NPTE: GI Signs and Symptoms

Anuria

inadequate urine output in 24 hours (<100 mL)

Endometrium

inner lining of the uterus, which is shed monthly as a result of hormonal influence

Impotence

inability to ejaculate or obtain orgasm

Nephrolithiasis

kidney stones

Urinary frequency normal vs abnormal

6-8x/day is normal but >8 is abnormal

Stress incontinence

sudden involuntary leakage of urine during cough or exercise (increase in pressure)

➤ Due to muscle weakness or laxity

➤ Treatment: Pelvic floor strengthening; Electrical stimulation and biofeedback therapy for pelvic floor muscles

Urge incontinence

involuntary loss of urine immediately after the "urge"

➤ Involuntary contraction of detrusor muscle with strong desire to void

➤ Often idiopathic, but can be caused by medications, alcohol, bladder infections,

bladder tumor, neurogenic bladder, or bladder outlet obstruction

➤ Treatment:Treatment of infections. Behavioral modifications, Biofeedback therapy, Pelvic floor muscle training along with bladder training (scheduled voiding, urge-suppression techniques), Prompted voiding (individuals with cognitive impairments), Patients should be encouraged to manage constipation, Avoid bladder irritants such as caffeine, alcohol, nicotine, and carbonated

drinks

Functional incontinence

Incontinence due to mobility, dexterity, or cognitive deficits

Treatment:

- Eliminate clutter

- Prompt voiding

- Modify the environment to increase accessibility

- Provide functional mobility training to increase timely access to bathroom facility

Overflow incontinence

overdistention of bladder and inability of bladder to empty

completely

➤ Urine leaks or dribbles → patient does not have any sensation of fullness or emptying

➤ Causes: deficient or contractile detrusor muscle, hypotonic or underactive detrusor muscle secondary to drugs, fecal impaction, DM, lower spinal cord injury (SCI), multiple sclerosis (MS); In males, overflow incontinence is mostly due to prostatic hyperplasia, prostatic carcinoma, or urethral stricture; In females, overflow incontinence is mostly due to obstruction caused by severe

genital prolapse or surgical overcorrection of urethral detachment

➤ Treatment: Medication and catheterization

Upper vs lower urinary tract infection

Upper UTI: kidney or ureteral infections

● More serious because the lesions can be a direct threat to renal tissue

● Pyelonephritis, acute and chronic glomerulonephritis, renal papillary necrosis, and renal tuberculosis

Lower UTI: cystitis or urethritis

● Usually secondary to ascending UTIs; may also involve kidney and ureters or lymphatics

● More common in females because of their shorter urethras and the proximity of the urethra to the vagina and rectum

Spinal control for micturition originates from sacral segments

S2, S3, S4

Spastic or UMN bladder

patients with lesions that occur above T12; AKA hyperreflexic bladder

● Reflex arc is intact; bladder contracts and reflexively empties in response to a certain level of filling (difficulty holding urine)

● Bladder and sphincter dyssynergia

➤ Hyperreflexive detrusor muscle

➤ Sphincter tone is increased

● Even with small volumes of urine, the detrusor muscle contracts

● Treatment

➤ Intermittent catheterization: 3 to 6 hours

➤ Suprapubic tapping

➤ Anticholinergic medications

➤ Voiding schedule

Flaccid or LMN bladder

patients with lesions that occur below T12 AKA flaccid bladder (difficulty in voiding urine)

● No preservation of reflex arc

● Treatment

➤ Intermittent catheterization: 3 to 6 hours

➤ Poor response to medications

➤ Valsalva maneuver

➤ Credé maneuver: manually compressing lower abdomen

➤ Timed voiding program

Renal cystic disease

Renal cysts are fluid-filled cavities that form along the nephron; These cysts can lead to the degeneration of renal tissue and the obstruction of tubular flow

■ Types: Polycystic kidney disease, cystic diseases of the renal medulla, acquired cystic kidney disease, single cysts, cystic renal dysplasia, miscellaneous renal cystic disorders

■ Clinical manifestations

-Pain

-Hematuria

-Fever

-HTN

-Abdominal or flank pain

Renal calculi or kidney stones s/s and tx

crystalline structures formed from urine

S/S:

