Gastrointestinal Disorders. Objectives. Objectives 2/5/2010. PTA 103 Intro to Clinical Practice 2
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1 Gastrointestinal Disorders PTA 103 Intro to Clinical Practice 2 Objectives Objectives 1. Recall the anatomy and physiology of the upper GI lower GI, and GI gland organs 2. Recall anatomic regions of the abdomen 3. Describe common classifications of GI disorders 4. Describe signs, symptoms and risk factors for common GI disorders Objectives 1. Describe treatments for common GI conditions 2. Describe common patient support equipment for patients with GI dysfunction 3. Describe obesity (cause, risk factors, classification using BMI, weight management, medical management, and surgical interventions) 4. Discuss the impact of the cost of treatment associated with obesity 1
2 Objectives Reflect on how prejudice and attitude may impact effectiveness of physical therapy Select tests and measures for activity progression based on the PT plan of care for a given case simulation Communicate with the PT based on analysis of data collected for a given case simulation Describe the role of the PTA in health and wellness management for a given case simulation 2
3 Common Classifications of GI Disorders Infectious (bacterial, viral) Autoimmune/Immunosuppressive Genetic predisposition Lifestyle (smoking, EtOH, diet, stress) Medication use (aspirin, NSAID, antibiotics) Cancer Trauma Abdominal surgery (current or history of) Common Signs and Symptoms of GI disorders Nausea Vomiting Anorexia Diarrhea Constipation Fluid and electrolyte imbalances Pain (abdominal and referred) Malnutrition Common Treatments For GI Disorders Dietary Modifications Alcohol Caffeine Stress Reduction Drugs Anti-emetic Anti-diarrheal Antacid Laxative Acid reducers Surgical intervention Hernia repair Gastric bypass Bowel resection Gland removal 3
4 Upper GI Candidiasis Yeastinfection the oral cavity Upper GI Herpes Simplex 1 Viral infection Thrush Cold Sore Fever blister Antibiotic use Immuno-suppression Contactby mouth with carrier/host Red, swollen mouth with white patches that can be scraped off Weigh loss due to pain in mouth with eating Burning blister in or around mouth Upper GI Dysphagia Aspiration Neuromuscular impairment GI Disease Difficulty with safe and effective, chew and swallow Coughing with eating and/or drinking Upper GI Upper GI GERD Reflux of gastric contents into stomach Barrett s Esophagus Change in epithelial cell morphology Acid Reflux Barium Swallow Endoscopy Chronic GERD NSAID use EtOHuse Infection Smoking Excessive acid production EtOHuse Smoking May lead to esophageal cancer Heartburn Regurgitation Esophagitis Dysphagia Pain(sub-sternal, non-cardiac) Sore or hoarse throat Hematemesis Sameas GERD with increased severity Upper GI Esophageal Cancer Squamous carcinoma Achalasia Stricture EtOHuse Smoking Diet imbalances Same as GERD,with increased severity, weight loss, pain Achalasia A Ka Lay ja 4
5 Stomach Stomach Gastritis Inflammation of inner stomach layer (mucosa) Can lead to electrolyte imbalance Peptic Ulcer Disruption of the gastric or duodenal mucosa Dyspepsia Bleeding Perforation Obstruction Trauma Samonellainfection NSAID Aspirin EtOH Renal failure Liver failure Mechanical ventilation >48 hrs EtOHuse Diet Stress NSAIDs Bacterial infection Hemorrhage Fever Epigastric Pain Nausea Anorexia Hematemesis Burning, gnawing pain Reduction of pain with eating Burping Nausea and/or vomiting Bleeding Lower GI Lower GI Irritable Bowel Syndrome(IBS) Colon dysfunction Crohn s Disease Inflammation of intestinal wall BRAT diet (banana, rice, apple, tea or toast) Ileitis Enteritis Stress Decreased sleep Dietary exacerbations (wheat, rye, barley, milk, EtOH, caffeine) Unknown Possible autoimmune response to bacterial or viral infection Alternating loose stoolsand constipation Bloating with abdominal pain Cramping Mucous/blood in stool Abdominal pain Diarrhea Occ.Rectal bleeding Weight loss Small bowel obstruction Fistula formation Nutritional Deficiencies Lower GI Ulcerative Colitis Inflammation of colon and /or rectum Inflammatory bowel disease Unknown Possible autoimmune response to bacterial or viral infection Alternating loose stoolsand constipation Bloating with abdominal pain Cramping Mucous/blood in stool 5
6 Intestinal Intestinal Whipple s Disease Bacterial malabsorption condition Short Bowel Syndrome Disorder from surgery where >50% of small intestine is removed Malabsorption condition Malnourishment Total parenteral nutrition (TPN) Exposure to Tropheryma Whippelli Hxof abdominal surgery Crohn s IBS UC Trauma Abdominal pain Weight loss Incomplete breakdown of intestinal materials Diarrhea Intestinal bleeding Fatigue and Weakness Weakness Fatigue Depression Dehydration and malnourishment Weight loss Diarrhea Cramping and bloating Heart burn Intestinal Intestinal/ bowel& abdomen Diverticulosis Small outpouchings or herniations in intestinal wall Ostomies Surgical openings of from intestine or bowel to the outside Diverticulitis Intestinal necrosis Ileostomy (removalof colon and rectum) Colostomy (removal of colon) Advanced age Low fiber diet HX cancer, intestinal disease Trauma Abdominal pain Fever and chills Nausea and vomiting Cramping Constipation Fistula formation External pouch for collection and elimination of waste Intestinal & abdominal Hernia Abdominal protrusion through a weak are in the abdominal wall Inguinal (groin) Abdominal Femoral Hiatal Herniorrhaphy or hernioplasty (reduction hernia and abdominal reinforcement) Obesity Heavylifting Straining during bowel movements Pregancy Impaired nutrition Placement of drains General debility Vascular Hemorrhoids Sitz bath Age(>50 yrs) Straining during bowel movements Chronic constipation Groin pain Palpable lump in groin Bowel obstruction Relief with applying pressure Shortness of breath Pain Discomfort in sitting Itching Bleeding (anal canal and/or rectum) 6
