QUIZLET COPY GI

Murphy's Sign

-Examine for ...

-How to:

-Positive sign =

-Examine for cholecystitis

-Deep palpation of RUQ along subcostal margin, ask patient to take a deep breath

-Positive sign = sharp, sudden pain and/or cessation of inspiration due to the inflamed gallbladder being pushed against your hand

McBurney's Point/Sign

-Examine for ...

-How to:

-Positive sign =

-Examine for appendicitis

-Anatomical landmark located 1/3 of the way between right ASIS and umbilicus

-Positive sign = pain/tenderness present and may be increased by direct palpation

Kehr's Sign

-Examine for ...

-Positive sign =

-Examine for splenic rupture

-Positive sign = palpation of LUQ elicits left shoulder pain

-May also indicate diaphragm or other peritoneal pathology

Aortic Aneurysm

Abnormal dilatation or outpouching of vessel wall due to degeneration or weakening of the elastin and protein fibers

Thoracic aortic aneurysm

-above diaphragm

-more life threatening

Abdominal aortic aneurysm (AAA)

-occur 4x more often than thoracic

-carry significant familial risk

Aortic Aneurysm & Dissection

-Palpation

-Palpation just left of umbilicus for enlarged, pulsating mass greater than 3 cm

Dissection/Rupture

Intimal tear creates a false lumen between the layers of the vessel wall, most likely to occur in aneurysms > 5cm

Aortic Aneurysm & Dissection: S&S

This is a medical emergency!

sudden, excruciating chest or upper back pain that migrates superior or inferior based on path of dissection, cardiogenic or hypovolemic shock, syncope, hypertension, reduced or absent pulses, murmur of aortic regurgitation, pleural effusion, neurologic compromise

Management of Aneurysm

-Nonsurgical: pharmaceutical (antihypertensives, anticoagulants)

-Surgical: resection, grafting, or repair via endovascular access or open incision

GI Diagnostic Procedures

Xray, CT, MRI, ultrasound, endoscopy, colonoscopy

endoscopy

scope entered through esophagus to duodenum to view stomach

colonoscopy

examination of the colon using a flexible colonoscope

Pneumoperitoneum

-what is it?

-what causes it?

-irration of ... causes...

-Free air or gas within the peritoneal cavity

-Common after laparoscopic surgery due to use of CO2 to inflate the abdomen leaves residual air bubbles behind

-Irritation on the phrenic nerve causes referred pain to shoulders (more commonly right side)

Typical Abdominal Surgical Precautions

-Do not ... items .. pounds

-Avoid movements that ...

-... for bed mobility

-... may be the most comfortable position while in bed

-Do not....

-Encourage ..

-Avoid ...

-An ... may be indicated

-Do not lift, push, pull items > 10 pounds

-Avoid movements that require you to over activate or stretch your abdominal muscles (Sitting straight up from a supine position, overtwisting your trunk, overextending backward)

-Logroll for bed mobility

-A pillow under the knees or sidelying may be the most comfortable position while in bed

-Do not bear down or hold your breath, splint with a pillow for coughing

-Encourage at least 3-5 "walks" per day: Mobility = Motility

-Avoid low seated surfaces

-An abdominal binder may be indicated

Antiemetic

prevents nausea and vomiting

1. ondansetron (Zofran)

2. metoclopramide (Reglan)

Antidiarrheal

1. atropine (Lomitil)

2. loperamide (Imodium)

GI irritation

famotidine (Pepcid)

Laxatives

1. psyllium (Metamucil)

2. docusate (Colace)

3. mineral oil (Fleet enema)

4. Fleet glycerin suppositories

5. lactulose

6. MiraLax

7. Dulcolax

8. Senokot

Proton Pump Inhibitors

1. omeprazole (Prilosec)

2. esomeprazole (Nexium)

3. lansoprazole (Prevacid)

4. pantoprazole (Protonix)

Esophageal Conditions: Dysphagia

Difficulty swallowing

-Oropharyngeal or esophageal

-Neuromuscular or structural

Esophageal Conditions: Dysphagia

diagnostic procedures

1. Barium Swallow Study

2. manometry

3. Esophagogastroduodenoscopy (EGD)

4. Upper GI Xray Series

5. fiberoptic endoscopic evaluation of swallowing (FEES)