-Renal colic pain: sudden, sharp, severe pain (Pain originates deep in the lumbar area and radiates around the side and down

toward the testicles in males and the bladder in females

-Ureteral colic pain: pain radiating toward the genitalia and thighs

-Nausea, vomiting

-Hematuria

-Fever and chills

-Urinary frequency

Treatment:

-Nonsteroidal anti-inflammatory drugs (NSAIDs), narcotics, thiazide diuretics

-Adequate fluid intake and dietary modification

-Restrict high oxalate foods (eg, peanuts, spinach, chocolate, and sweet potatoes)

Hydronephrosis

when a stone blocks the flow of urine, causing urine pressure to build up in the ureter and kidney

Male sex hormones

testosterone and androgen

Erectile dysfunction causes

➤ Neurogenic causes: stroke, cerebral trauma, SCI, MS, Parkinson disease

➤ Psychogenic causes: anxiety, fear, depression, stress, fatigue

➤ Hormonal causes: decreased androgen, hypothyroidism, hypopituitarism

➤ Vascular causes: HTN, CAD, hyperlipidemia, cigarette smoking, DM

➤ Medication causes: antidepressants, antipsychotics, alcohol, antihypertensives, antiandrogens, amphetamines

➤ Increased age

➤ Surgical causes: transurethral procedures, radical prostatectomy, proctocolectomy, abdominoperineal resection

PT interventions for erectile dysfunction

-External supports (SI belt, corsets)

-Stabilization exercises

-Avoid single-leg weight-bearing exercises, excessive hip abduction, and hyperextension

-No quadruped fire hydrants

Prostatitis what is it and types

infection and inflammation of the prostate gland, causing enlargement

S/S of prostatitis

➤ Fever, chills

➤ Low back, inner thigh, and perineal pain

➤ Testicular or penis pain

➤ Urinary urgency and frequency

➤ Nocturia

➤ Dysuria

➤ Weak or interrupted urine stream (hesitancy)

➤ Inability to completely empty bladder

➤ Sexual dysfunction (painful ejaculation, cramping and/or discomfort after ejaculation, infertility)

➤ General malaise

➤ Arthralgia

➤ Myalgia

Benign prostatic hyperplasia

Prostate cancer

● Approximately 50% to 75% of men aged > 75 year have carcinoma in situ (slow growing)

● Increase in prostate-specific antigen (PSA)

➤ PSA level rises in patients with an enlarged prostate, prostate tumor, or prostate infection

Clinical S/S of BPH and prostate cancer

➤ Bladder palpable above pubic symphysis

➤ Urinary problems

Hesitancy

Weak urine stream

Dribbling at the end of urination

Frequency: urinate every 2 hours

Nocturia

● Lower abdominal discomfort → need to void

● Low back pain (LBP) and/or hip or upper thigh pain or stiffness

● Suprapubic or pelvic pain

● Difficulty having an erection

● Blood in urine or semen

External vs internal genitalia of female reproductive system

■ External genitalia: mons pubis, labia majora, labia minora, clitoris, perineal body (Urethra and anus are in close proximity, which can lead to cross-contamination)

■ Internal genitalia: vagina, uterus, cervix, fallopian tubes, paired ovaries

Ovaries functions

➤ Production and storage of ova (female germ cells)

➤ Produce sex hormones (estrogen and progesterone)

➤ Under control of hypothalamus and anterior pituitary gland

What does estrogen do?

➤ Estrogen decreases the rate of bone resorption (risk of OP and bone fracture increases after menopause)

➤ Estrogen increases the production of thyroid and increases the HDL level (increased risk of heart disease and cerebrovascular accident [CVA] after menopause)

Females taking raloxifene (estrogen) are at an increased risk of

deep vein thrombosis (stroke)

Endometriosis

Varicose veins

➤ Varicosities are aggravated during pregnancies by increased uterine weight, venous stasis in legs, increased venous distensibility

