NPTE - GI System

Mouth

mechanical and chemical digestion (amylase starts CHO breakdown)

Esophagus

transports food to stomach via peristalsis

Stomach

mixes/churns food

secretes acid and enzymes

Small intestine (duodenum —> ileum)

main site of nutrient absorption

Large intestine

absorbs water

forms feces

Liver

produces bile

detoxifies blood

stores glycogen

Gallbladder

stores/releases bile

Pancreas

secretes digestive enzymes and insulin/glucagon

Rectum/Anus

stores and eliminates stool

Gastroesophageal reflux disease (GERD)

acid reflux into esophagus

Sxs: heartburn, chest p!, sour taste

worsens in supine/after eating

avoid therapy immediately after meals

keep head elevated

Peptic Ulcer Disease (PUD)

erosion of stomach/duodenal lining

caused by H. pylori, NSAIDs

p! relieved by food (duodenal), or worsened (gastric)

red flag: refer if pt has back pain + GI sxs + tarry stools —> possible bleeding

Irritable Bowel Syndrome (IBS)

chronic ftnal disorder —> altered bowel habits

no structural damage

sxs: abdominal p!, bloating, constipation/diarrhea

manage stress/anxiety; regular aerobic activity helps

Inflammatory Bowel Disease (IBD)

Chron’s disease

Ulcerative colitis

red flags: bloody stool, weight loss, fatigue, risk of dehydration and malabsorption

Chron’s Disease

Anywhere in GI tract

skip lesions, fistulas

Ulcerative Colitis

colon only

continuous, mucosal layer only

Appendicitis

inflammation of appendix

R LQ p!, rebound tenderness, nausea, fever

McBurney’s point, Rovsing sign, psoas sign (+)

emergency referral if suspected!

Diverticulosis

pouches (individual) in the colon wall

asymptomatic

Avoid increased intra-abdominal pressure

Diverticulitis

infected/inflamed pouches —> p!, fever

Avoid intra-abdominal pressure

Liver enzymes (AST/ALT)

Normal: <40IU/L

high = liver damage (hepatitis, cirrhosis)

Bilirubin

Normal: <1.2mg/dL

high = liver destruction/bile obstruction

Albumin

Normal: 3.5-5g/dL

low = poor liver ftn/malnutrition

Amylase/Lipase

Normal Amylase: <140

Normal Lipase: <160

high = pancreatitis

INR/PTT

Normal INR: 0.8-1.1

high = bleeding risk if liver failure

Red Flags for Referral

Back/shoulder p! + GI sxs

Tarry stools (melena)/bright red blood in stool

persistent vomiting/unexplained weight loss

abdominal p! with fever

signs of dehydration/electrolyte imbalance

PT Implications of GERD

Avoid supine

schedule PT before meals

PT Implications of IBD (Chron’s, UC)

fatigue common

watch for dehydration

PT Implications of Liver Disease (cirrhosis)

low endurance, risk of bruising/bleeding

PT implications of Ascites

Difficulty breathing, decreased activity tol

PT implication of Malabsorption/malnutrition

risk of osteoporosis, anemia —> low exercise tol

PT implications of Stoma/colostomy

avoid abdominal strain

modify core exercises

Boards tips pt 1

small intestine = nutrient absorption

large intestine = water absorption

Liver disease —> coagulopathy, jaundice, ascites, fatigue

Psoas sign and obturator sign —> indicate peritoneal inflammation (appendicitis)

Boards Tips Pt 2

McBurney’s Point: RLQ - appendicitis

P! relieved by food = duodenal ulcer

bright red blood = lower GI bleed, Black tarry = upper GI bleed

liver disease = low albumin, high bilirubin

exercise improves IBS, but avoid overexertion in IBD

portal HTN = complication of cirrhosis —> leads to varices, ascites

Gallbladder p! —> RUQ, may radiate to R shoulder/scapula (Murphy’s sign)

Murphy’s sign

p! on RUP palpation with inspiration —> gallbladder issue

McBurney’s point

tenderness at 1/3 from ASIS to umbilicus —> appendicitis

Psoas Sign

p! with hip extension —> peritoneal/appendiceal irritation

Obturator sign

p! with passive IR/flexion of hip —> pelvic inflammation