1
Q
Hiatal Hernia
Definition/Presentation
Protrusion, Affects % population?
A
- A protrusion of a portion of the stomach through
the esophageal hiatus - Affects ~15% of the population; possible it rises
to ~60% for persons 60+ - Very few have symptoms, and even fewer require
treatment or surgery - Presentation:
- minor to severe reflux
- indigestion, bloating, and/or dysphagia
2
Q
Hiatal Hernia
Etiology
Diaphragm, injury, born with
A
- Unknown causes for most hiatal hernias, however there are certain things that increase risk:
- Age-related changes in your diaphragm (>50, progressive weakness)
- Injury to the area, for example, after trauma or certain types of surgery
- Being born with a very large hiatus
- Constant and intense pressure on the surrounding muscles. This can happen while coughing, vomiting, straining during a bowel movement, exercising or
lifting heavy objects. - Obesity
3
Q
Hiatal Hernia
Types of Hiatal Hernia
Two types
A
- There are two types of hiatal hernias, categorized by what portion of the stomach bulges through the diaphragm
- Sliding Hernia (Type I): 95%
- Paraesophageal Hernia (Type II): 5%
4
Q
Types of Hiatal Hernia
Sliding Hernia (Type I)
Protrusion of…, creates bell-shaped,
A
- protrusion of the LES and gastroesophageal junction through the diaphragm
- Creates bell-shaped dilation d/t constriction of LES about and constriction of diaphragmatic narrowing below
5
Q
Types of Hiatal Hernia
Paraesophageal Hernia (Type II)
Fixed protrusion of…
A
- fixed protrusion of a separate portion of the stomach into the thorax
- LES and gastroesophageal junction remain below the diaphragm, while herniated portion is beside the esophagus
6
Q
Hiatal Hernia
Signs and Symptoms
Most sliding hernias, MC ssx, incarceration, bleeding
A
- Most sliding hernias are asymptomatic or have minor SSx
- MC SSx:
- indigestion, especially if laying after eating
- May have dull chest pain, SOB, heart palpitations
- Increased w/ trunk flexion, straining, heavy lifting, and pregnancy
- Can lead to incarceration, especially paraesophageal hernias
- Microscopic or massive bleeding in either type is rare
7
Q
Hiatal Hernia
Complications
Strangulation, stomach pinched by, SSx
A
- Strangulation = painful and emergent complication of paraesophageal hernias
- Stomach pinched by diaphragm and loses blood supply
- SSx: chest pain, bloating, belching, and dysphagia
8
Q
Hiatal Hernia
Diagnosis & Treatment
A
Diagnosis
- Barium x-ray
Treatment
- Most sliding hernias do not require treatment
- Lifestyle changes: raising head of bed, eating small meals/not eating before sleep, weight
loss, smoking cessation, looser clothing - Eliminate cola, acidic juices, alcohol, coffee, and spicy/fatty foods
- Rx: H2 blockers or PPI
- Paraesophageal hernias that cause SSx should be surgically repaired to prevent
strangulation
9
Q
Hiatal Hernia
Massage and Hiatal Hernia
A
- LOCAL CONTRAINDICATION
- Avoid or only light pressure over effective area
- Be conscious of patient positioning and comfort
10
Q
Gastroesophageal Reflux Disease (GERD)
Definition
Backflow of,
A
- Backflow of stomach acid and enzymes from the stomach into the esophagus, causing esophageal inflammation (called reflux esophagitis)
- Stomach lining includes mucus secreting cells to protect from acid
- Esophagus lacks protective lining
- Acid causes inflammation and eventually erosion
11
Q
Gastroesophageal Reflux Disease (GERD)
Etiology
A
- Malfunction of LES permits stomach contents into esophagus
- Risk factors: hiatal hernia, obesity, pregnancy, fatty foods, chocolate, caffeinated and carbonated drinks, alcohol, smoking, certain drugs
- Anticholinergic drugs, calcium channel blockers, progesterone, and nitrates may interfere with LES fxn
12
Q
Gastroesophageal Reflux Disease (GERD)
Signs and Symptoms
A
- MC SSx: heartburn and regurgitation
- Occasionally pain extends to neck, throat, and face
- Other SSx: sore throat, hoarseness, excessive salivation, sensation of lump in throat, dry cough
- Slight or massive bleeding d/t inflammation
- Vomited or passed as black, tarry stool (melena)
13
Q
Gastroesophageal Reflux Disease (GERD)
Complications
A
- Esophageal ulcers d/t chronic reflux (present like heartburn)
- Stricture d/t chronic ulceration
- dysphagia, SOB, and wheezing
- Barrett’s esophagus: metaplastic changes d/t acid irritation
- Changes may occur even in the absence of symptoms
14
Q
Gastroesophageal Reflux Disease (GERD)
Barrett’s esophagus
A
- GERD complication: Barrett’s esophagus
- Switch of cell type from stratified squamous
epithelium to columnar - Why?
