Term
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Definition
| Lower esophageal sphincter weakens allowing stomach to pass through diaphragm into thoracic cavity |
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Term
| How do congenital and acquired hiatal hernia occur? |
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Definition
Congenital: Failure of formation/fusion of developmental components of diaphragm.
Usually occurs neonatally.
Acquired: GSW/stab wound/blunt trauma |
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Term
| What is the incidence and etiology of hiatal hernia? |
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Definition
Incidence: 5/1000, increases with age (60% of pts >60yo), F>M
Etiology: Weakening of diaphragm mm., alteration of diaphragmatic hiatus |
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Term
| What are symptoms of hiatal hernia? |
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Definition
1. Heartburn
2. Regurgitation/bitter taste
3. Substernal chest pain
4. Odynophagia (painful swallowing)
5. Dysphagia (difficulty swallowing)
6. Hematemesis (throwing up blood) |
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Term
| What are implications for the PT for patients with hiatal hernia? |
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Definition
1. Avoid supine position to decrease chance of reflux
2. Limit exercises requiring Valsalva Maneuver (increase intra-abdominal pressure) |
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Term
| What is GERD (Gastroesophageal Reflux Disease)? |
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Definition
Backward flow of gastric juices into esophagus causing irritation/inflammation.
Contributing Factors to Reflux: Reduction in LES pressure; Increased gastric pressure; Esophageal clearance; hiatal hernia |
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Term
| What are the symptoms of GERD? |
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Definition
1. Heartburn/bitter taste/regurgitation
2. Chest pain - may radiate to back, neck, jaw
3. Hoarse voice/laryngitis
4. Cough
5. Wheezing -> Asthma
6. Dysphagia -> Stricture
7. Odynophagia -> Esophagitis |
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Term
| How to prevent symptoms of esophageal adenocarcinoma? |
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Definition
1. Elevate the head 2-6 inches
2. Avoid certain foods: spicy, tomato juice, etc.
3. Do Not Lie Down 2 hrs Post Eating
4. Limit coffee: 2-3 cups per day
5. Avoid tight clothing
6. Eat smaller meals
7. Lose weight
8. Proton Pump Inhibitor - 30 min before meals |
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Term
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Definition
1. Decreased pressure of LES: Foods, beverages, caffeine, nicotine/cig smoke, meds, estrogens, scleroderma, pregnancy
2. Increase Gastric Pressure: Food (protein), pregnancy (increased abdominal pressure), obesity, ascites, tight clothing, histamines |
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Term
| Implications of GERD for the PT? |
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Definition
1. Strenuous exercise
2. Provide education & encourage lifestyle modifications
3. Modify positions if symptoms persist
4. Strengthen mm around esophageal sphincter
5. Encourage pt to sleep with head of bed elevated |
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Term
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Definition
1.Inflammation of the lining of the stomach
2. Limited to the mucosa |
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Term
| What are characteristics of acute and chronic gastritis? |
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Definition
1. Acute: reflects presence of bleeding from mucosa
2. Chronic:
Type A - Less common, associated with pernicious anemia
Type B - More common, caused by chronic bacterial infection |
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Term
| What are some symptoms of gastritis? |
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Definition
1. Abdominal pain
2. N/V
3. Loss of appetite
4. Belching or bloating
5. A feeling of fullness in the upper abdomen after eating
6. Weight loss |
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Term
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Definition
1. Avoid irritating substances (caffeine, nicotine, ETOH)
2. Antacids
3. PPI
4. Meds
5. Pepto-bismol |
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Term
| Implications of gastritis for the PT |
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Definition
1. Ask about medication history (NSAIDs, ETOH, steroids)
2. Monitor pt for any signs of GI involvement indicating need for med referral
3. Urge pt to take prophylactic meds |
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Term
| What is a peptic ulcer disease? |
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Definition
A hole in the gut lining of the stomach or duodenum
DU (duodenal ulcer) 2-3x more common than gastric
DU - 95% bulb
Gastric - 60% benign ulcers in lesser curve & most frequently on post. wall |
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Term
| What are symptoms of PUD? |
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Definition
1. Pain occurs after meals. Gnawing, burning, or aching
2. Anorexia, wt. loss, belching, bloating, nausea, &/or heartburn
3. Vomiting
4. Hematemesis or melena |
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Term
| Characteristics of Peptic Ulcer Bleeding |
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Definition
1. 5% of emergency admissions
2. 80% stop spontaneously
3. 10% of patients die
4. Rebleeding increase mortality by 10x |
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Term
| Implications of PUD for the therapist |
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Definition
1. Monitor pts for any signs of GI bleeding: observe color, activity tolerance
2. Abdominal pain
3. Look at stool
4. Back pain |
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Term
| What is the function of the gallbladder? |
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Definition
1. Stores bile produced by hepatocytes
2. Fat and protein induce small bowel CCK release which in turn stimulates gallbladder contraction |
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Term
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Definition
1. Water
2. Electrolytes
3. Bilirubin
4. Bile acids
5. Cholesterol/phospholipids
6. Proteins |
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Term
| What is bile essential for? |
