CD/UC)
-tuberculous enteritis

129

Symptoms of Appendicitis

-abdominal pain
-anorexia
-nausea
-vomiting
-low-grade fever (higher in children)
-TTP over McBurney's point
-agg by valsalva, bend over

130

Treatment of Appendicitis

-surgical removal

131

PT management of Appendicitis

-refer to right hip, thigh, groin
-screening: palp of McBurney's Point
-Blumberg Sign (rebound pn)
-local pn on coughing/valsalva

132

Peritonitis

-inflam of serous membrane lining abdominal cavity

133

Primary Peritonitis

-spontaneous

134

Secondary Peritonitis

-due to trauma, surgery, ulceration (contam by bowel contents)

135

Symptoms of Peritonitis

-rigid/board-like abdomen
-severe abdominal pn
-high fever
-nausea
-vomiting
-Blumberg Sign (rebound pn)

136

Treatment of Peritonitis

-surgical drainage/repair
-antibiotics
-supportive measures to correct fluid, electrolyte and nutritional disorders

137

Kehr's sign

-left shoulder pain with splenic irritation
-associated with peritonitis due to blood, infectious fluids in abdominal cavity contacting spleen

138

Spleen refers to

-left shoulder

139

Liver refers to

-right shoulder