15
Q
Gastroesophageal Reflux Disease (GERD)
Diagnosis
A
- Based on SSx; no diagnostic tests needed to start treatment
- Special testing available when Dx is unclear or when treatment has failed to control sx
- Endoscope, x-ray studies, pressure measurement of LES, and esophageal pH testing
16
Q
Gastroesophageal Reflux Disease (GERD)
Treatment
A
- Lifestyle changes: similar to changes for hernias
- Eating habits, remove irritating foods, etc.
- Parasympathetic stimulators to tightly close LES
- H2 (histamine-2 receptor) blockers or PPIs (proton pump inhibitors) to reduce acid
17
Q
Gastroesophageal Reflux Disease (GERD)
Massage and Gastroesophageal Reflux Disease (GERD)
A
- No contraindications
- Be mindful of patient positioning and timing of massage
18
Q
Diaphragmatic Hernia
Definition
A
- protrusion of organs into the thoracic cavity through a weakening in the diaphragm (that’s not the esophageal hiatus)
- Stomach and/or intestines push through weakened opening
19
Q
Diaphragmatic Hernia
Etiology
Congenital, Acquired
A
- Congenital: d/t embryologic defect of diaphragm (affected neonates usually present in the first few hours of life w respiratory distress)
- Acquired: MC cause is blunt force trauma (diaphragm usually injured in association w other thoracic and abdominal organs)
20
Q
Diaphragmatic Hernia
Signs and Symptoms
A
- abdominal pain
- decreased breath sounds
- SOB
- auscultation of bowel sounds in chest
- potential bulge
- Nearly half of adults don’t have any SSx
21
Q
Diaphragmatic Hernia
Complications
A
- Incarceration of organs
- Incarceration can cause strangulation
- Strangulation can lead to perforation and peritonitis
- Surgical emergency
22
Q
Diaphragmatic Hernia
Treatment
Congenital, Acquired
A
- Congenital: surgical repair within 24-48 hours
- Acquired: surgical repair as soon as patient presents with symptoms
23
Q
Diaphragmatic Hernia
Prognosis
A
- Recurrence possibly, but rare
- Routine check-ups w/ CXR and PFTs
24
Q
Diaphragmatic Hernia
Massage and Diaphragmatic Hernia
A
- LOCAL CONTRAINDICATION
- Avoid or only light pressure over effective area
- Be conscious of patient positioning and comfort
25
# Pyloric Stenosis
Definition
* Congenital or acquired pyloric hypertrophy resulting in **blockage of passageway between stomach and duodenum**
* Pylorus fxn: contracts to keep food in stomach for digestion and relaxes to release food into duodenum
* Results in gastric outlet obstruction - prevents stomach from emptying into SI and food backs up into esophagus
26
# Pyloric Stenosis
Etiology
| Congenital
* Congenital (more common): congenital, idiopathic hypertrophy that becomes apparent w/in first month of life
* Possible genetic component
* Linked to other genetic and congenital conditions: Turner syndrome, trisomy 18, and esophageal atresia
* 3-4x more common in males
27
# Pyloric Stenosis
Etiology
| Acquired:
* Acquired: pyloric hypertrophy related to gastritis or peptic ulcers near gastric antrum
28
# Pyloric Stenosis
Signs and Symptoms
* Regurgitation
* Persistent, projectile, nonbilious vomiting after feeding (projectile vomiting)
* Can lead to dehydration and FTT in infants
* Common to have infants seem hungry and want to feed again after they vomit
* PE reveals visible peristalsis and palpable, olive sized mass
29
# Pyloric Stenosis
Diagnosis and Treatment
**Diagnosis**
* Abdominal US
**Treatment**
* Surgical muscle splitting (pyloromyotomy)
* IV fluids to correct dehydration
30
# Pyloric Stenosis
Massage and Pyloric Stenosis
* LOCAL CONTRAINDICATION
31
# Acute Gastritis
Definition
* aka Erosive Gastritis
