High Yield Gastrointestinal, Genitourinary, and metabolic/endocrine

Major organs of the gastrointestinal system

Mouth, esophagus, stomach, small and large intestines, liver, pancreas, and gallbladder. These organs function together to process food, absorb nutrients, and eliminate waste.

Primary functions of the GI system

Ingestion, digestion, absorption, and elimination — essential processes for nutrient utilization and body homeostasis.

PTA relevance to the GI system

PTAs must recognize how GI disorders affect mobility and endurance, apply post-surgical precautions, and be aware of systemic signs like abdominal pain, fatigue, and nutritional deficits.

Gastroesophageal reflux disease (GERD)

Condition where stomach acid flows back into the esophagus, causing heartburn and discomfort. PTA Note: Avoid supine positioning or forward bending after meals to prevent reflux.

Peptic ulcer disease

Sores in the stomach or duodenum lining that may cause abdominal pain, nausea, or anemia from blood loss. PTA Note: Monitor for fatigue and avoid NSAID use if possible.

Inflammatory bowel disease (IBD)

Includes Crohn's disease and ulcerative colitis — chronic inflammatory conditions of the GI tract. PTA Note: Modify exercise intensity during flare-ups; monitor for dehydration and fatigue.

Irritable bowel syndrome (IBS)

A functional bowel disorder often triggered by stress or diet; symptoms include abdominal pain, bloating, and altered bowel habits. PTA Note: Encourage stress management and relaxation techniques.

Hepatitis

Inflammation of the liver caused by viral infection, alcohol, or toxins. PTA Note: Monitor for fatigue, jaundice, and reduced exercise tolerance.

Cirrhosis

Chronic liver disease causing fibrosis and impaired function. PTA Note: Avoid overexertion; monitor for ascites (abdominal swelling) and signs of hepatic encephalopathy.

Exercise precautions post-meal

Avoid supine or Trendelenburg positions after eating to reduce risk of reflux.

Exercise modifications for GI disorders

Adjust intensity for patients experiencing fatigue, malnutrition, or anemia.

Hydration monitoring

Watch for dehydration due to vomiting or diarrhea; encourage fluid intake.

Patient education points

Teach posture correction, breathing exercises, and energy conservation strategies.

Red-flag monitoring

Remain alert for GI bleeding, hepatic dysfunction, or unexpected fatigue during sessions.

Abdominal pain with referred shoulder pain

May indicate liver or gallbladder involvement — refer to medical provider.

Hematemesis or melena

Vomiting blood or black, tarry stools → possible GI bleed (medical emergency).

Jaundice

Yellowing of skin or eyes indicating liver dysfunction.

Rebound tenderness

Pain upon release of pressure → suggests peritonitis (requires immediate referral).

Common symptom of GERD

Pain that worsens when lying flat (due to acid reflux). Rationale: Supine positioning increases reflux; sitting upright helps relieve symptoms.

Exercise precaution for ulcerative colitis

Avoid exercise if the patient has active rectal bleeding. Rationale: Exercise should be postponed during acute flare-ups or bleeding to prevent complications.

Cause of increased abdominal girth and dyspnea in cirrhosis

Ascites — fluid accumulation in the peritoneal cavity due to portal hypertension. Rationale: Common in advanced liver disease and can affect breathing mechanics.

Key infection-control measure with hepatitis C

Use universal (standard) precautions during all sessions. Rationale: Hepatitis C is bloodborne; gloves and proper hygiene prevent transmission.

Post-cholecystectomy instruction

Avoid lifting more than 10 lb for 4-6 weeks after surgery. Rationale: Prevents incisional strain and allows proper healing.

Antacids (Tums, Maalox, Mylanta)

Neutralize stomach acid to relieve heartburn. Side effects: constipation or diarrhea. PTA Note: Avoid supine positions after meals.

H₂ blockers (Pepcid, Zantac)

Reduce acid production. Side effects: dizziness, confusion. PTA Note: Monitor for fatigue during sessions.

Proton-pump inhibitors (Prilosec, Protonix)

Inhibit acid secretion at the gastric parietal cell level. Side effects: headache, B₁₂ deficiency, bone loss. PTA Note: Encourage weight-bearing exercise for bone health.

Antidiarrheals (Imodium, Pepto-Bismol)

Decrease intestinal motility to control diarrhea. Side effects: constipation, dry mouth. PTA Note: Monitor hydration status.

Laxatives (Senna, MiraLAX)

Stimulate or soften bowel movements. Side effects: dehydration, cramping. PTA Note: Schedule therapy after bowel movement when possible.

Antiemetics (Zofran, Reglan)

Prevent nausea and vomiting. Side effects: drowsiness, extrapyramidal symptoms. PTA Note: Monitor balance and alertness.

Antispasmodics (Bentyl)

Reduce intestinal spasms and cramping. Side effects: blurred vision, urinary retention. PTA Note: Watch for dizziness or orthostatic changes.

