DPT 742 Midterm STUDY GUIDE 8 (GI pathologies)

Define a hiatal hernia

A herniation of a portion of the stomach through the diaphragm

SIFTT for hiatal hernias (2)

Avoid flat supine positions and movements requiring Valsalva maneuver

Define gastroesophageal reflux disease (GERD, esophagitis)

An irritation of the esophagus d/t stomach acid washing back into esophagus (heartburn)

Pathogenesis of GERD

Alterations of GE sphincter to control fluid movement

Subsequent granulation tissue (fibroblasts) cause scarring, which turn to esophageal strictures and narrow esophagus

Clinical manifestations of GERD (7)

Heartburn 30-60 mins post meal

Reflux

Dysphagia

Painful swallowing

Reflux w/o esophagitis

Sometimes morning hoarseness

Sometimes asthma

Treatments for GERD (9!)

Proton pump inhibitors

Surgery to tighten LES

Wear loose clothing

Dietary restrictions

Avoid caffeine, nicotine, alcohol, salicylates, NSAIDS

Remain upright 3hrs after meal

Avoid eating at night

Elevate head of bed

Lose weight

SIFTT for GERD (4)

Exercise can induce GERD in anyone

Avoid high-calorie or fatty foods immediately before exercise

Provie education and encouragement

Avoid supine after meal

Define esophageal varices

Veins that have distended and lost their integrity in the GI system

SIFTT for esophageal varices

Instruct proper lifting technique

Avoid activities that increase intraabdominal pressure

Define peptic ulcer disease

Stomach ulcers, typically caused by H. pylori bacteria or aspirin

SIFTT for peptic ulcer disease

Monitor for symptoms of internal bleeding

Observe for activity tolerance

Monitor vitals for drop in BP, increase in HR, orthostatic hypotension (may signal bleeding)

Define inflammatory bowel disease (IBD)

A combination of Crohn's disease and ulcerative colitis that causes pain, abdominal issues and incontinence

Clinical manifestation of IBD

Usually begins in young adulthood and has variable periods of remission.

LLQ abdominal pain + constipation + diarrhea.

SIFTT for IBD (6)

Screen for IBD via non-judgmental questions

Joint problems may occur

Use typical MSK interventions

Low bone mineral content, high prevalence of osteoporosis

Observe for dehydration

Increase in pain or output must be reported to doc

Medical management of IBD (4)

Stress reduction program of relaxation techniques

Exercise

Psychotherapy

Biofeedback

Define an inguinal hernia

A bulging of the contents of the abdomen through the inguinal canal

Grades of hernias (just names) (3)

Reducible

Irreducible and incarcerated

Strangulated

Define a reducible hernia

When the contents of the hernial sac can be put back into abdomen via manipulation

Define an irreducible hernia

When a hernia can't be reduced or replaced by manipulation

Define a strangulated hernia

When protruding organ is constricted to the extent of impaired circulation

Treatment for a hernia

Can be either manipulated back into place or surgically fixed

SIFTT for hernias (3)

Screen for hernias in pts w/chronic cough, groin pain or pregnancy

NO heavy lifting 4-6 weeks post surgery

Educate pts about proper lifting techniques

Define appendicitis

Inflammation and clogging of the appendix that leads to intense pain

SIFTT for appendicitis (4)

Pain may be in R thigh, groin, pelvis or hip

Pain localizes to appendix if pt coughs

NO heat

MCBURNEY'S TEST

Contact doc