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

a laryngoscopic technique for viewing swallowing

Barium Swallow Study

Diagnostic procedure to assess the upper gastrointestinal tract

Esophageal Conditions: Dysphagia treatment

Airway protection & nutrition maintenance is the priority

-Alternative means of nutrition

-Modified diet consistency

Dysphagia: PT consideration

caloric deficit impacting activity tolerance, fluid & electrolyte imbalance, positioning to reduce risk of aspiration

Enteral nutrition

Administered through a variety of tubes & routes directly into GI system

Parenteral nutrition

-Administered through ... with long-term usage requiring ...

-Terminate in the ... for ...

· Also used for ...

-Administered through intravenous access with long-term usage requiring central venous catheter (CVC)

-Terminate in the heart for direct administration of nutrition

· Also used for medications and therapeutic procedures

Enteral nutrition includes

NG, PEG, PEJ

Parental nutrition includes

CVC: Groshong, Hickman, port

Peripherally inserted central catheter (PICC)- typically in upper arm

Nasograstric tube (NG)

tube inserted through the nose into the stomach

PEG tube (percutaneous endoscopic gastrostomy)

an endoscopic procedure in which a tube is passed into a patient's stomach through the abdominal wall and mostly provides a means of feeding or oral intake

PEJ tube

percutaneous endoscopic jejunostomy tube - feeding tube

Varices

-what is it?

-strong association with:

-risk for:

-Dilated blood vessels in the lower third of the esophagus

-Strong association with portal hypertension, alcohol abuse, liver disease

-Risk for hemorrhage - eventual need for banding and/or resection

Varices

PT considerations

monitor for s/s of bleeding

Vomiting blood

hematemesis

Vomiting blood

Esophagectomy

-what is it?

-when is it used?

-invasiveness?

-the surgical removal of all or part of the esophagus

-esophagectomy is only primary treatment following chemotherapy and/or radiation

(for esophageal cancer)

-Advancements in minimally invasive surgery, but classically a very invasive, intense procedure with open incisions and thoracotomy

Esophagectomy

oral intake

Restricted oral intake until safe airway is established and diagnostics reveal no "leaks"

Esophagectomy PT considerations

PT Considerations: airway clearance, safe positioning to reduce aspiration risk, normal to have chest tube and surgical drain(s), standard postoperative effects

Stomach Conditions: Hemorrhage

-Upper (UGIB):

-commonly caused by:

-Upper (UGIB): esophagus, stomach, duodenum

-Commonly caused by ulcers, erosion, varices

-Peptic ulcer disease (PUD): most commonly caused by H. pylori infection or chronic NSAID use

(UGIB) Hematemesis

Hematemesis: fresh, bright blood in vomit

(UGIB) coffee ground emesis

"coffee ground" emesis: dark, gastric-acid exposed blood

(UGIB) Melena

Melena: black, tarry feces from blood moving through the entire GI tract - strong, rotten iron-like odor

(UGIB) Stomach Conditions: Hemorrhage

interventions:

PT considerations:

Interventions: blood transfusions, surgery to resect or cauterize the source

PT Considerations: immediate notification, monitor CBC, dietary restrictions

Stomach Conditions: Cancer

most common malignant tumor

Adenocarcinoma is most common malignant tumor - very rare for benign tumors

Stomach Conditions: Cancer

.... following chemo and radiation

Gastrectomy and anastomosis following chemotherapy and/or radiation

Stomach Conditions: Cancer

PT considerations

PT Considerations: dietary restrictions, standard postoperative effects

Intestinal Conditions: Hemorrhage

Lower (LGIB):

Lower (LGIB): colon or anorectum

Intestinal Conditions: Hemorrhage (LGIB)

-commonly caused by

-diagnostic procedures

-Commonly caused by inflammatory disease, ischemia, colitis, lesions (hemorrhoids), polyps, or cancer

-Diagnostic Procedures: endoscopy, colonoscopy, or both

Intestinal Conditions: Hemorrhage (LGIB):

S&S

-Hematochezia: fresh, bright blood in feces

-Bright red blood per rectum (BRBPR)

Intestinal Conditions: Hemorrhage (LGIB):

intervention

PT considerations

-Interventions: blood transfusions, surgery to resect or cauterize the source

-PT Considerations: monitor CBC, watch for S/S during bowel movement, dietary restrictions

Varices: CBC

pt presents with...

