Introduc?on. A Massage Therapist s Guide to Pathology, 5e. Introduc?on. Introduc?on. Celiac Disease. Celiac Disease 6/10/14

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1 Introduc?on A Massage Therapist s Guide to Pathology, 5e Chapter 8 Diges?ve System Condi?ons The Diges?ve Tract: Structure and Func?on Follow a piece of food through the GI tract: Mouth, esophagus, stomach, small intes?ne, large intes?ne, rectum, anus Gallbladder and pancreas secre?ons into small intes?ne Introduc?on The Accessory Organs: structure and func?on Liver, gallbladder, pancreas The Liver Hepatocytes have great power of regenera?on High blood supply: hepa?c artery and portal vein Sugar storage, protein synthesis, detoxifica?on, recycling products of dead RBCs into bile Introduc?on The Gallbladder Receives bile, stores and concentrates it Releases bile into duodenum Emulsifies fats The Pancreas Endocrine and exocrine Diges?ve juices and bicarbonate to neutralize acidic chime Capable of autodiges?on if duct is blocked Celiac Disease Villi are flaxened, destroyed as reac?on to gluten 1% of US popula?on has it, although majority undiagnosed Gluten is in wheat, rye, barley, spelt, some other grains Villi degenerate, can t absorb anything: malabsorp?on, malnutri?on Gene?c link easy to trace but age of onset varies greatly Celiac Disease Signs and Symptoms: Malabsorp?on GI pain, vitamin deficiency Gas, bloa?ng, diarrhea Weight loss, failure to thrive, anemia, irritability, depression, muscle cramps 1

2 Celiac Disease Avoid all gluten: villi grow back Short- term steroidal an?- inflammatories Vitamin and mineral supplements as necessary Celiac Disease Risks: Abdominal work within comfort level, of course. Encourage clients to pursue nagging diges?ve symptoms. Skin rash that may be present is a local contraindica?on Benefits: Clients who manage celiac disease with diet have no contraindica?ons Op?ons: Use non- gluten topical oil or lo?on Inflamma?on of the stomach or small intes?ne Related to infec?on, can be hard to discern causes Some pathogens secrete toxins that damage intes?nal mucosa Some pathogens invade healthy cells When diges?on is impaired, pathogens can become more aggressive Causes: Viruses: Norwalk virus, rotavirus, hepa??s, enterovirus Bacteria: Salmonella, E. Coli: food poisoning Helicobacter pylori (pep?c ulcers) Parasites: Giardia, cryptosporidium Infec?ous forms are highly communicable Oral- fecal Contaminated water, ice Food prepared on contaminated surfaces Dehydra?on Signs and Symptoms: Abdominal pain, nausea, vomi?ng, and diarrhea Bloa?ng, cramps, gas, mucous or blood in stool Usually self- limi?ng Prevent through rigorous hygiene An?bio?cs can make symptoms worse An?- diarrhea meds are discouraged IV fluids if necessary 2

3 Risks: Client may be uncomfortable, contagious Benefits: Helps with parasympathe?c state Damage to the squamous epithelial lining of the esophagus Chronic exposure to gastric juices from stomach Problems at lower esophageal sphincter (LES) LES is too relaxed Hiatal hernia Slow stomach emptying, back- pressure at LES Risk factors include Pregnancy, obesity, smoking, diet, connec?ve?ssue diseases Radia?on for chest tumors, infec?on of the esophagus, some medica?ons Signs and symptoms: BiXer taste, heartburn, gas, indiges?on, bloa?ng, pain in chest Can look like angina, heart axack Aggravated by lying down, bending over Lose weight; smaller por?ons; don t lie down afer meal; avoid caffeine, alcohol, nico?ne; raise head of bed; wear loose clothing; hea?ng pad on abdomen Surgery to repair LES, hiatal hernia Medica?on Antacids H2 blockers to reduce histamine and acid produc?on Proton pump inhibitors to reduce acid produc?on Risks: Cau?on not to exacerbate symptoms. Schedule hours afer last meal. Not lying flat. Cau?on around superior abdomen Benefits: Can enjoy same benefits as the rest of the popula?on if managed correctly 3