* Transient, self-limiting inflammation of the gastric mucosa with neutrophilic infiltration
* Characterized by hemorrhagic defects that extend through the entire thickness of the mucosa w/ sloughing of the superficial mucosa
32
# Acute Gastritis
Etiology
* MC causes: NSAIDs (aspirin), H. pylori, EtOH, smoking, and Crohn’s
* Emotional stress
* Increased acid production and decreased mucous production
* Severe stress to the body
* Illness or injury w/ severe burns or bleeding
* Results in ischemia of mucosal lining
33
# Acute Gastritis
Signs and Symptoms
* Often there are no SSx, but are variable if they do occur
* Common SSx: epigastric pain/pressure, indigestion, nausea/vomiting
* Severe SSx: overt hemorrhage, massive hematemesis, melena
* Anemia w/ fatigue, weakness, and light-headedness
34
# Acute Gastritis
Complications
* Ulceration w/ significant bleeding
* Gastric perforation w/ peritonitis
* Gastric atrophy leading to chronic gastritis
35
# Chronic Gastritis
Definition
* Inflammation of the gastric mucosa w/ infiltration of lymphocytes and plasma cells and associated with mucosal atrophy and intestinal metaplasia
* Thinning (atrophy) of stomach lining leads to loss of many or all cells that produce acid and digestive enzymes
36
# Chronic Gastritis
Etiology
* Subtypes: autoimmune & environmental
* H. pylori is MC environmental cause
* Other examples: NSAIDS (aspirin), EtOH, smoking, Crohn’s
37
# Chronic Gastritis
Signs and Symptoms
* Most often asymptomatic
* Common SSx, if they occur: vague, mild dyspepsia
* Poor digestion and decreased protein breakdown if HCl secretion is reduced
* Malabsorption
* Pernicious anemia and polyneuropathies d/t lack of B12 absorption
* Why?
38
# Chronic Gastritis
Treatment
* Discontinue and avoid drugs that can aggravate gastritis (aspirin, NSAIDs)
* Eradicate H. pylori
* Triple therapy
* PPIs and 2 antibiotics
39
# Gastritis
Acute v. Chronic Gastritis
| Onset, duration, immune reaction, etiology, symptoms
**Onset:**
* Acute: Abrupt,
* Chronic: Gradual
**Duration:**
* Acute: 1 day-6 months,
* Chronic: > 6 months
**Immune Reaction:**
* Acute: Neutrophils,
* Chronic: Lymphocytes and plasma cells
**Etiology:**
* Acute: H. pylori, alcohol, NSAIDS, severe stress,
* Chronic: H. pylori, autoimmune
**Symptoms:**
* Acute: Dyspepsia, N/V, hemorrage, hematemesis
* Chronic: Dyspepsia, malabsorption, pernicious anemia
40
Massage and Gastritis
* LOCAL CONTRAINDICATION
* Avoid abdominal massage
* Patients with acute gastritis may need medical treatment depending on severity
* Postpone massage until recovered
41
# Peptic Ulcer Disease (PUD)
Definition
* sharply demarcated, round or oval ulcerations in the lining of the stomach or duodenum
* Can be Acute or Chronic
* Acute usually shallow gastric lesions w/o mounted immune response and are related to NSAIDs
42
# Peptic Ulcer Disease (PUD)
Anatomic classifications
| Duodenal, Gastric, Marginal
* **Duodenal:** most common type, occurs in first few inches of unprotected duodenum d/t gastric juice and digestive enzymes
* **Gastric:** typically occur along lesser curvature at the antrum stomach
* **Marginal:** occur where stomach has been surgically removed and anastomosed to intestine
43
# Peptic Ulcer Disease (PUD)
Etiology
* Imbalance in gastroduodenal mucosal defense mechanisms and damaging forces (HCl and pepsin)
* MC cause: H. pylori
* Present in 90% of people w/ duodenal ulcers and 75% of people w/ gastric ulcers
* Other causes: NSAIDs, corticosteroids, severe stress, smoking
44
# Peptic Ulcer Disease (PUD)
Signs and Symptoms
* ~70% of peptic ulcers are ASx
* MC SSx: Gnawing, burning, aching epigastric pain
