PT 740 – Acute Care --Gastrointestinal - Final 2025

PT 740 - ACUTE CARE GASTROINTESTINAL SYSTEM

AGENDA

  • 1. Anatomy and Physiology Review

  • 2. Relevant lab & diagnostic tests

  • 3. Surgical procedures

  • 4. Conditions of the GI system

  • 5. Physical therapy considerations

  • 6. Pharmacology

ANATOMY AND PHYSIOLOGY REVIEW

Layers of the Abdominal Wall

  • Skin: epidermis and dermis

  • Superficial fascia (subcutaneous tissue):

    • Camper’s fascia: superficial fatty layer

    • Scarpa’s fascia: deeper membranous layer

  • Investing fascia: connective tissue covering muscle layers

  • Abdominal muscles:

  • Endoabdominal fascia

  • Extraperitoneal fat

  • Peritoneum

Abdominal Muscles

  • Rectus abdominus:

    • Located within the rectus sheath for superior 3/4

    • Function: Compresses abdominal viscera and flexes trunk

  • External oblique:

    • Function: Compresses/supports abdominal viscera; flexes and rotates trunk

  • Internal oblique:

    • Function: Compresses/supports abdominal viscera; flexes and rotates trunk

  • Transversus abdominus:

    • Function: Compresses abdominal viscera and flexes trunk

Referred Pain

  • Visceral Peritoneum: innervated by visceral afferent fibers through sympathetic and parasympathetic nerves.

  • Characteristics of Pain:

    • More poorly localized, giving rise to referred pain

Pain Referral Patterns

  • Structure: Segmental Innervation: Areas of Pain Referral

    • Esophagus: T4-6 - Substernal region, Upper abdomen

    • Stomach: T6-10 - Upper abdomen, Middle/lower thoracic spine

    • Small Intestine: T7-10 - Middle thoracic spine

    • Pancreas: T6-10 - Upper abdomen, Upper/lower thoracic spine

    • Gallbladder: T7-9 - Right upper abdomen, Middle/lower thoracic spine

    • Liver: T7-9 - Thoracic spine, Right cervical spine

    • Common Bile Duct: T6-10 - Upper abdomen, Middle lumbar spine

    • Large Intestine: T11-L1 - Lower abdomen, Middle lumbar spine

    • Sigmoid Colon: T11-12 - Upper sacral region, Suprapubic region, Left lower quadrant of abdomen

RELEVANT LAB AND DIAGNOSTIC TESTS

Relevant Lab Tests

  • Serum Albumin:

    • Indicates nutritional status, oncotic pressure of blood, protein loss due to liver, renal, skin, or intestinal diseases

    • Reference range: 3.5-5.2 g/dL

  • Serum Prealbumin:

    • Indicates current nutritional status

    • Reference range: 19-39 mg/dL:

      • 0-5 mg/dL: severe protein depletion

      • 5-10 mg/dL: moderate protein depletion

      • 10-15 mg/dL: mild protein depletion

    • Implications: Monitor skin and nutrition, assess for edema, hypotension

  • Serum Bilirubin:

    • Evaluates liver function

    • Reference range: 0.3-1.0 mg/dL; Critical value: > 12 mg/dL

    • Clinical presentation of trending upward: Fatigue, jaundice

    • Implications: activity levels and education adjustments

Additional Lab Tests

  • Ammonia (NH3):

    • Liver function and metabolism evaluation

    • Reference range: 15-60 μg/dL; High levels indicate hepatic dysfunction

    • Symptoms of high ammonia: confusion, lethargy

    • Therapy implications: Adjust communication, increased fall risk

  • MELD Score: predicts survival for advanced liver disease, considers bilirubin, creatinine, INR

  • Diagnostic Tests:

    • Laparoscopy, Colonoscopy, Endoscopic evaluations, etc. with implications for therapy noted

SURGICAL PROCEDURES

Open vs. Laparoscopic Approach

  • Laparoscopic procedures reduce length of stay and complications

  • Common postoperative complications: pulmonary infection, wound infection, deconditioning

Anesthesia Considerations

  • Postoperative effects: nausea/vomiting, vital signs monitoring

  • Nerve blocks may cause lower extremity weakness

Common Surgical Procedures

  • Appendectomy: Removal of appendix

  • Cholecystectomy: Gallbladder removal, typically laparoscopic

  • Colectomy: Resection of colon segment, can involve stoma

  • Fundoplication: Reinforces esophageal sphincter

  • Hernia Repair: Open/laparoscopic; may involve mesh

  • Colostomy/Ileostomy: Diverts stool outside the body, requires care

Other Surgical Procedures

  • Gastric Bypass: Limits intake for weight loss

  • Whipple Procedure: Extensive surgery for pancreatic conditions

CONDITIONS OF THE GASTROINTESTINAL SYSTEM

Common Symptoms

  • Esophagus: Dysphagia, Chest pain

  • Stomach/Intestines: Abdominal pain, Nausea, Vomiting

  • Liver/Gallbladder: Fatigue, Jaundice

  • Infectious Processes: Fever, Tachycardia

Dysphagia

  • Classifications: oropharyngeal vs. esophageal

  • Symptoms include pain with swallowing, feeling of food getting stuck

Aspiration Pneumonia

  • Characterized by micro-aspiration into lungs, risk factors include age and neurological disease

Dysphagia PT Considerations

  • Ensure upright positioning, encourage oral hygiene practices

  • Team coordination for feeding and swallowing techniques

PHYSICAL THERAPY CONSIDERATIONS

Management for GI Patients

  • Postoperative: Limited movement, monitoring, and pain management

  • Early mobilization to minimize complications

PHARMACOLOGY

Common Medications

  • Opioids: Pain management; decreased GI motility

  • Nonabsorbable disaccharides: Treatment for hepatic encephalopathy

REFERENCES

  • Hansen JT. Netter’s Clinical Anatomy. Fifth Edition. Elsevier; 2022.

  • Paz JC et al. Acute Care Handbook for Physical Therapists. Fifth edition. Elsevier; 2020.

  • APTA Acute Care Laboratory Values Interpretation Resource.

  • Simpson AJ et al. BTS clinical statement on aspiration pneumonia. Thorax. 2023.