Module 8: GI System (Part 1)

What are common S/S related to the GI System? (Part 1 - 4)

• Abdominal pain (Acute and Chronic)

• Indigestion, Nausea, Vomiting including blood

• Loss of Appetite

• Early Satiety (Eat small amount and be full right away)

What are common S/S related to the GI System? (Part 2 - 4)

• Dysphagia and/or Odynophagia (Painfull Swallowing)

• Change in bowel function

• Diarrhea, Constipation

• Jaundice

Mouth and Esophagus:

• Pierces through what structure?

• Innervated by what nerve?

• Diaphragm

• Vagus Nerve

• What structure is considered the BEGINNING of the Small Intestine?

  • What shape does this structure have?

  • Where is it located in the body?

• What SC level is Umbilicus?

• Duodenum

  • C Shaped Tube

  • Location:

    • Back Abdominal Wall of Abdomen

    • Posterior side of the body

• L4

Small Intestine:

• Small Intestine is composed of what 2 parts?

• What is the Small Intestine connected to?

• What body function occurs at the Small Intestine?

• Jejunum and Ileum

• Mesenteric Root

• Nutrient Absorption

How much blood is shunted to the GI System after a meal for digestion?

2L

Large Intestine:

• Trace the structures of the Large Intestine from R to L: (9)

• Ileocecal Valve

• Cecum

• Ascending Colon

• R Hepatic Flexure

• Transverse Colon

• L Splenic Flexure

• Descending Colon

• Sigmoid Colon

• Rectum

Sigmoid Colon and Rectum:

• What structures are considered the LAST section of the Large Intestine?

• What structures is the Sigmoid Colon and Rectum POSTERIOR to in:

  • Men:

  • Women:

• Sigmoid Colon and Rectum

• Posterior to:

  • M: Prostate and Bladder

  • W: Uterus and Bladder

GI System (Lateral View)

Areas of Pain:

• Imaginary lines crossing what structure?

• Can give clues about what?

• Crossing Umbilicus

• Which structures are involved

Visceral Pain in Abdomen:

• Visceral Pain in Abdomen occurs when the abdominal muscles do what? (3)

• Prolonged can causes what?

• Often difficult to ____:

• Abdominal Organs:

  • Contract in forceful manner

  • Stretched or Distended

  • Tissue Inflamed

• CNS Changes

• Localize

Enteric NS:

• Enteric NS sits at the intersection of what?

• T/F: The GI System had more nerve connections than the Spinal Nerves/Cord due to interneurons

• CNS (Fight or Flight) AND PNS (Rest and Digest)

• True

Referred Pain in Abdomen:

• Referred pain in the abdomen is usually felt where?

  • Which are innervated at approximately where?

• T/F: Often NOT the same as the initial site of pain

• Referred pain in abdomen becomes more ____ and travels as the ___ ___ gets worse.

• May be referred to the abdomen from what 3 structures?

• Distant Sites

  • Innervated at approximately the SAME level as dysfunctional structures

• True

• Intense; Original Site

• Chest, Spine, Pelvis

4 Quadrant Division (More Commonly Used)

9 Abdominal Areas/Divisions (Less Commonly Used)

Abdominal Pain Subjective Questions:

• What are common GI Subjective questions to ask? (Part 1 - 5)

• Can you describe the pain in your own words?

• Where is it?

• Where did it start?

• Where did it travel to?

• Timing of pain?

Abdominal Pain Subjective Questions:

• What are common GI Subjective questions to ask? (Part 2 - 5)

• How did it begin?

• How gradually did it come on?

• 24 hr pain pattern?

• Are you acutely ill?

• Is this a chronic problem and something that you have had before?

What type of pain is common for GI issues? (5)

• Cramping

• Sharp

• Colicky

• Knifelike

• Burning

Esophageal Pain

Esophageal Pain: Hiatal Hernia

• How does an Hiatal Hernia occur?

• Prevalence rate:

• Increased w age:

• Occurs where the cardiac (lower esophageal) spinchter becomes WEAK allowing the stomach to pass through the diaphragm into the thoracic cavity

• Prevalence: 20%

• Age:

  • 50% over 50yo

  • 60% over 60yo

  • 70% over 70%

Esophageal Pain: Hiatal Hernia

• What are the 2 types of Hiatal Hernia?

• Sliding Hiatus Hernia

  • Stomach goes in and out

• Paraesophageal Hiatus Hernia

  • Stomach is stuck and stays there

Esophageal Pain: Hiatal Hernia

• Hiatal Hernias can be caused by what 2 things?