* Pain often waxes and wanes (in periods of weeks or months)
* Other SSx: hematemesis, bloating, belching
* Complications include: iron-deficiency anemia, hemorrhage, or perforation (usually in children and elderly)
45
# Peptic Ulcer Disease (PUD)
Gastric Symptoms
* Gastric antrum or near pylorus
* Epigastric pain after eating – due to visceral sensitization and gastroduodenal dysmotility
* Pain worse with eating (possible weight loss)
* Postprandial belching and epigastric fullness
* Early satiety
46
# Peptic Ulcer Disease (PUD)
Duodenal Symptoms
* First few inches of duodenum
* Epigastric pain w/ empty stomach
* Increased night pain d/t increased acid output at night (11pm-2am)
* Decreased pain shortly after eating (possible weight gain)
* Pain occurs 2-5hrs post meal when acid is secreted in the absence of a food buffer
* Hematemesis or melena
* GERD may coexist but may or may not be related to peptic ulcers
* Cannot lead to gastric carcinoma
47
# Peptic Ulcer Disease (PUD)
Complications
| Fistula, Perforation, Bleeding
* **Fistula**
* borrowing through muscular wall of stomach or duodenum and continuing into an adjacent organ (fistula)
* **Perforation (occurs in 2-10% of PUD pt)**
* tearing through anterior muscular wall of organ into the free space of the abdominal cavity
* Suspect in those who develop sudden, diffuse, severe abdominal pain that radiates in back, LUQ, and/or chest
(may mimic cardiac pain)
* Classic perforation triad = sudden onset abdominal pain + tachycardia + abdominal rigidity
* More common w/ gastric ulcers
* **Bleeding**
* hemorrhage of friable tissue
* Hematemesis that can be bright red or reddish brown clumps (coffee ground) of partially digested blood
* ~10% mortality rate
* Melena or hematochezia
48
# Peptic Ulcer Disease (PUD)
Complications
| Scarring, Gastric outlet, Cancer
* **Excessive scarring (cicatrization)**
* healing of ulcerated tissue
* **Gastric outlet obstruction**
* inflamed tissue around ulcer swells or scars and narrows pyloric antrum
* Can occur with ulcer located in pyloric channel or duodenum
* Early satiety, epigastric pain shortly after eating, persistent projectile vomiting
* **Cancer**
* related to ulcers caused by H. pylori
* Risk is increased 3-6x
49
# Peptic Ulcer Disease (PUD)
Diagnosis
* Suspicion related to characteristic abdominal pain
* Tests may be needed to confirm: endoscopy or barium x-ray
* Used when tx fails to resolve SSx
* Used when pt is >45yo and has SSx of weight loss (r/o gastric CA)
50
# Peptic Ulcer Disease (PUD)
Treatment
* Discontinue any NSAID use or any other irritants
* Antibiotics for H. pylori infection
* Neutralize or reduce stomach acid w/ OTC or Rx drugs while ulcer heals
* Do not themselves heal ulcers, but relieve SSx and raise pH of stomach
* Take for 4-8 weeks
51
Massage and Peptic Ulcer Disease (PUD)
* LOCAL CONTRAINDICATION
* If the patient has abdominal discomfort, it is best to avoid abdominal massage
52
# Gastric Cancer
Definition
* primary adenocarcinomas from glandular cells of the stomach
* 95% of gastric cancers are primary adenocarcinomas
53
# Gastric Cancer
Epidemiology
* Most common populations: > 50 years old, eastern Asia has the highest incidence, Africa has the lowest
* More common in males
* > 4000 diagnoses per year in Canada
* 5th most common cancer, 3rd highest mortality rate worldwide
54
# Gastric Cancer
Etiology
* Risk factors:
* H. pylori infection
* Large or multiple gastric polyps
* Potential dietary link (smoked, salted, pickled food, nitrates)
* Smoking and obesity
* Major RF for gastric cancer is H. pylori infection w/ sustained inflammation of gastric lining