RBC, hemoglobin, and hematocrit decrease

acute anemia

pt presents with pallor, fatigue, and decreased activity tolerance

ileostomy/colostomy

Diseased section of colon or ileum removed + stoma + bag

Intestinal Conditions: Inflammatory diseases

nonsurgical

-Pharmacological agents to treat bowel symptoms and source of inflammation or infection

-Dietary and activity modifications

-Psychotherapy

Intestinal Conditions: Inflammatory diseases

surgical

-Resection with or w/out ostomy creation

-Parastomal hernia occurrence is nearly 50%

-Ostomy may be permanent or reversed later depending on disease process

Intestinal Conditions: Inflammatory diseases

PT considerations

PT Considerations: identify lines and drains, communicate with nursing to manage ostomy bag contents, monitor fluid & nutritional intake, electrolyte panel, standard postoperative effects

Abdominal Hernia common locations

inguinal, femoral, ventral, incisional, umbilical

Abdominal Hernia types

-Reducible: contents replaced within the surrounding musculature

-Irreducible or incarcerated: cannot be replaced

-Strangulated: compromised circulation, potentially fatal

Abdominal Hernia S&S

Distension, N/V, observable or palpable bulge, paresthesia with nerve compression, pain

Abdominal Hernia

nonsurgical

surgery

-Nonsurgical management in asymptomatic cases

-Surgery: reduction with reinforcement using mesh, wiring, fascia, or muscle flap

Abdominal Hernia

PT considerations

strict adherence to abdominal precautions, consider muscle flap source to avoid overuse, very commonly will use abdominal binder for external cueing and surgical site reinforcement

Hiatal Hernia is

Protrusion in an upward direction through the esophagus hiatus of the diaphragm into the thoracic cavity

Hiatal Hernia

S&S

Mimic *GERD*, dysphagia, epigastric or chest pain, dyspnea, hoarseness

Hiatal Hernia

-Nonsurgical management:

-Surgery:

-Nonsurgical management: lifestyle modifications and acid-reducers

-Surgery: reduction and repair

Hiatal Hernia

PT

-mixture of esophageal positions and abdominal precautions

-diaphragmatic breathing likely painful (accessory m breathing is okay)

Intestinal Conditions: Obstruction

mechanical

adhesions, tumor, herniation, inflammation

Ileus

Functional inhibition of normal bowel propulsion and motility most commonly caused by surgery, hypokalemia, peritonitis, trauma, spinal fractures, narcotics

(constipation after surgery)

Intestinal Conditions: Obstruction

S&S

Sudden onset of crampy pain, distension, N/V, lack of gas or bowel movements, high-pitched or absent bowel sounds

Intestinal Conditions: Obstruction

-Nonsurgical management:

-Surgery

-Nonsurgical management: NG or OG tube suction

"stomach pumping"

-Surgery: resection of blockage

Intestinal Conditions: Obstruction

PT

drain management, Mobility = Motility, monitor fluid & electrolytes due to quick shifts in fluid balance

Intestinal Conditions: Tumors

-... that may affect...

-Colorectal cancer is...

-Commonly associated with ...

-Benign, malignant, or metastatic neoplasms that may affect normal GI motility and function

-Colorectal cancer is third most common cancer worldwide

Second leading cause of cancer-related death

-Commonly associated with genetic predisposition and lifestyle factors as risk ↑ with age

Intestinal Conditions: Tumors management

-Resection with or w/out ostomy creation with chemotherapy and/or radiation

-Ostomy may be permanent or reversed later depending on disease process

Anorectal Conditions

-similar...

-includes:

-Similar etiologies & management as intestinal conditions

-Inflammation, obstruction, perforations, fistula, fissure, hemorrhage, tumor

Anorectal Conditions

S&S

PT:

-Most common sign is painful bowel movement & bloody stools

-PT Considerations: only difference is for transanal surgical approach which may restrict ability to sit and/or type of sitting surface