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PTA 120 Pathophysiology Week 9

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Pathology for the Physical Therapist Assistant, Ch 12 Physical Therapy Clinical Handbook for PTAs

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Discuss anatomic structures and physiologic processes related to the digestive system. Discuss physical effects of aging on the body.

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Define digestive pathological conditions including signs and symptoms of each: Carcinomas TMJ Dysfunction from Periodontal disease Hemorrhoids Cirrhosis of the Liver

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Discuss how digestive pathologies can adversely affect function requiring the modification of treatment intervention to protect the patient from worsening the condition and optimize treatment outcomes.

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Discuss the modifications and precaution that may be required for the treatment of patients with digestive disorders. Demonstrate understanding of the PTAs role in the disease process

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Mouth Pharynx Esophagus Stomach Small intestine Large intestine Anus

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Ingestion Propulsion Mechanical digestion Chemical digestion Absorption Metabolism

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Physiologic ChangeFunctional Effect Decreased muscular elasticityEsophagus and stomach empty more slowly Slowed muscular contractionsConstipation Bacterial overgrowth more commonDecreased nutrient and mineral absorption 2010-2011 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, N.J., U.S.A.

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Description Can occur in the mouth, esophagus, stomach, liver, pancreas, colon Etiology Various factors including diet, alcohol use, smoking, increasing age, infection, heredity

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Signs and Symptoms Often not seen until disease is in the later stages Dysphagia, weight loss, pain, nausea, vomiting, indigestion, change in bowel habits, bleeding Treatment Surgery Chemotherapy Radiation

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Physical therapy may be indicated for strengthening, mobility, and transfer training for patients both in the hospital after surgical resections or at home in later disease stages. Speech and occupational therapy may be involved as well for any speech, eating, or swallowing difficulties.

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Description Impaired functioning of the temporomandibular articulation of the jaw. Etiology Tooth extractions due to gingivitis, periodontitis, cavities all lead to jaw imbalances Arthritis, muscle spasms, clenching of teeth

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Signs and Symptoms Pain in face, neck, and jaw, and with movement of the TMJ (clicking and grinding); headaches Stiff neck and jaw muscles Treatment Occasionally none indicated Realignment of bite by dentist, mouth inserts to prevent grinding Heat, NSAIDs, soft food

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For Temporomandibular Joint Dysfunction Treatment may include exercises for strengthening and muscle re-education, modalities for pain relief, relaxation training, and manual therapies for correction of alignment. The PT or PTA will usually work in conjunction with a dentist while treating TMJ dysfunction.

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Description Veins in the anal or rectal regions that are dilated and inflamed Etiology Any condition that causes pressure on veins in the lower rectal area Prolonged sitting, pregnancy and childbirth, constipation or diarrhea, straining to defecate

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Signs and Symptoms Rectal bleeding Tumor-like lesions, itch or bleed Treatment Stool softeners, avoidance of straining during defecation, diet high in fiber Warm sitz baths, topical anesthetics for pain Medical procedures to remove

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From Lewis SM, Heitkemper MM, Dirksen SR: Medical-surgical nursing: assessment and management of clinical problems, ed 7, St. Louis, 2007, Mosby.

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Physical therapy may be indicated for patients with hemorrhoids to provide exercise programs and pelvic floor strengthening.

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Description Progressive liver disease that destroys liver cells Fibrous scar tissue replaces cells Liver functions deteriorate, damage is irreversible Death can occur 5-15 years after diagnosis without transplant Etiology Chronic alcohol abuse Viral hepatitis B and C Autoimmune or metabolic diseases

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Signs and Symptoms Initial Loss of appetite, weight loss, nausea, anemia, fatigue, diarrhea; dull, aching pain in the upper right quadrant of the abdomen as liver enlarges Disease progresses Edema of the legs, jaundice, bruise easily; small, red, spidery marks on the skin (may itch) Testicular atrophy, reduced chest hair, abnormal breast enlargement Enlarged spleen, abdominal distension, bleeding from the GI tract Memory and mental confusion

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Treatment Prescribed medications Liver transplant From Fazier MS< Drzymkowski JW: Essentials of human diseases and conditions, ed 2, Philadelphia, 2000, WB Saunders.

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Physical therapy may be indicated for associated decreases in strength, endurance, mobility, and function.

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Whipples Disease Arthritic condition from disease Irritable Bowel Syndrome Relaxation exercises Peritonitis, Pancreatitis, other chronic digestive disorders Mobility, strengthening, endurance Rectal Prolapse Biofeedback, electrical stimulation

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Surgery moving one end of the large intestine through the abdomen Stool drains into colostomy bag Done after bowel obstruction or bowel resection http://www.nlm.nih.gov/medlineplus