Corticosteroids (Prednisone, Budesonide)

Decrease GI inflammation in conditions like Crohn's disease. Side effects: muscle weakness, osteoporosis. PTA Note: Use gradual strengthening and monitor vitals closely.

Immunosuppressants (Imuran, Remicade)

Suppress immune response in severe IBD or autoimmune hepatitis. Side effects: fatigue, increased infection risk. PTA Note: Avoid infection exposure; monitor energy levels.

Recognize GI red flags

Pain patterns, GI bleeding, jaundice, and rebound tenderness must be identified quickly for referral.

Exercise tolerance in GI disorders

Modify therapy for fatigue, malnutrition, or anemia; monitor vitals and hydration.

Post-surgical GI precautions

Understand restrictions after cholecystectomy or colectomy; avoid heavy lifting or abdominal strain early post-op.

PTA education priorities

Reinforce posture, hydration, and symptom management strategies to enhance safety and function.

Medication awareness

Recognize common GI drugs and side effects that can impact strength, balance, and endurance

Urinary Tract Infection (UTI)

Commonly presents with dysuria, urgency, and frequency — more frequent in females. PTA Note: Monitor for fever, fatigue, and refer if infection suspected.

Renal Failure

Characterized by fatigue, edema, hypertension, and potential need for dialysis. PTA Note: Avoid overexertion and monitor for fluid retention and orthostatic changes.

Urinary Incontinence

Four major types: stress, urge, overflow, and functional. PTA Note: Identify type to apply proper pelvic floor or behavioral training.

Prostatitis / Benign Prostatic Hyperplasia (BPH)

Causes urinary hesitancy, nocturia, and weak urinary stream. PTA Note: Avoid prolonged sitting; educate on pelvic floor relaxation.

Endometriosis

Ectopic growth of endometrial tissue causing pelvic pain and fatigue, often worsening with menses. PTA Note: Modify exercise intensity during menstruation and encourage relaxation.

Pelvic Organ Prolapse

Downward displacement of bladder, uterus, or rectum through the pelvic floor. PTA Note: Avoid Valsalva maneuver and excessive intra-abdominal pressure during exercise.

Pregnancy physiologic changes

Increased blood volume, joint laxity, postural alterations, and risk of diastasis recti. PTA Note: Avoid supine positioning after first trimester, avoid Valsalva and excessive heat exposure.

Pregnancy exercise focus

Emphasize pelvic floor and core stabilization, breathing control, and postural alignment.

Postpartum considerations

Encourage gradual return to activity; monitor for depression, pain, and fatigue.

Male reproductive pathology: Prostatitis/BPH

Symptoms include urinary retention and pelvic discomfort. PTA Note: Focus on pelvic floor reeducation and gentle strengthening to reduce discomfort.

Prostate Cancer

Can lead to urinary incontinence and erectile dysfunction post-surgery. PTA Note: Address fatigue management and bladder control retraining.

Erectile Dysfunction

May result from diabetes, vascular disease, or medication side effects. PTA Note: Encourage cardiovascular fitness and safe activity participation.

Female reproductive pathology: Endometriosis

Cyclic pelvic pain and infertility; modify exercise during menstrual cycle.

Pelvic Floor Dysfunction

Includes stress incontinence and pelvic organ prolapse. PTA Note: Teach Kegels, posture control, and core engagement.

Cystocele / Rectocele

Herniation of bladder or rectum through weakened pelvic floor tissue. PTA Note: Avoid activities that increase intra-abdominal pressure.

Ovarian Cancer

Often diagnosed late with symptoms such as bloating, pain, and fatigue. PTA Note: Focus on gentle endurance and energy conservation.

Diuretics (Lasix, HCTZ)

Increase urine output for fluid control. Side effects: dehydration, orthostatic hypotension, and cramping. PTA Note: Monitor BP and hydration.

Antibiotics (Ciprofloxacin, Nitrofurantoin)

Used for UTIs. Side effects: GI upset, dizziness, and fatigue. PTA Note: Watch for orthostatic issues during activity.

Antispasmodics (Ditropan, Detrol)

Reduce bladder spasm frequency. Side effects: dry mouth, blurred vision, constipation. PTA Note: Monitor for dizziness or confusion.

Alpha-blockers (Flomax)

Relax bladder neck and prostate to ease urination. Side effects: dizziness, orthostatic hypotension. PTA Note: Instruct slow positional changes.

Hormone Therapy (Estrogen, Tamoxifen)

Used in menopausal symptoms or cancer. Side effects: weight gain, DVT risk, mood changes. PTA Note: Encourage mobility and monitor for swelling.

Erectile Dysfunction Medications (Viagra)

Facilitate blood flow to erectile tissue. Side effects: headache, hypotension, flushing. PTA Note: Avoid concurrent nitrates and monitor vitals.

Prenatal Vitamins / Iron Supplements

Used during pregnancy to prevent anemia. Side effects: constipation, dark stools. PTA Note: Encourage hydration and mobility to prevent GI discomfort.

Diastasis Recti definition

Separation of the linea alba greater than 2 cm, commonly seen in pregnancy or postpartum.