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Definition
1. Intestinal fat digestion and absorption, including fat soluble vitamins
2. Cholesterol homeostasis
3. Hepatic excretion of lipid-soluble drugs and heavy metals |
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Term
| What are the three types of gallstones? |
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Definition
1. Cholesterol (most common, 80%)
2. Pigmented
3. Mixed |
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Term
| What populations are gallstones more common in? |
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Definition
1. Women
2. Native Americans
*4Fs: Female, fat, forty, fertile |
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Term
| Most gallstones should be left alone. When should they be removed? |
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Definition
1. Certain Native Americans
2. Calficied gallbladder
3. Extended travel to remote areas
4. Specific surgeries |
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Term
| What symptoms occur with biliary colic? |
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Definition
1. RUQ or epigastric pain after eating meals lasting from 15min to 4-6hrs
2. N/V/diaphoresis
3. R upper back, scapula, shoulder pain |
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Term
| What are the characteristics of cholecystitis? |
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Definition
1. Gallstones permanently block the cystic duct resulting in bile build up, increasing pressures, and eventually gallbladder inflammation
2. Pts have persistent pain >4-6hrs
3. Fevers/chills/N/V
4. Requires hospitalization |
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Term
| What is the function of the pancreas? |
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Definition
1. Mostly an exocrine gland that secretes digestive enzymes and bicarb
2. Endocrine portion releases hormones (insulin, glucagon) into the blood stream |
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Term
| What are characteristics of Acute Pancreatitis? |
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Definition
1. Pain is epigastric, sharp and radiates to the back
2. Dx is based on 2 of 3 criteria: Characteristic epigastric abd pain; elevated amylase &/or lipase levels; CT showing inflammation |
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Term
| What are the 2 most common causes of pancreatitis? |
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Definition
1. Alcohol
2. Biliary (gallstones) |
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Term
| What are the hallmarks of chronic pancreatitis? |
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Definition
1. Chronic abd. pain
2. Evidence of panreatic exocrine and endocrine insufficiency
3. Imaging shows calcifications |
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Term
| What is the most common type of pancreatic cancer? |
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Definition
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Term
| What populations are more affected by pancreatic cancer? |
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Definition
1. ~30,000 cases/yr = ~30,000 deaths/yr
2. 4th leading cause of cancer
3. Males
4. African Americans |
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Term
| What is the only treatment of pancreatic cancer? |
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Definition
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Term
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Definition
1. A type of chronic inflammatory bowel disease
2. Patchy, transmural chronic inflammation
3. Can involve any segment of the GI tract, mouth to anus
4. Can manifest as: inflammatory, fibrostenotic, or fistulizing disease
5. Cause is unknown |
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Term
| Common clinical features of Crohn's Disease |
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Definition
| Fever, abd pain, wt loss, malnutrition, growth failure in children and adol., diarrhea, rectal bleeding, perianal disease |
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Term
| Complications of Crohn's Disease |
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Definition
| Carcinoma, bowel obstruction, abscess/fistula, massive rectal bleeding, osteoporosis, |
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Term
| What is Ulcerative Colitis |
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Definition
1. Another form of chronic IBD
2. Limited to mucosa/submucosa
3. With ulcerations and inflammation in a continuous manner
4. Cause is unknown
5. Colectomy is a cure |
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Term
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Definition
| Diarrhea, rectal bleeding, fever, wt. loss, malnutrition, abd pain, growth failure, NO perianal disease |
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Term
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Definition
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Term
| What are the 3 most important musculoskeletal manifestations of IBD? |
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Definition
1. Peripheral arthritis (20% of pts)
2. Axial arthropathy
3. Ankylosing spondylitis |
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Term
| What are the 2 types of Peripheral Arthritis? |
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Definition
1. Type 1 (pauciarticular): <5 joints, acute, self-limiting attacks, strongly associated with other extrainstestinal manifestations (EIM) of IBD
2. Type 2 (polyarticular): 5+ joints, Sx may persist for months to years, independent of bowel disease, associated with uvetitis but not otehr EIM |
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Term
| What is Irritable Bowel Syndrome? |
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Definition
1. Affects 15% of the population and is 2nd leading cause of lost work
2. Describes a constellation of sx affecting primarily the lower GI
3. Sx usually begin in late teens to early 20s
4. 3 classic sx: abd pain, diarrhea, and constipation
5. IBS is a dx of exclusion!! |
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Term
| Implications of IBS for the PT |
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Definition
1. Regular physical activity helps relieve stress and assists in bowel function
2. Encourage pts w/ IBS to continue and participate in physical activity during sx
3. Educate pts in proper breathing techniques during physical activity |
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