4 Diver?cular Disease Bulge in colon forming diver?culum Diver?culosis: presence of bulges Diver?culi?s: infec?on of bulges One- half of year olds have diver?culae Most common with ea?ng habits with white flour, animal fats Diver?cular Disease Mul?factoral: Inefficient mo?lity Poor strength in colon wall Lack of sufficient dietary fiber Signs and symptoms: May be silent With infec?on: bloa?ng, fever, nausea, cramping, pain usually on lower lef side of abdomen May have sudden or gradual onset Diver?cular Disease Prevent with high fiber diet, adequate water Surgical correc?on if necessary An?bio?cs when infec?on is present Analgesics as necessary An?- inflammatories as necessary An?- spasmodics to decrease colon pressure Diver?cular Disease Risks: Important to advise client to pursue formal diagnosis if showing upset diges?ve symptoms for more than two weeks. If diagnosed, deep abdominal work is contraindicated. Acute infec?on systemically contraindicates bodywork Benefits: As long as care is taken not to exacerbate symptoms, bodywork can be a helpful strategy to deal with anxiety and abdominal pain Diges?ve system dysfunc?on without structural changes Also called spas?c colon, irritable colon, mucus coli?s, func?onal bowel syndrome Colon is hyperreac?ve: small s?muli create big responses Peristalsis is irregular, uncoordinated Hypersensi?vity to pain, pressure in colon Appears with chronic fa?gue syndrome, fibromyalgia 4

5 Signs and symptoms: Abdominal pain, cramps, bloa?ng, cons?pa?on/ diarrhea, general malaise Recurrent abdominal pain at least 3 days every month Pain with defeca?on Changes in stool frequency and appearance Depends on the individual Manage diet, stress Eliminate nico?ne, alcohol, caffeine, sorbitol, maybe dairy Supplement fiber Alterna?ve medicine: acupuncture, peppermint, probio?cs An?spasmodics Fecal binders for diarrhea An?diarrheals Antacids An?depressants/an?anxiety for stress management Risks: Clients can be extremely self- conscious about passing gas, nervous about touch in general. Make it difficult for a person to enjoy the experience of massage Benefits: Can be useful for stress management if well tolerated Greek kirrhos = yellow condi?on Replacement of healthy hepatocytes with non- func?oning scar?ssue Can interfere with every liver func?on Hepatocytes usually replace themselves easily, but they can lose that ability: Chronic inflamma?on, irrita?on E?ology Causes include: Alcoholism, hepa??s C, B, D, drug related, autoimmune hepa??s NAFLD: non- alcoholic faxy liver disease 5

6 Complica?ons: Portal hypertension: liver is congested, can t accept blood from major vessels Ascites Fluid in peritoneal cavity Jaundice Bilirubin does not get recycled Complica?ons Systemic edema Significant reduc?on of albumin, cannot maintain proper body fluids Hormone disrup?on Feminizes men, masculinizes women, decreased sex drive for both Liver failure Liver cancer Signs and symptoms Silent or subtle early Nausea, vomi?ng, weight loss, rashes Later: complica?ons listed above Stop liver damage (quit drinking) Liver transplant Living donor is possible Diure?cs Beta blockers Hepa??s may be treated with interferon Antacids Steroidal an?- inflammatories for autoimmune problems Risks: Advanced disease contraindicates circulatory massage (fluid movement) as clients do not have the capacity to adapt. Benefits: Gentle, reflexive (non- circulatory) bodywork can be safe and helpful for anxiety reduc?on. If client is encouraged to exercise to promote muscle recovery, massage will fit well into this context Gallstones Concentrated deposits of bile salts or pigments in the gallbladder Stone lodged in common bile duct Inflamma?on of ducts = cholangi?s 800,000 hospitaliza?ons, 500,000 surgeries/year Women > men 2:1 6

7 Gallstones Gallbladder squeezes bile into duodenum through common bile duct Most gallstones = cholesterol Signs and symptoms: Extreme local pain rises to peak, then subsides as stone moves Refers pain to mid- back, scapula, right shoulder Gallstones Surgery to remove gallbladder; usually laparoscopic Diges?ve supplements to aid fat diges?on Analgesics for acute gallbladder axacks Gallstones Risks: Contraindicated during axack. Costal angle on right side a local cau?on if client knows stones are present Benefits: History of stones or surgery is fine for massage. Hepa??s Inflamed liver Usually a viral infec?on (hepa??s A- G) Almost always A B or C Viral axacks on hepatocytes Exposure to one type confers no protec?on from others Hepa??s Signs and Symptoms General malaise, weakness, fever, nausea, food aversion, some?mes jaundice HAV most extreme symptoms for shortest?me HBV and HBC more subtle un?l much liver func?on is lost Hepa??s HBV, HBC treated with rest, good nutri?on, and pa?ents during a long recovery period Liver transplant in serious cases HAV typically treated with a shot of immunoglobin HBV, HBC treated with an?viral agents 7

8 Hepa??s Risks: Any bodywork that puts adap?ve stress on the body may be overwhelming during acute phase. Some types of hepa??s are contagious without direct contact with body fluids which presents a risk to the therapist Benefits: Appropriate for non- acute if client can adapt. Can improve QOL for a person dealing with a challenging situa?on. A client who has fully recovered can enjoy all benefits 8