• Weakening of Diaphragm

• Increased Intra-Abdominal Pressure

  • Ex: Tight Clothing and Preg

Esophageal Pain: Hiatal Hernia

• 3 Common S/S:

• Common location of pain:

• S/S:

  • Burning pain in Chest and Throat

  • Belching

  • N/V

• Site:

  • Back Pain

  • Chest Tightness

Esophageal Pain: Gastroesophageal Reflux Disease (GERD)

• GERD is a consequence of what?

• Consequence:

  • Backward flow of gastric contents into the esophagus

Esophageal Pain: Gastroesophageal Reflux Disease (GERD)

• How does GERD occur?

• Occurs:

  • Transient relaxation of the Lower Esophageal Sphincter (LES) not related to swallowing that allows the stomach acid to pass into the esophagus

Esophageal Pain: Gastroesophageal Reflux Disease (GERD)

• 4 main GERD Complications:

• Esophagitis

  • Necrosis of the esophageal epithelial lining that leads to erosions and ulcers

• Strictures that narrow the esophagus secondary to scar tissue formation

• Barret Esophagus

  • Precancerous Condition

• Adenocarinoma

Esophageal Pain: Gastroesophageal Reflux Disease (GERD)

• Which GERD complication presents the MOST CONCERN?

• Strictures

Esophageal Pain: Gastroesophageal Reflux Disease (GERD)

• 4 main Clinical Manifestations

  • Heartburn that may irradiate to where?

  • Esophageal symptoms can include what 3?

  • Pt may demonstrate what?

• Heartburn that may irradiate to the stomach, chest, back

• Esophageal symptoms can include:

  • Cough

  • Asthma

  • Laryngitis

• Demonstrate:

  • Decreased mobility of L Lower Rib Cage and L Shoulder

What are 4 things to consider when treating a pt w UPPER GI Diagnosis?

• Timing tx away from meals (esp if doing intense exercise)

• Avoid lying flat after meals

• Avoid exercise that increase IAP in supine position

• Assess diaphragm mobility (L Side)

What are 4 common MSK structure considerations for pts w Upper GI Diagnosis?

• Diaphragm

• Shoulder Mobility/Strength

• T/S

• C/S

Where to palpate LES?

• Just LEFT of the Sternum on 6-7 costal cartilage

  • Xiphoid Process

Stomach Pain

Stomach Pain: Gastritis

• Gastritis is a condition that affects what?

• Acute Gastritis = (2)

• Chronic Gastritis = (3)

• Condition affecting the mucosa of the stomach

• Acute:

  • Hemorrhagic

  • Erosive

• Chronic:

  • H Pylori Gastritis

  • Multifocal Atrophic Gastritis

  • Autoimmune Metaplastic Gastritis

Stomach Pain: Gastritis

• S/S of Gastritis include what? (3)

• How is diagnosis made?

• Can be caused by what?

• S/S:

  • Feeling of Abdominal Distention

  • Loss of Appetite

  • Nausea

• Endoscopy

• Long Term use of NSAIDS

Stomach Pains: Peptic Ulcer Disease

• What does Peptic Ulcer Disease involve?

• Erosion (Do not extend through muscularis mucosae)

  • OR

• Ulcer of the stomach or duodenum

Stomach Pains: Peptic Ulcer Disease

• Peptic Ulcer Disease extends into where?

  • Replaces what?

• Potential for damage to what?

• Could lead to what?

• Extends to muscle layer

  • Replaced w Scar Tissue

• Blood Vessels

• Bleeding Risk (Hemorrhage)

Stomach Pains: Peptic Ulcer Disease

• What type of ulcer is it?

  • Response to what?

• 3 Common Causes:

• Stress Ulcer

  • Physiologic Stress

• Causes:

  • Long Term use of NSAIDS

  • Low Dose Aspirin

  • H Pylori Bacteria Infection

Stomach Pains: Peptic Ulcer Disease

• What are the 2 Peptic Ulcer Complications?

• Bleeding

  • Requires Hospitalization

• Perforation of stomach or duodenum may occur presenting w severe sudden pain

  • T/S from T6-T10 w radiation to RUQ

Stomach Pains: Peptic Ulcer Disease

• What is the 3 main Tx for Peptic Ulcer Disease?

• Reduce H Pylori Bacteria

• Stop use of NSAIDS

• Bleeding can be treated endoscopically

Stomach Pains: Peptic Ulcer Disease

• What are 3 pt conditions for stomach pathology?

• Acute changes in fatigue level

• Discuss changes in stool

• Monitor for signs of bleeding

How to palpate for Pyloric Sphincter?

• 6-7 cm above umbilicus

  • May be slightly L or R of midline

    • 4 finger

  • Size fo quarter

  • At level of L1