Gastrointestinal Diseases/Red Flags

Gastritis

Inflammation of inner stomach

Worse than GERD

Erosive v Non-Erosive

What type of gastritis is characterized as erosive?

Erosive Gastritis

What are the common causes of erosive gastritis?

Stress, NSAIDs, Alcohol, Viral Infection, Direct Trauma

What are the signs and symptoms of erosive gastritis?

Dyspepsia, Nausea/Vomiting, Hematemesis

What is a common diagnostic test for erosive gastritis?

Blood test for anemia, stool test, GI endoscopy

What is the primary treatment for erosive gastritis?

Removal of stimulus

What should patients with erosive gastritis be educated to avoid?

Aspirin

What type of gastritis is characterized as non-erosive?

Chronic Type B

What is the primary cause of Chronic Type B gastritis?

Helicobacter pylori infection (H. pylori)

What are the symptoms of Chronic Type B gastritis?

Asymptomatic - will progress to symptoms if progresses

How is Chronic Type B gastritis diagnosed?

Stool tests for H. pylori and upper GI endoscopy

What is the treatment for Chronic Type B gastritis?

Aggressive treatment of H. pylori with Proton pump inhibitors and antibiotics

What are the implications for physical therapy in Chronic Type B gastritis?

Same as erosive gastritis

What is Ulcerative Colitis?

Chronic inflammation and ulceration of the colon

What are some potential etiologies of Ulcerative Colitis?

Unknown; links to stress, autoimmune disorders, diet, heredity, high intake of unsaturated fat and vitamin B6

What are the signs and symptoms of Ulcerative Colitis?

Inflammation and ulcers in the lining of the colon and rectum, abdominal pain, bloody stools, anemia, diarrhea, increased risk for colon cancer

What are common diagnostic methods for Ulcerative Colitis?

Blood tests (anemia), stool samples, CT scan, colonoscopy, electrolyte studies, renal and liver testing

What are some treatment options for Ulcerative Colitis?

Limited diet, mild sedatives, anti-inflammatory medications, stress reduction, surgery (temporary or permanent colostomy)

What is an implication of managing Ulcerative Colitis?

Stress relief with low-impact exercise

What is peritonitis?

Inflammation of the peritoneum

What are the two types of etiology for peritonitis?

Primary and Secondary

What causes primary peritonitis?

Organisms from blood or the genital tract

What causes secondary peritonitis?

Contamination by GI secretions from perforations of the GI tract or other organs

What are some signs and symptoms of peritonitis?

Fluid accumulation, abdominal pain, nausea/vomiting, profuse sweating, weakness, fever, abdominal tenderness, distension, obstruction

What can happen if peritonitis leads to leaks?

Body absorbs causing septicemia, shock, and possibly death

What lab findings are associated with peritonitis?

Elevated WBC, abnormal serum levels of sodium/potassium/chloride

What imaging or cultures are used in the diagnosis of peritonitis?

X-ray and culture of fluid

What is the treatment for peritonitis?

Broad-spectrum antibiotics, anti-nausea agents, analgesics, fluids/electrolytes, and surgery if perforation occurs

What is the implication of peritonitis?

It is a medical emergency

What is a Hiatal Hernia?

Part of the stomach protrudes through the chest cavity via the diaphragm and esophagus.

What causes a Hiatal Hernia?

Weakening of the cardiac sphincter in older individuals and increased abdominal pressure.

What are some factors that increase abdominal pressure leading to a Hiatal Hernia?

Heavy lifting, bending over, frequent or hard coughing, hard sneezing, violent vomiting, straining during defecation, and obesity.

What are common symptoms of a Hiatal Hernia?

Many are asymptomatic; symptomatic individuals may experience esophageal reflux, dull chest pain, shortness of breath, palpitations, and discomfort from food 'balling up' in the lower esophagus.

How is a Hiatal Hernia diagnosed?

Upper GI x-ray and high-resolution manometry.

What are the treatment options for a Hiatal Hernia?

Medications that block acid production, medications for infections, pain medications, corticosteroids, IV nutrition, endoscopy, and surgery.

What are some implications for managing a Hiatal Hernia?

Exercise 30 minutes after a meal and keep the head elevated as lying flat can aggravate symptoms.

What is an inguinal hernia?

Pouching of small intestine and peritoneum into the groin.

What are common etiologies of inguinal hernia?

Congenital conditions or weakness in abdominal wall, smoking, COPD, obesity, peritoneal dialysis, pregnancy, collagen vascular disease, previous open appendectomy.

What are the signs and symptoms of an inguinal hernia?

Bulge in groin or scrotum with increased pain with lifting or bending, relieved with lying down; if strangulated, sudden pain, nausea, vomiting.

How is an inguinal hernia diagnosed?

Patient history, physical exam, ultrasound (US), or CT scan.

What is the primary treatment for an inguinal hernia?

Surgical repair.

What is a non-surgical option for treating minimal symptoms of an inguinal hernia?

Hernia truss.