➤ Can occur in lower extremities, rectum (hemorrhoids), and vulva

➤ Usually present during first trimester and repeat pregnancies

➤ Pregnant women are more susceptible to DVT

➤ S/S: heaviness and/or aching in dependent positions

➤ Physical therapy interventions: Elevate legs; avoid crossing legs, which can press on veins; Elastic support stockings

Small vs large intestine

small: major digestive and absorption processes occur here

large: primarily absorbs water and electrolytes and stores and eliminates waste products

Accessory organs: liver, salivary glands, pancreas

aid in digestion by producing digestive secretions

GI motility: peristaltic movement

propels food and fluids by rhythmic intermittent contractions

of smooth muscle

● Except for the pharynx and the upper half of the esophagus

Vagus nerve controls

secretions and motility of GI tract

Gastrin role

secretes gastric acid in stomach; aids in digestion of proteins

Abdominal quadrants referrals

➤ Right upper quadrant (RUQ): peptic ulcer, gallbladder pathology, head of pancreas

➤ Right lower quadrant (RLQ): appendix, Crohn disease (CD)

➤ Left lower quadrant (LLQ): diverticulitis, ulcerative colitis (UC), IBS

➤ Left upper quadrant (LUQ): tail of pancreas, spleen pathology

Referred pain felt in midback and scapula

esophagus, gallbladder, stomach, pancreas

Referred pain in shoulder

liver, diaphragm, pericardium

left: heart, diaphragm, tail of pancreas

right: gallbladder, liver, head of pancreas, peptic ulcer

Referred pain in pelvis, low back, and sacrum

colon, appendix, pelvic viscera

Referred pain from kidneys is

constant back pain that radiates upward toward thorax and anteriorly into abdomen

C diff precautions

contact (gloves, gown); life threatening diarrhea

CNS disorders that cause dysphagia

(stroke, Alzheimer disease, Parkinson disease), peptic esophagitis with stricture, GERD, neoplasm, asthma drugs, antidepressants, antihypertensives

Achalasia

condition in which the lower esophageal sphincter fails to relax and food is trapped in the esophagus

peptic ulcer, ulcerative colitis, duodenal ulcer, liver, bleed in GI tract stool types

What can cause black stools and a patient's tongue to turn black

Diarrhea medications: such as pink bismuth (bismuth subsalicylate; brand names: Pepto-Bismol, Bismatrol, Kaopectate);

Radiation therapy can cause rectal bleeding

Occult (hidden) GI bleeding

can appear as midthoracic back pain with radiation to the RUQ; can be revealed only by fecal occult blood test (brand name: Hemoccult test) and laboratory test

Hepatitis

acute or chronic inflammation of liver

causes:

➤ Viral infection

➤ Chemical agents

➤ Drug reaction

➤ Alcohol abuse

➤ Autoimmune hepatitis

➤ Biliary cirrhosis

➤ Metabolic disorders (eg, Wilson disease: too much copper accumulates in organs)

Hep A

-Acute infectious: mild to severe

-Transmission through fecal oral route (contaminated food or water)

-Prevention: good personal hygiene, hand washing, sanitation, vaccination

Hep B

-Mild (acute, usually lasts for several weeks) to severe (chronic, lifelong)

-Transmission through blood, body fluids, or body tissues (transfusion, oral or sexual contact, sharing needles); Body fluids such as spinal, peritoneal, and pleural fluids; saliva; semen;

and vaginal secretion

-Prevention: education on disposable needles, screening of blood donors, immunization

Hep C

-Acute or chronic

-Transmission through blood, body fluids (transfusion, oral or sexual contact, sharing needles), organ transplants

Hep D

-Acute or chronic

-Transmission through blood, body fluids (transfusion, oral or sexual contact, sharing needles)

-Dependent on having HBV coinfection

-Poor prognosis, liver failure

Hep E

-Acute, infectious

-Transmission through fecal-oral route (contaminated food or water)

Classic s/s acute hepatitis

Malaise, fatigue, mild fever, nausea, vomiting, anorexia, RUQ pain, occasionally diarrhea, jaundice, dark urine, clay-colored stools

S/S chronic hep

fatigue, malaise, jaundice, RUQ pain, anorexia, arthralgia, fever, splenomegaly, hepatomegaly, weakness, ascites, hepatic encephalopathy