7 Liver Liver Liver Jaundice Excessive bile production Cirrhosis Fibrosis of liver tissue Hepatitis Inflammatory Process in the liver; typically viral Fatty liver (alcoholic) Blood born pathogen Cirrhosis Hemolytic anemia EtOH Hepatitis B, C, D Drugs and infection Autoimmune hepatitis Viral infection EtOH Yellowing of skin, eyes and fingernails Effects multiple body systems Effects multiple body systems Gallbladder Cholelithiasis Gallstones Gender (Female) Diabetes Obesity Ethnicity Pancreas Pancreatitis Inflammation of pancreas EtOH Calcium malabsorption Infection Abdominal trauma Severe epigastric or RUQ pain Referred pain under the right scapula Indigestion after eating fatty foods Nausea and/or vomiting Abdominal/epigastric pain (worse with eating, walking, supine) Radiating pain to back Abdominal swelling Nausea or vomiting Fever Dehydration Hypotension Obesity Second most preventable cause of death (smoking is first) Classified by Body Mass Index of >+30 body weight as fat Increased risk of developing physiological impairments and disease Type II diabetes HTN CAD CVA OA Asthma Obstructive sleep apnea 7
8 Obesity Psychosocial impacts Poor functional status results in restricted activity Pain Negative health perception Depression Cost of health care increases due to preventative, diagnostic and treatment services Higher incidence of disability Discrimination and abuse reported Evidence shows health care providers associate obese patient with poor hygiene, laziness General lack of equipment/supplies to accommodate larger patients (BP cuffs, gowns, exam tables, scales) decreases willingness to seek medical care Weight Loss 5-10% reduction can produce measurable health benefits Decreased absenteeism from work reported from surgical and non-surgical weight loss programs Patients who are morbidly obese (BMI > 40 kg/m2, or 100 pounds over ideal weight) may qualify for bariatric surgery (gastric bypass) for weight control Patient support equipment Intravenous fluids (IV) Total Parental Nutrition (TPN;IV delivery of food and nutrients) PEG, N-G tube Red blood cell infusions Jackson-Pratt drains (JP) aids in removing fluid from abdominal wounds Sump drains suction device to remove fluid from abdominal/surgical wounds Foley catheter Colostomy bag 8
9 Role of the PT Complete a systems review and an examination Collect and document baseline subjective and objective data, tests, and measures Interpret examination findings Prioritize primary and secondary impairments, functional limitations and disability Document any contraindications to PT treatment Develop a plan of care comprised of interventions to address reason for skilled PT Develop a plan of care Set short and long term, patient-specific, measureable goals and expected outcomes for PT treatment Set a frequency and duration for treatment Establish a discharge plan based on expected outcome PT/PTA Relationship Maintain positive, open, timely, patient-centered communication Delegate and accept responsibilities for treatment based on the skill level of the PTA POC PT: Modify and update POC based on progress reported or reassessment PTA: Document patient status (progress/barriers) and request clarification or input as needed depending patient response and skill set Tests and Measures Aerobic Capacity and Endurance VS pre-post-activity, Borg PLE, O2 sats, observation for s/sxof cardiopulmonary response Anthropometric Characteristics Height, weight, BMI, edema measures Arousal, attention, cognition A&O, memory and recall 9
10 Pain Tests and Measures VAS, faces scale, location, referral patterns Joint Integrity and Mobility Range of motion(prom/arom) extremities and trunk Functional Activity Performance FIM, Oswestry Disability Index Interventions for Impairments Impairment of endurance/aerobic capacity Treatment: 1. Log rolling/bracing with pillow 2. Transfer training 3. Endurance training (gait, exercise) Interventions for Impairments Impairment of ventilation/respiration Treatment: 1. breathing exercises 2. incentive spirometry 3. huffing/directed cough 4. chest percussion and vibration 10
11 Interventions for Impairments Impairment of integument integrity Treatment: 1. Wound care for incisions 2. Skin/wound care for ostomies Interventions for Functional Limitations Decreased ADLs and Self-Care Treatment: 1. Training in adaptive devices and equipment 2. Environmental assessment and modifications Interventions for Disability Prevention and Wellness Education in 1. Lifestyle modification/decreasing risk of recurrence 2. Energy conservation (pacing and prioritizing) 3. Ostomycare 11
12 Considerations for Billing Document minutes spent providing direct patient care (can include set up and patient communication/family training if patient is present) Consider the impairment you are treating when selecting an appropriate billing code Endurance (therex or theract 97530) Joint mobility (therex 97110) Functional mobility (ther act ) Breathing exercises ( therex 97110) Energy conservation techniques ( ther act 97530) Chest PT (manual therapy 97140) 12
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