Diastasis Recti assessment

Positive finding: two-finger width gap during partial curl-up.

Diastasis Recti contraindicated exercises

Avoid sit-ups, crunches, double leg lifts, and heavy ab work.

Diastasis Recti recommended exercises

Encourage transverse abdominis activation, pelvic tilts, and Kegels with core control.

Diastasis Recti progression

Advance to modified planks, quadruped stabilization, and functional core exercises as tolerated.

Goal of Diastasis Recti rehabilitation

Restore abdominal wall integrity and trunk stability before advancing to higher-level strengthening.

Stress Urinary Incontinence

Leakage during coughing, laughing, or exertion. Treatment: Kegels, posture correction, biofeedback.

Urge Incontinence

Sudden strong urge to urinate. Treatment: bladder training, urge suppression, relaxation techniques.

Overflow Incontinence

Continuous dribbling due to incomplete bladder emptying. Treatment: timed voiding, Crede's maneuver (with MD clearance).

Functional Incontinence

Due to physical or cognitive limitations preventing timely toileting. Treatment: transfer and mobility training.

Exam Tip for incontinence

Kegels = stress; bladder training = urge; timed schedule = overflow/functional.

Hematuria

Presence of blood in urine — report immediately.

Flank pain with fever

May indicate infection — requires prompt referral.

Postpartum bleeding lasting >6 weeks

Abnormal finding — report to physician.

Severe pelvic or abdominal pain

May signal cyst rupture or peritonitis — medical emergency.

Modalities contraindication in pregnancy

Avoid all modalities over the uterus or pelvis.

Contraindicated position in pregnancy

Supine positioning greater than 5 minutes after the first trimester is contraindicated. Rationale: can compress vena cava and reduce venous return.

PTA action for dizziness in patient on diuretics

Report to PT or nurse and monitor BP. Rationale: Orthostatic hypotension common with diuretics.

Best initial exercise for postpartum stress incontinence

Begin with supine Kegel exercises. Rationale: Start in gravity-minimized position for pelvic floor reeducation.

Likely cause of dizziness in patient with BPH

Orthostatic hypotension due to alpha-blockers. Rationale: Move slowly and monitor vitals.

Pregnant patient with back pain and hand numbness

Best modification is postural correction and neutral spine activities. Rationale: Avoid supine and high-resistance movements.

Functions of the metabolic and endocrine system

Regulate hormones, metabolism, electrolyte and fluid balance, and stress response.

Major endocrine glands

Pituitary, thyroid, parathyroid, adrenal, pancreas, and gonads.

PTA focus in endocrine/metabolic disorders

Address fatigue, weakness, fluid imbalance, and exercise tolerance.

Thyroid gland function

Regulates metabolism, energy, and growth through thyroxine (T4) and triiodothyronine (T3).

Hypothyroidism (↓ metabolic rate)

Caused by Hashimoto's thyroiditis, surgery, or iodine deficiency. Signs: weight gain, cold intolerance, fatigue, bradycardia, constipation, dry skin, myxedema.

Hypothyroidism assessment findings

Decreased HR and BP, pale skin, fatigue, slowed cognition.

PTA intervention for hypothyroidism

Gradual warm-up, low to moderate intensity exercise, warm environment, avoid overexertion.

Medication for hypothyroidism

Levothyroxine (Synthroid); overmedication side effects: tremor and tachycardia.

Hyperthyroidism (↑ metabolic rate)

Commonly caused by Graves' disease. Signs: weight loss, heat intolerance, tachycardia, tremor, anxiety, exophthalmos, hyperreflexia.

Hyperthyroidism assessment findings

Elevated HR and BP, agitation, tremor, risk of thyroid storm (fever, delirium).

PTA intervention for hyperthyroidism

Low-intensity exercise, avoid overheating, relaxation and pacing techniques.

Medications for hyperthyroidism

Methimazole (antithyroid), Propranolol (beta-blocker). Side effects: hypotension, fatigue.

Thyroid disorders comparison

Hypothyroidism: ↓ metabolism, cold intolerance, bradycardia, weight gain. Hyperthyroidism: ↑ metabolism, heat intolerance, tachycardia, weight loss.

PTA focus for thyroid conditions

Hypo—energy conservation and low-intensity activity. Hyper—avoid heat and monitor HR.

Key endocrine disorders

Diabetes mellitus, adrenal disorders, parathyroid disorders, and fluid/electrolyte imbalances.

Diabetes mellitus (Type 1 & 2)

Hyperglycemia leading to neuropathy and fatigue. PTA Note: Monitor blood glucose and avoid extreme activity.

Hypoglycemia

Symptoms: sweating, confusion. PTA Note: Provide carbohydrate snack and monitor vitals.

Hyperglycemia

Symptoms: thirst, lethargy. PTA Note: Delay therapy and notify nurse or MD.

Adrenal disorders (Addison's and Cushing's)

Addison's: fatigue, hypotension, weight loss. Cushing's: obesity, hypertension, skin fragility.