Module 8: GI System (Part 2)

Small and Large Intestine Pains

Duodenum

• Can also show symptoms of what other pathology?

• Will refer to where?

• What does the duodenum do?

• Gastritis

• Refer:

  • Back (Mid Thoracic Area)

    • OR

  • RUQ and R Shoulder

• Finishes chemical digestion before getting into the small intestine

Duodenum:

• Where is Duodenum located in the body?

• Curves around what organ?

• What 2 substances enter the GI tract

• How many parts is the Duodenum divided ino?

• Retroperitoneal

• Head of the Pancreas

• Bile and Pancreatic Juices

• 4 Parts

• How to Palpate the Sphincter of Oddi?

• Sphincter of Oddi is the size of what?

• Sphincter of Oddi lines up w what spinal level?

• 2-3 cm up from the umbilicus on the R side

• Size of a pea

• L2

• How to palpate the DJ Junction

• DJ Junction is the size of what?

• DJ Junction is at what spinal level?

• 2-3 cm abobe umbilicus on L side

• Quarter

• L2

Metabolic Disorders:

• What is a Metabolic Disorder?

  • 4 Examples:

• Group of pathologies that contribute to reduced intestinal absorption

  • Celiac, Cystic Fibrosis, AIDS, Crohn’s Disease

Metabolic Disorders:

• 6 main S/S:

• Diarrhea (MC)

• Bloating

• Indigestion

• Anemia

• Weight Loss

• Abdominal Cramping

Pt considerations for Malabsorption:

• What are 3 pt considerations for malabsorption?

• Decreased exercise tolerance

• Potentially decreased bone density

• Spasms/muscle craps due to decreased electrolyte balance

IBS:

• How does a physician diagnose a pt w IBS?

• Recurrent symptoms of upper and lower GI system that interfere with normal functioning of the colon

• Rome IV Critera

• Uses Bristol Stool Scale

IBS:

• When diagnosing IBS, pt will be associated with what?

• IBS is AKA

• What type of problem is IBS?

• Recurrent abdominal pain > 1 day/wk in last 3 months

  • Defecation increases or decreases pain

  • Associate w change in stool frequency and form/apperance

• Functional GI Disease

• More functional than structural

IBS:

• T/F: Unknown Etiology

• How is IBS diagnosed?

  • Can IBS be identified w testes?

• How is IBS usually treated?

• True

• Diagnosis of Exclusion

  • Naur

• Tx:

  • Diet changes

  • Lifestyle changes

    • Stress management

  • Pharmacology (when necessary)

IBS:

• Is IBS MC in men or women?

• IBS co-occurs frequently w diagnoses such as: (4)

• W > M

• Dx:

  • Fibromyalgia

  • Chronic Fatigue Syndrome

  • Chronic Pelvic Pain

  • TMJ

IBS:

• What are 4 possible pt considerations for IBS?

• Stress management

• Sleep habits

• Diet

• CNS processing

Inflammatory Bowel Disease (IBD):

• What is IBD?

  • 2 Common IBD Diseases:

• 2 Inflammatory conditions of unknown cause involving genetic and immunologic influences on the GI Tract

  • Crohn’s Disease

  • Ulcerative Colitis

IBD:

• Higher production of what?

• Etiology is between what?

• What is the HALLMARK sign for IBD?

• Inflammatory Cytokines

• Gut and Microorganisms

• Bloody Diarrhea

  • Abdominal pn

  • GI Bleed

  • Weight Loss

IBD: Crohn’s Disease

• What is Crohn’s Disease?

• Where can Crohn’s Disease happen?

• What is:

  • Inflammation of full thickness of bowel wall

• Any part of digestive tract

IBD: Ulcerative Colitis

• What is Ulcerative Colitis?

• What does Ulcerative Colitis cause?

• What body part does Ulcerative Colitis usually affect?

