GI system Hepatic, pancreatic, and biliary systems (week 7)

A&P of digestive system

 Consists of the mouth, tongue, pharynx, esophagus, stomach, small intestine, large intestine (colon), appendix, rectum, and anus

 It’s one long continuous tube that runs from the  mouth to the anus

 If you stretched out an adult's small intestine, it would be about 22 feet long — that's like 22 notebooks lined up end to end, all in a row!

 

 Ingestion

eating/drinking through the mouth

Elimination

removal of solid waste from the body

 Absorption

transfer of digested food from the small intestine to the blood stream

 Digestion

mechanical and chemical breakdown of food to be used by the body

Diagnostic medical testing

Barium Tests

­Enema – detects lesions in colon

• ­aka lower GI series

• ­radiographic images taken of the large intestine after barium contrast given rectally

1. ­Lower GI = cecum to anus

­ Swallow – upper gastrointestinal series (UGI);

• ­radiographic images taken of the pharynx, esophagus, stomach, and duodenum after barium contrast taken orally 

• ­UGI= mouth to ileum

­Colonoscopy 

­Esophagogastroduodenoscopy (EGD) – visual exam

­Endoscopic retrograde cholangiopancreatography (ERCP)-radiographic images of the biliary ducts and pancreatic ducts

­Exploratory laparoscopic surgery

Biliary system

consists of the liver, gall bladder and bile ducts, and how they work together to make, store and secrete bile. 

Bile consists of water, electrolytes, bile acids, cholesterol, phospholipids and conjugated bilirubin.

hepatitis

Several different kinds Hep A, B, C, D, E, G, alcoholic

Caused by diseases and viruses that infect the liver

•Hep A

•Transmitted through contact with body fluids, feces, and ingestion of contaminated food and drinking water

•Usually in underdeveloped countries where food is fertilized with human excrements or have poor sewage treatment plants

•Children are especially at risk

•Symptoms resolve in ~2 months

•Prognosis is good with no damage to the liver

•Vaccine is recommended if working in high risk areas

HEP B

Transmitted through contact with contaminated blood, blood products, or through sexual contact

Health care workers are at high risk

Can be protected by a series of Hep B vaccinations (not a live virus)

Prognosis HEP B

Acute – symptoms resolve in a few weeks, liver returns to normal in a few months

Chronic – liver failure, cirrhosis, liver cancer

Prevention HEP B

(vaccination-series of 3 doses)

Medications HEP B

Hypsers, Baraclude, antiviral meds-interferon, lamivudine - Interferon reduces virus reproduction in ~90% of patients with chronic Hep B

PT intervention HEP B

Standard Precautions & Vaccination of Self

Hepatitis B virus can survive outside the body at least 7 days on such places as on a table or piece of equipment

Always wear gloves to clean up body fluids

Signs and symptoms HEP B

Loss of appetite, N/V, Weakness, Fatigue, Low-grade fever, Joint & muscle pain, Possible skin rash

Etiology HEP B

Blood-borne pathogen; transmitted through blood transfusions, direct contact with blood from infected person into eyes or skin cut, contaminated instruments, needle sharing, unsafe sex, infected mother to child during birthing process; Incubation period is 6wks-6mos

How to disinfect surfaces that were contaminated with the virus: 

Clean up spills immediately and properly using Universal Precautions and using a solution of one part bleach diluted in 10 parts water. Bleach solution should be sprayed and left on the contaminated surface 20 min.  Dispose of contaminated items in a red bag.

Etiology HEP C

Transmitted via infected blood, Most common in those who use IV illicit drugs or have multiple sexual partners. Blood transfusions less likely now due to pretesting

Signs and Symptoms HEP C

Incubation is ~6-7 weeks but could be years
Acute phase - decreased appetite, fatigue, abdominal pain, tenderness over liver, muscle and joint pain
Chronic phase - cirrhosis due to HIV or ETOH abuse
Cirrhosis – enlarged liver and spleen, jaundice, atrophy, skin abrasions or rash, ascites, ankle edema, occasional neuropathy in LE

Medical Intervention HEP C

Prevention; No vaccine; Most don’t get better without treatment; Liver function test; Possible liver biopsy;
Medications are limited to anti viral (alpha interferon or ribavirin); Possible liver transplant for severe damage

PT Intervention HEP C

Usually with patients who have arthritis or fibromyalgia
Increase function, gait, ADLs, increase joint mobility, muscle strength, endurance energy conservation techniques

The hepatitis C virus can survive outside of the body for up to 3 weeks. However, it can only do so at room temperature on clinical or household surfaces, such as a drawer handle or sink.

Prognosis HEP C

Depends on severity
If chronic, increase risk of liver failure and death

Other types of hepatitis

Hepatitis D (HDV), E (HEV), and G (HGV) – rare

Alcoholic Hepatitis

Etiology other HEP

A chronic and serious condition of the liver caused by extreme alcohol intake, Genetic markers, Caused by acetyldehyde (toxic by-product of alcohol)

Signs and Symptoms / Complications other HEP

Pain, Tenderness in abdomen, Ascites, Nausea, Fever, Decrease appetite, Fatigue, Increased thirst, Dry mouth, Pallor, Rapid and unexplained weight loss, Tachycardia, Anemia, Confusion, Thrombocytopenia, Portal HTN (increased BP in portal vein), Varices (enlarged and distended veins), Increased bruising and bleeding in GI tract, Cirrhosis, Hepatic encephalopathy (d/t build up of ammonia in brain)

Prognosis other HEP

Main predictor of severity is presence of hepatic encephalopathy (increase mortality rate)

If less severe, may recover if stop drinking

Medical Intervention other HEP

Blood tests for elevated levels of liver enzymes, liver function for albumin and bilirubin, US of liver, biopsy; Stop drinking; Nutritional consult; Possible liver transplant

PT intervention other HEP

Depends on what was affected but usually balance, gait, function, strengthening