55
# Gastric Cancer
Signs and Symptoms
| Early SSX, SSx
* **Early SSx** are vague and may mimic burning pain and early satiety of peptic ulcers
* R/o gastric CA if tx of peptic ulcers do not resolve SSx
* **SSx include:**
* Weight loss (MC) – results from insufficient caloric intake d/t nausea, pain, early satiety
* Abdo pain – when present, epigastric and mild
* Nausea – usually a result of the tumor mass itself that disrupts ability of stomach to distend
* Dysphagia – more common with CA arising at gastroesophageal junction
* Melena, early satiety, ulcer type pain
* MC PE finding of metastatic dz is enlarged L supraclavicular lymph node (Virchow’s node)
56
# Gastric Cancer
Diagnosis
* Suspect dx in pt with abdominal pain, weight loss and Hx of gastric ulcer or chronic gastritis
* Best test: upper endoscopy w/ biopsy
57
# Gastric Cancer
Prognosis
* Five year survival rate is 10%
* Late diagnosis w/ metastatic disease
* Prognosis is better if CA has not penetrated too deeply
* Early metastasis d/t vast supply of lymph vessels and nodes
58
# Gastric Cancer
Treatment
* Surgical excision of large portion of stomach and local lymph nodes
* May be palliative to eliminate obstruction and allow food to pass
* Chemotherapy and radiation have limited effectiveness beyond palliative care
59
Massage and Gastric Cancer
* No contraindications
* Be aware of patient comfort in certain positions
60
# Celiac Disease
Definition
* Aka celiac sprue, non-tropical sprue, gluten enteropathy
* Immune disorder triggered by an environmental agent (gluten) in genetically predisposed individual
* Gluten: a protein found in wheat, barley, and oats
* Genetic component in 10% of cases
61
# Celiac Disease
Pathophysiology
* Immune response to gluten ingestion causes inflammation and flattening of villi in small intestine that results in malabsorption
62
# Celiac Disease
Etiology
| Risk Factors
* Having 1st or 2nd degree relatives with celiac (genetic component)
* Often associated with other autoimmune diseases
* Type 1 DM
* Autoimmune thyroiditis
* Down’s Syndrome and Turner Syndrome
63
# Celiac Disease
Signs and Symptoms
* SSx depend on severity of damage to small intestine
* **GI SSx**
* chronic diarrhea (foul smelling stools), bloating, malnutrition, weight loss
* Malabsorption syndromes and resultant symptoms. Common deficiencies include:
* Iron: anemia w/ fatigue and weakness
* Calcium & Vit D: osteopenia, tooth decay, and higher risk of fractures
* B12: pernicious anemia, extremity paresthesia
* Protein: fluid retention and edema
64
# Celiac Disease
Extraintestinal SSx:
| Dermatitis Herpetiformis
* multiple pruritic papules and vesicles in grouped arrangements (MC sites are elbows, dorsal forearms, knees, scalp, back, and buttock)
65
# Celiac Disease
Diagnosis
* SSx raise suspicion and are followed up with blood or stool Ab-Ag tests
* Dx confirmed w/ biopsy
66
# Celiac Disease
Treatment
* Gluten free diet
* Corticosteroids
67
# Celiac Disease
Prognosis
* Potential risk for developing intestinal lymphoma and GI CA
* Unknown if GF diet decreases risk
* Small absolute increase in overall mortality in patients with celiac disease compared with the general population
68
# Massage and Celiac Disease
* NO CONTRAINDICATIONS
* Depending on patients symptoms, massage around
the abdomen may need to be adjusted or avoided
69
# Inflammatory Bowel Disease
Broken into 2 conditions
* Inflammatory conditions of the bowel broken down into two diseases:
* Crohn’s Disease
* Ulcerative Colitis (UC)
70
# Crohn’s Disease
Definition
* Immune mediated inflammatory disease characterized by transmural inflammation