What is an implication of having an inguinal hernia?

Exercise to assist with pain.

What is the action of antacids?

Chemically neutralize gastric acid and increase intragastric pH.

How are antacids classified?

Aluminum-containing, calcium carbonate-containing, magnesium-containing, or sodium bicarbonate-containing.

What are the indications for using antacids?

Episodic minor gastric indigestion (heartburn), peptic ulcer, gastroesophageal reflux disease (GERD).

What are common side effects of antacids?

Acid rebound phenomenon, constipation or diarrhea, may affect metabolism of other medications, electrolyte imbalances.

Do antacids have any implications for physical therapy?

No side effects that interfere with physical therapy.

What are some examples of antacids?

Tums, Milk of Magnesia.

What is the action of antibiotics in the treatment of H. pylori?

Treatment of H. pylori bacteria to facilitate healing of gastric ulcerations

What are the indications for using antibiotics?

H. pylori bacteria

What are common side effects of antibiotics?

Hypersensitivity, diarrhea, nausea

What should physical therapists be aware of regarding antibiotics?

Potential side effects, including severe dermatological and respiratory reactions associated with hypersensitivity

Name two examples of antibiotics.

Tetracycline, Amoxicillin

What is the action of anticholinergics?

Block the effects of acetylcholine on parietal cells in the stomach and decrease the release of gastric acid.

What are the indications for anticholinergics?

Gastric ulcers.

What are common side effects of anticholinergics?

Dry mouth, confusion, constipation, urinary retention.

What are the implications for physical therapy when using anticholinergics?

Potential side effects and recognition.

Can you name an example of an anticholinergic medication?

Gastrozepin

What is the action of antidiarrheal medications?

Slow serious debilitating effects of dehydration due to prolonged diarrhea

What are the indications for using antidiarrheal medications?

Prolonged diarrhea

What are common side effects of antidiarrheal medications?

Constipation, abdominal discomfort

What are the implications for physical therapy when a patient is on antidiarrheal medications?

Well-tolerated and patients likely to participate

What are two examples of antidiarrheal medications?

Kapectolin, Pepto-Bismol

What is the action of antiemetics?

Decrease symptoms of nausea and vomiting

What are the indications for using antiemetics?

Nausea due to motion sickness, anesthesia, pain, or oncology treatments

What are common side effects of antiemetics?

Sedation, dysrhythmias, and pain

Are there antiemetic agents with no side effects?

Yes, some agents have no side effects and are well-tolerated

What are the implications for physical therapy when a patient is on antiemetics?

Sedative effects which can be limiting to PT pending specific agent

Can you name two examples of antiemetics?

Scopolamine and Meclizine

What is the action of an emetic?

Induce vomiting

What are the indications for using an emetic?

Induction of vomiting after ingestion of a toxic substance

What are some side effects of emetics?

Dehydration, electrolyte imbalance, upper GI erosion with inappropriate or prolonged usage

What should be addressed before physical therapy when emetics are involved?

Vomiting concerns

What are two examples of emetics?

Apomorphine, Ipecac

What is the action of H2 Receptor Blockers?

Bind specifically to histamine receptors to prevent histamine-activated release of gastric acid stimulated during food intake.

What are the indications for H2 Receptor Blockers?

Dyspepsia, acute and long-term treatment of peptic ulcer, GERD.

What are common side effects of H2 Receptor Blockers?

Headache, dizziness, mild GI distress, tolerance, arthralgia, acid rebound with discontinuation.

What are the implications for physical therapy regarding H2 Receptor Blockers?

Well-tolerated and patients are able to participate.

What are examples of H2 Receptor Blockers?

Tagament, Pepcid.

What is the action of a laxative?

Facilitate bowel evacuation and should be used sparingly.

What are the indications for using a laxative?

Promotion of defecation.

What are common side effects of laxatives?

Nausea, abdominal discomfort, cramping, electrolyte imbalance, dehydration, dependence with prolonged use.

What is an implication for physical therapy regarding laxatives?

Timing of use of laxative.

What are two examples of laxatives?

Citrucel and Colace.

What is the action of Proton Pump Inhibitors?

Inhibit H+/K+-ATPase enzyme, blocking secretions of acid from gastric cells into the stomach.

What condition do Proton Pump Inhibitors help prevent?

Erosive esophagitis.

What antibacterial effects do Proton Pump Inhibitors have?

They have antibacterial effects against H. pylori.

What are the indications for using Proton Pump Inhibitors?

Dyspepsia and GERD.

What is a side effect of Proton Pump Inhibitors when discontinued after prolonged use?

Acid rebound phenomenon.

How are Proton Pump Inhibitors tolerated?

Well-tolerated.

Can you name examples of Proton Pump Inhibitors?

Prevacid and Nexium.

Common GI Complaints

Abdominal pain/bleeding

Anterior Neck Pain

Bathroom issues

Food related issues

Kehr's Sign

Pain in lower left abdomen goes into left shoulder

Danforth Sign

Shoulder pain during inhalation