Other systems part 2

What is a safe lying position during pregnancy

Side lying due to hypotensive syndrome

What weight gain is essential for baby’s nourishment?

25-35lbs

What are MSK postural changes during pregnancy

Forward head, kyphosis, increased lordosis, anterior pelvic tilt

Does postural stress improve with postpartum?

It does due to lifting and carrying a baby

MSK treatments for pregnancy

Postural education, stretching of tight muscles and strengthening of weaker ones, pelvic stabilization exercises, pelvic tilts

BP in Pregnancy

Low in 1st and 2nd trimester and increases 3rd semester

What does supine lying cause during pregnancy after 1st trimester?

Compression of inferior vena cava. This decreases cardia output and may cause supine hypotensive syndrome.

Resting HR does what during pregnancy

Increases by 10-20 beats/min

Other reasons why left side lying beneficial during pregnancy

Left side lying decreases GERD by keeping the lower esophageal sphincter above the level of gastric contents and improves maternal and fetal circulation

Pulmonary Pregnancy

- Edema and tissue congestion of upper respiratory act>>coz of hormonal changes, hormonally stimulated upper respiratory hyper secretions occur

subcostal angle increases; ribs flare up and out anteroposterior and transverse chest diameters each increase by 2 cm

Chest circumference increases

Diaphragm elevated by 4cm; caused by change in rib position

Respiratory Rate unchanged, Depth of respiration inc tidal volume (TV) & minute ventilation increased, but total lung capacity (TLC) unchanged or slightly dec

15 to 20% increased in oxygen consumption

Work of breathing increased coz of hyperventilation; dyspnea with mild exacerbations at 20 weeks

Cardiovascular Changes in pregnancy

Blood volume progressively increases 35-50%

Venous pressure in LE increases in standing as a result of increased Uterine size and Venous distensibility

Increased pressure in inferior vena cava-->decline in venous return and resulting decreased in CO may lead to supine Hypotensive Syndrome (left side lying sleeping position to avoid it)

1st trimester- BP dec-slight dec in systolic pressure & greater dec in diastolic pressure

Although CO increase, BP dec because of venous distensibility Heart- size increase, heart rhythm disturbances, HR increase 10 to 29 bpm by full term CO increase 30 to 60% and most in side lying sleeping position; uterus places le

Thermoregulatory System during Pregnancy

Metabolic rate and Heat production increases

Normal fasting blood glucose levels lower

Eclampsia

After pregnancy

Headache, visual disturbances, seizures

Its a severe complication of preeclampsia

Preeclampsia

Acute hypertension after 20th week of gestation

Edema, hyperreflexia, visual disturbances, headache, increase protein in urine, sudden weight gain

Emergency

Having certain conditions before you become pregnant such as chronic high BP, migraines, type 1 or 2 diabetes, kidney disease, a tendency to develop blood clots, or lupus increases your risk of preeclampsia

What BP level is associated with Preeclampsia?

A blood pressure reading more than 140/95 mmHg. Second abnormal blood pressure reading four hours after the fist confirms the diagnosis

Contradictions for exercise in Pregnancy

Hemodynamically significant heart disease

• Restrictive lung disease

• Incompetent cervix: Early dilation of the cervix before full term

• Vaginal bleeding, especially second or third trimester

• Placenta previa after 26 weeks: Placenta covers the opening of the cervix, which may obstruct delivery and lead to hemorrhage.

• Preeclampsia or pregnancy-induced hypertension

• Rupture of membranes: Loss of amniotic fluid before the onset of labor

• Premature labor: Labor beginning before the 37th week of pregnancy

• Maternal Type I diabetes (uncontrolled)

• Severe anemia

Head lift

Patient is in hook-lying position and crosses arms around the stomach area for support. Have client exhale and lift only the head off the floor while at the same time, using her hands to gently approximate the rectus muscles toward midline, then lower the head slowly and relax

Head lift with pelvic tilt

Patient is positioned in hook-lying. Arms are crossed over the diastasis for support as described in the “head lift” exercise. Have patient slowly lift only the head off the floor while approximating the rectus muscles and performing a posterior pelvic tilt, then slowly lower the head and relax.

How do you minimize intra-abdominal pressure during exercises?

Perform all abdominal contractions with an exhalation

GERD

Reflux of gastroduodenal contents into the esophagus

Symptoms of GERD

• Heartburn- 30 minutes after eating and at night lying down

• Dysphagia

• Sour taste- from regurgitation of acids

• Hoarseness of voice

• Atypical chest pain

Complications of GERD

• Aspiration pneumonia, asthma

• Esophagitis

Treatment for GERD

• Maintain upright positions

• Eat meals at least 3-4 hours before sleep

• Avoid supine- removes gravity assistance against reflux

• Sleep on left side preventing nocturnal reflux

• Exercise must be completed 2-3 hours after eating or before meals

• Avoid spicy, chocolate, fatty food, peppermint

• Drugs ̶Antacids ̶H2 receptor blockers ̶Proton pump inhibitors

Spleen Rupture

Kehr’s sign (pain in L shoulder)