* may involve any part of the GI tract, from oral cavity to perianal area
* Get characteristic **“skip lesions”**
71
# Crohn’s Disease
Etiology
* An idiopathic, autoimmune condition
* Immune mediated inflammatory disease characterized by transmural inflammation and damage to the lining of the GI tract
72
# Crohn’s Disease
Pathophysiology
* Full thickness of bowel (transmural inflammation) is affected
* **MC affected area:** distal ileum & proximal colon
* 80% of patients have small bowel involvement (usually distal ileum) with 1/3 of patients having ileitis exclusively
* Skip lesions are common
73
# Crohn’s Disease
Signs and Symptoms
* MC early sx is abdominal pain, diarrhea (with or without gross bleeding), fatigue, weight loss
* Abdominal pain usually cramping in quality (if dz limited to distal ileum, will be RLQ pain)
* Extraintestinal Sx:
* Enteropathic Arthritis (MC extraintestinal manifestation)
* Primarily involves large joints
* Can also be sacroiliitis or ankylosing spondylitis
* Uveitis, erythema nodosum, pyoderma gangrenosum, stomatitis
* Gallstones, renal stones
74
# Crohn’s Disease
Complications
* Flare-ups
* Can be mild or severe, brief or prolonged
* Tend to reappear in same areas
* Can spread to adjacent area if diseased segment has been removed
* Obstruction d/t scarring
* Abscesses and/or fistula formation
* Increased risk of colon cancer with longstanding CD involving the colon (similar risk as UC)
75
# Crohn’s Disease
Diagnosis
* GP suspects Crohn’s based on Hx of crampy abdominal pain and diarrhea and anal issues (bleeding, fissures, etc)
* PE may reveal palpable lump or fullness in RLQ
* Stool inflammatory markers
* Autoimmune markers on blood testing
* Confirmation: colonoscopy w/ biopsy and/or barium x-ray
* Colonoscopy will not be useful if Dz is limited to small intestine
76
# Crohn’s Disease
Treatment
* No cure; Tx aimed at relieving SSx and reducing inflammation
* Antidiarrheal, anti-inflammatories, corticosteroids, dietary changes
* SSx may resolve w/o any Tx
* Some require surgical removal of small intestine or colon, to repair fistula, or to remove obstruction
* Not curative, can recur in any location of GI tract
77
Massage and Crohn’s Disease
* LOCAL CONTRAINDICATION
* During flare-ups, no massage over the area
* Discuss with patient their level of comfort with abdominal massage
78
# Ulcerative Colitis
Definition
* Chronic, autoimmune disease characterized by recurring episodes of inflammation limited to the mucosal layer of the colon
* Affected area: rectum and sigmoid colon
* Limited to the large intestine
* Progressive lesions (continuous lesions)
79
# Ulcerative Colitis
Etiology/Epidemiology
* idiopathic autoimmune
* Genetic connection, dietary and infections can exacerbate or trigger
**Epidemiology**
* SSx usually begin between 15 and 30
* small number of persons with UC don’t have first attack until ages 50-70
80
# Ulcerative Colitis
Symptoms
* Diarrhea (more often associated with blood than in Crohn’s), bowel urgency, possible bowel incontinence, LLQ abdominal pain
* If dz is limited to the rectum, stool will be dry but will have mucus, WBC, and RBC
* If dz extends through the colon, stool is looser and BM are more frequent
* **Extraintestinal**
* Enteropathic Arthritis – typically involving large peripheral joints, also includes ankylosing spondylitis
* Uveitis, erythema nodosum, pyoderma gangrenosum
81
# Ulcerative Colitis
Complications
* **Severe bleeding** – may occur in up to 10% of patients with UC and may necessitate urgent colectomy (MC
complication)
