The GI system Review Exam 3A (copy)

Lets cook

What is included in the upper GI System?

• mouth

• esophagus

• stomach

• duodenum

What is included in the lower GI system?

• Small intestine

  • Digest and absorb nutrients

• Large intestine

  • Water and electrolyte absorption

  • stores waste to be eliminated

Common symptoms for GI disorders

• nausea and vomiting

• diarrhea

• heartburn

• GI bleeding

• anorexia

• fever

• incontinence

Type 1 Hiatal Hernia

• "Sliding Hernia” Most common

• Stomach and esophagus slide into the chest through the hiatus in the diaphragm

• Creates a bell shaped dilation

Type 2 hiatal hernia

• Nonaxial hernia- paraoesophageal

• More of the stomach enters the thorax via the hiatus

• Both types often present with chest pain and heartburn in supine position 30-60 mins after eating.

Hiatal Hernia and PT

• symptomatic control with antacids and elevating the bed

• possible need for surgery

• Avoid supine, valsalva maneuver and anything that increases abdominal pressure.

Gastroesophageal reflux disease (GERD)

• Reflux of gastric contents into the esophagus

• Prevalence increases with age.

Causes of GERD

• Pretty general causes

• can be caused by certain foods

• caffeine in high quantities

• obesity

• high abdominal pressure

• Intrinsic sphincter pressure

Clinical presentation of GERD

• heartburn 30-60 mins after eating like hiatal hernia

  • Includes reflux and sour taste in mouth.

• Laryngitis

• Morning hoarseness

• Painful burning radiating to the back, neck, or jaw.

Treatment for GERD

• surgery is not common

  • tightening the Lower esophageal sphincter if choosing surgery

• Strenuous exercise can make symptoms worse

• Avoid supine laying just after eating

Gastritis

Inflammation of the gastric mucosa. Can be acute or chronic.

• Chronic is the majority of cases.

Causes of Gastritis

• often times people with gastritis have high doses of prescribes NSAIDS or aspirin

• Bacillus Helicobacter Pylori bacteria

• Stress

Clinical Presentation of Acute gastritis

• Epigastric pain

• small abdominal distension

• Painless GI bleed - Results in black Tar-like stool

• Low grade fever if there is an infection.

Clinical Gastritis

• Often asymptomatic

• Some pain after eating.

Peptic Ulcer Disease

• Break in the mucosal lining of any point in the GI tract exposed to acid-peptic juices.

  • Sores in the lining of the stomach, intestines and esophagus

• Chronic can have relapsing lesions

Etiology of PUD

• 90% of all ulcers are strongly associated with H. pylori infection

• Exposure to gastric acid and NSAIDS

• Stress

  • depression

  • poor coping skills

Clinical Presentation of PUD

• Gnawing, burning pain from the umbilicus to the sternum

  • Pain is increased on an empty stomach

  • occurs often at night time when we are in a fasted state

• can result in weight loss but needs further testing to rule out cancer.

• Vomiting blood that is red or black.

  • Coffee ground vomitus

Treatment for PUD

• Most common is proton pump inhibitors

• Avoid NSDAIDS

• avoid foods that aggravate symptoms

• Exercise to lower stress

Usually heals within a few weeks.

Celiac disease

• Malabsorption syndrome

• 70% in women

• Destroys villi that line the small intestine

• inability to absorb fat, protein, vitamins and minerals.

• Triggered by gluten

Risk factors for celiac

• other present diseases

  • lupus

  • diabetes

  • thyroid disease

Clinical presentations of celiac

• skin rash

• mouth sores

• bad abdominal cramps, gas and bloating

• tingling in legs and feet

Best way to diagnose celiac disease

Gluten free diet to see if symptoms subside

Inflammatory Bowel Disease

• autoimmune disease

• includes crohn’s and ulcerative colitis

Crohn’s disease vs Ulcerative colitis

• Crohn’s can affect any portion of GI tract from mouth to anus

  • Most often involves the small intestine and colon

• Ulcerative colitis is limited to the colon

Crohn’s risk factors

• majority of cases are between 10 and 30 years old

• disproportionately affects caucasian’s

Ulcerative Colitis risk factors

• any age, but 10-40 years old is most common

Crohn’s prognosis

• No cure

• Increased risk of intestinal cancer

• mostly able to manage the symptoms

Ulcerative Colitis prognosis

• Chronic and can be debilitating

• only cure is a colon resection

Inflammatory bowel disease and PT

• Psoas abscess

• Arthritis

• Osteoporosis

Irritable bowel syndrome

• Most common disorder of GI tract

• anywhere in small and large intestines

• Chronic condition with no inflammation

• Abnormal contractions of intestines in response to stress, fatigue, alcohol, food

Clinical presentation of irritable bowel syndrome

• At least three months of abdominal pain relieved by bowel movements along with 3 other symptoms.

  • bloating

  • stool changes

  • constipation

  • cramps

  • gas

Diverticular disease (diverticulitis)

• uncomplicated

• presence of outpouchings

• herniation through colon muscular wall

Diverticulosis

• complicated by inflammation

• Secondary to low fiber diets

Etiology of diverticular disease

• weakness of bowel muscles

• inherited defect

• obesity

Clinical manifestations of diverticular disease

• 80% are asymptomatic

• anemia

• severe pain in left quadrant of the abdomen that radiates to the back (diverticulitis)

• pelvis pain

Prevention of diverticular disease

• bran

• Bulk laxatives'

• exercise

• parenteral fluids

Intestinal hernia

protrusion of organ or tissue die to weakness of abdominal muscle

• equally affects men and women

• 5 million cases of some type of hernia in the U.S.

Clinical presentation of intestinal hernia

• intermittent or persistent bulge

• 'can radiate from groin into testicles, thigh or flank

• irritated by sudden movements

• irritated by bowel movements

Treatment for intestinal hernia

• taping is not recommended

• can stitch the area in surgery

• mesh repair to hold the intestine down

Appendicitis

• most common acute surgical abdominal condition

• affects 9% of people in the US and western countries

• Peaks in 2nd and 3rd decade of life

• more males

• 50% idiopathic

Clinical manifestations of appendicitis

• Right lower abdominal quadrant pain is the most common

• anorexia

• vomiting

• either really easy or or really hard to diagnose

Diagnosis of appendicitis

• early to prevent perforation

• family history

• elevated wbc >20,000/mm3

Prognosis of appendicitis

• Less than 1% mortality and morbidity

• perforations come with complications like septic shock or peritonitis that have poor prognosis