• What is:

  • Inflammation of inner lining of LARGE intestine

• Causes infalmmation and ulcers in lining of LARGE intestine

• Colon and Rctum

DiverticulITIS:

• What is it?

• Diverticulitis is a multi-factorial disease related to what?

• What are the 2 types of changes that occur?

• Where can Diverticulitis refer to?

• What is it:

  • Infection or inflammation of the diverticula

• Related to diet

• 2 Types:

  • Structural changes in the colonic wall

  • Changes in functional mobility

• Low Back and Hip (L > R)

DiverticulOSIS:

• What is it?

• Where do the outpouchings herniate from?

• More chronic form can be seen throguh where?

• Presence of outpouchings in the walls of the Small Intestine OR Colon

• Outpouchings from the mucosa and submucosa through the muscular layers of the colon

• Imaging

What are 6 considerations for Diverticulitis?

• Do NOT eat seeds

• Do NOT Smoke

• Eat fiber

• Stay hydrated

• Physical Activity improves bowel function

• Breathing techniques for stress reduction

What are 4 MSK considerations for Diverticulitis?

• Anterior Hip/Hip Flexor

• Lumbar Spine (L4)

• SIJ

• Pelvic Floor (as needed)

• How to palpate ICV?

• What size is it?

• ICV aligns w what spinal level?

• 1/3 away from the R ASIS to Umbilicus (just above McBurney’s Point)

• Dime

• L5/SIJ

Inguinal Hernia:

• What is an Inguinal Hernia?

• Outpuching of abdominal contents through weak area in lower abdominal wall

Umbilical Hernia

Apendicitis:

• What is Appendicitis:

• Appendix is mostly what type of tissue?

• What is the cause for Appendicitis?

  • At least 1/3 are accompanied by what?

• What is:

  • Inflammation of the appendix that can lead to rupture and necrosis

  • Lymphatic Tissue

  • Unknown

    • Obstruction and Improper Drainage

Appendicitis:

• What type of referral?

• What is the Tx?

• Emergent Referral

• Tx:

  • Surgical Removal

  • Antibiotics after sx

Bowel Function:

• What are 6 subjective questions to ask for Bowel Function?

• How often do they go?

• Volume, Consistency?

• Do u have difficulty?

• Do you have excessive gas?

• Are u constipated?

• Do u have diarrhea?

What does an Ideal Bowel Movement look like? (5)

• Medium brown, color of plain cardboard

• Leave body easily w no straining or discomfort

• Consistency of toothpaste and ~4-8 inches long

• Should enter the water smoothy and slowly fall once reaches water

• Minimal gas or odor

Bristol Poop Chart:

• What is the ideal type fo poop?

• Type 4

Bowel Function:

• What does it mean if there is blood, pus, or blood in bowel?

• Mucus can be caused by inflammation in intestines

• Blood, Ulcers, Cancer

Bowel Function:

• What does it mean if the stool is greasy, frothy, or foul smelling?

  • What is needed to break down fat?

  • Causes:

  • Frothy =

• High fat content (Steatorrhea)

  • Lipase

  • Causes:

    • Pancreatic Insufficiency

    • Chronic Pancreatitis

    • Obstruction of Bile Duct

    • Bacterial Growth

    • Celiac Disease

  • Frothy = Malabsorption

Bowel Function:

• What does sinking stool mean?

• What color can the stool be from sitting for a while?

• Can also be due to what?

• Sinking Stool = Not enough fiber

• Color = Dark

• Infection

Bowel Function:

• Constipation:

  • Can be due to:

• Diarrhea:

  • Can be due to:

• C:

  • Bowel Obstruction of carcinoma in colon

• D:

  • Infection

  • Dehydration

  • Increased fall risk

Bowel Function:

• What does dark blood indicate in the stool?

  • What does this stool look like?

• Light stool may be due to what?

• Dark Blood:

  • Bleed father up the GI Tract

    • Tarry Black Stools, Coffee Grounds

• Light Blood:

  • Hemorrhoids

    • Lower GI Bleeding