* Resulting in Iron deficiency anemia
* **Toxic megacolon** – massive distention of colon
* sx of > 10 stools/day, continuous bleeding, abdominal pain and distention, fever anorexia
* Characterized by colonic diameter >6cm and presence of systemic toxicity
* **Perforation** – most commonly occurs as a consequence of toxic megacolon
* Increased risk of colon cancer
* Higher risk when entire colon is affected
* Higher risk if dx is >8 years, even if dz is not clinically active
* **Flareups** – often gradual onset w/ defecation urgency, mild cramps, and stools w/ blood and mucus
* Some have sudden and severe flare-up of sx w/ profound illness
* Can last weeks to months and can recur at any time
82
# Ulcerative Colitis
Diagnosis
* History, symptoms, and a stool sample are initial indicators
* Confirmation: sigmoidoscopy and/or barium studies
* Colonoscopy later used to determine extent of damage
83
# Ulcerative Colitis
Prognosis
* Chronic w/ repeated flare-ups and remissions
* Rapidly progressive initial attack w/ serious complications in 10%
84
# Ulcerative Colitis
Treatment
* Tx aimed at controlling inflammation, reducing sx, and replacing lost fluids and nutrients
* Antidiarrheal and anti-inflammatory drugs, corticosteroids
* Dietary changes: iron supplements, avoiding raw fruits/vegetables
* Surgery: colectomy is curative
85
# Inflammatory Bowel Disease
Radiographic findings for Crohns and Ulcerative Colitis
* Crohns: String sign on barium x-ray
* Ulcerative Colitis: Lead pipe colon on barium x-ray
86
Massage and Ulcerative Colitis
* LOCAL CONTRAINDICATION
* During flare-ups, no massage over the area
* Discuss with patient their level of comfort with abdominal massage
87
# Malabsorption Syndrome
Definition
* Absorption through the small and/or large intestine is compromised
* Many causes, but usually due to damage to the mucous membrane of the GI tract
88
# Malabsorption Syndrome
Signs and Symptoms
* SSx depend on the nutrients that are not absorbed
* MC general SSx: weight loss
* **Fats:**
* light-colored, soft, foul smelling stools (steatorrhea)
* Float, stick to side of bowl, and are difficult to flush away
* **CHO:**
* explosive diarrhea, bloating, and flatulence
* **Protein:**
* generalized swelling, dry skin, hair loss
* **Calcium:**
* bone pain and deformities w/ increased risk of Fx and osteoporosis, muscle spasms, tooth decay and discoloration
* **Iron:**
* microcytic anemia w/ fatigue and weakness
89
# Malabsorption Syndrome
Signs and Symptoms
* Magnesium: muscle cramps
* Vitamin A: night blindness and dry eyes
* Thiamine B1: wet or dry Beriberi syndrome with neurological changes and cardiovascular
effects
* Riboflavin B2: glossitis, angular cheilitis
* Niacin B3: pellagra (4 Ds – dermatitis, diarrhea, dementia, death), beefy glossitis
* Folate B9: megaloblastic anemia w/ fatigue and weakness
* Cobalamins B12: megaloblastic anemia, peripheral glove and stocking neuropathies
* Vitamin C: scurvy w/ connective tissue weakness
* Vitamin D: osteomalacia
* Vitamin K: bleeding
90
# Malabsorption Syndrome
Diagnosis
* Based on SSx and weight loss despite a healthy diet
* Various blood tests can help confirm and Dx specific malabsorbed nutrients
* Fat is malabsorbed in most malabsorption disorders
* Stool samples to monitor for >7g of fat in stool/day
* Potential biopsy to dx underlying cause
91
# Malabsorption Syndrome
Treatment
* Depends on cause
92
Massage and Malabsorption Syndrome
* NO CONTRAINDICATIONS
* Depending on patients symptoms, massage around
the abdomen may need to be adjusted or avoided
700 - Sys Path
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