Cholecystitis

Positive murphy’s sign, Boas sign radiate to R scapula

Pancreatitis

Cullen’s sign and Grey Turner’s sign, Radiate to back and worse in supine

Hernia

Hiatal- L shoulder pain, femoral-lateral pelvic wall, inguinal-groin pain, Umbilical-pain around umbilical ring

Diverticulitis

Pinch an inch on left

Appendicitis

Rebound tenderness (Blumberg’s sign)

Mcburney’s point

Rovsing’s Sign

Psoas Sign

Obturator Sign

Markle’s Sign

Pinch an inch on Right

Pancoast Tumor

C8-T2 (mimic’s TOS)

Upper UTI

Murphy’s Sign (tenderness over costovertebral angle)

Right shoulder

Gall bladder

Liver

Head of pancreas peptic

Ulcers

Left shoulder

Heart

Tail of pancreas Diaphragm

Spleen rupture

RLQ

AC

Appendicitis

Crohn’s

RUQ

Head of pancreas, R kidney, gall bladder pathology, peptic ulcers

LLQ

Diverticulitis, ulcerative colitis, IBS

LUQ

Tail of pancreas, spleen pathology

Cholecystitis

Blockage or impaction of gallstones in the cystic duct resulting in inflammation of the gallbladder

Pain in RUQ radiating to the right scapula. Nausea, vomiting and low grade fever. Pain increases with ingestion of fatty food.

Cholecystitis

Palpate near right subcoastal margin as patient takes a deep breath; if pain and tenderness is elicited during inspiration, th test is positive.

Murphy’s sign for Cholecystitis

Lateral pelvic wall pain and groin pain

Femoral hernia

Causes pain around the umbilical ring in the mid lower abdomen

Umbilical hernia

What hernia causes shoulder pain and has similar symptoms to GERD?

Hiatal hernia

What allows for hiatal hernia?

A weakness in the diaphragm

Heartburn, usually occurs 30-60 mins after eating and at night while lying down supine

GERD

Same as GERD

Hiatal hernia

Coffee ground emesis, melena tarry stools, (Gastric ulcer-pain increases with presence of food, duodenal ulcer-pain increases without food)

Peptic ulcer

Pain increases after eating fatty food, positive murphy’s sign

Cholecystitis

Pain decreased by passing gas, reactive arthritis

Crohn’s disease

Bloody diarrhea with mucus and pus

Ulcerative colitis

Abdominal cramping, ribbon like stools, pain decreased by passing stools and at rest

IBS

McBurney’s point tenderness, fever, increased WBC,

Appendicitis

Light (clay) colored stools, dark colored urine, palmar erythema, easy bruising, asterixis (flapping tremor of hand)

Liver Disease

Obturator Sign

Appendicitis test

PROM- IR of flexed thigh

Psoas Sign

Appendicitis

PROM-extension of thigh

Blumberg’s sign

Appendicitis

Rebound tenderness

Single hop test

Hopping on R side pain

Appendicitis

Markels sign

Heel drop/jar-pain on right

Appendicitis

Appendicitis

Inflammation of the vermiform appendix. Progression can lead to swollen/gangrenous appendix. If perforated can lead to peritonitis

Anorexia, Nausea, Vomiting, elevated temperature, leukocytosis, fever

Appendicitis

Coffee ground emesis

Peptic ulcer

Bloody diarrhea

Ulcerative colitis

Melena (black tarry) tarry stools

Duodenal ulcer

White, clay, grey stool

Liver/pancreas/colon disorder

Red color blood in stool

Bleed in GI tract

Emotional stress, anxiety, high fat, lactose foods

IBS

Pain is relieved by defecation. Sharp cramps in the morning or after eating. Nausea, vomiting, bloating, foul breath, diarrhea.

IBS

Ribbon like stools

IBS

Symptoms disappear while sleeping

IBS

IBS treatment

Stress reduction, dietary modification and exercise

Gastric (stomach) Ulcers

Ulcerative lesions in the stomach caused by chronic of NSAIDS, stress, anxiety, H. pylori bacteria

Pain increases with the presence of food due to acid secretion, pain after eating

Gastric stomach ulcers

What pain can be relieved with antacids, medically treating the H. pylori infection

Gastric stomach ulcer

Duodenal ulcers

Ulcerative lesions in the duodenum caused mainly by H. pylori infection

Pain increases with absence of food, early morning and in between meals

Duodenal ulcers

Symptoms: pain relieved by passing gas, abdominal pain, weight loss, join arthritis

Crohn’s disease

What happens with reiters and what condition associated with it?

Crohns disease

Can’t pee-Urethritis

Can’t see-Conjunctivitis

Can’t climb a tree-OA of hip

Where does Crohns disease occur?

Occurs anywhere in the GI tract, skip lesions

Crohn sends pain to what quadrant?

RLQ

What are examples of inflammatory bowel disease (IBD)?

Ulcerative colitis

Crohn’s disease

Where is the site of ulcerative colitis?

Only large intestine and rectum

Rectal pain, bleeding, bloody diarrhea with mucus/pus, fecal urgency, weight loss and LBP.

Ulcerative colitis

Where does ulcerative colitis refer pain?

LLQ