Gastrointestinal Disorders

1
Gastrointestinal Disorders

• BCE 542 (Physical Disabilities, Rehabilitation
  and Employment)
• September 24, 2002

2
Gastrointestinal System Structure and Function

• Components
• Stomach
• Large and Small Intestines
• Liver and Gall Bladder
• (Pancreas)
• Purpose
• Digestion--breaking down food into components
  that can be used by the body.

3
Hernias

• Rips in muscle wall surrounding the digestive
  organs, allowing organs to protrude (herniate)

4
Types of hernias

• Inguinal--tear in abdominal wall near midline of
  body, usually caused by heavy lifting. More
  common in men.
• Femoral--follows femoral artery into thigh area.
• Diaphragmatic--Hernia through diaphragm into
  chest cavity.
• Hiatal/Hiatus--protrusion of stomach through
  diaphragm opening into the esophagus.
• Epigastric --Weakness of the upper abdominal
  wall. This type of hernia may be present at
  birth.
• Incisional--Hernia through improperly healed
  surgical incision.
• Ventral--Separation of muscles in lower abdominal
  wall, common in pregnancy.

5
Complications, Treatment, and Rehabilitation

• Strangulation--blood supply cuts off to herniated
  area, eventually leading to gangrene.
• Treatment
• Usually surgery, using synthetic mesh to repair
  muscle tears.
• Some persons may wear trusses (compression
  garments to hold the hernia in place), but this
  is now rare.
• Rehabilitation
• Hernias are usually not a rehabilitation concern
  if surgically corrected in some cases, return to
  work in a lighter occupation may be necessary.
• Prevention is important--teaching of proper body
  mechanics.

6
Stomach and Stomach Disorders

• The stomach is a muscle lined with a coating of
  mucous in which food is exposed to secretions
  (hydrochloric acid) and turned into a substance
  called chyme.
• Gastritis--inflammation of the stomach. If
  chronic, can lead to stomach hemorrhage, damage
  to stomach lining.

7
Peptic Ulcers

• Peptic ulcer--erosion of the mucous lining of the
  stomach, allowing underlying tissue to become
  exposed to gastric acids.
• Cause is unknown smoking, emotional factors are
  related.
• Person with ulcer has pain when stomach is empty,
  may be nauseous.
• Ulcer can perforate, cause ruptures. These are
  medical emergencies.

8
Treatment and Rehabilitation with Peptic Ulcers

• Treatment
• Avoidance of certain foods and beverages.
• Changes in eating patterns, lifestyle.
• Smoking Cessation
• Antacids (taken an hour after meals to reduce
  acids)
• Rehabilitation
• Persons with peptic ulcers in high-stress
  occupations may require a change in occupation.

9
Intestines

• Small Intestine--
• digested food is absorbed into the body.
• Large intestine
• absorption of fluids, formation of wastes.

10
Disorders of the Small Intestine

• Crohns Disease--Chronic inflammations of small
  intestine with abscessing.
• Cause unknown, appears to be related to certain
  bacteria, autoimmune factors, lifestyle,
  genetics.
• Treatment is difficult, with bland diet, rest,
  anti-inflammatory drugs.
• Sometimes surgery is employed to resect (remove
  bypass) affected areas.
• Rehabilitation concerns involve improving
  adjustment of person to work. There may be no
  specific functional limitations, but reduction of
  emotional issues will assist in healing.

11
Disoders of the Large Intestine

• Ulcerative colitis--inflammation of the large
  intestine with ulceration.
• Symptoms include diarrhea with pus and blood,
  anemia, nausea, and dehydration.
• Cause unknown, but appears related to personality
  factors (rigid, opinionated, emotionally
  immature, compulsively neat)
• Cancer risk increased.
• Treatment involves drugs, involvement of
  signficant others, lifestyle changes. Surgery
  may be used to bypass affected area (colostomy)
• Rehabilitation Individual requires job
  appropriate to personality, needs to feel secure
  and accepted in job. If a colostomy is
  performed, this will add additional
  rehabilitation concerns.

12
Disorders of the Large Intestine, Cont.

• Diverticulosis--Development of pouches in the
  large intestine.
• Diverticulitis--Inflammation of these pouches.
• Incidence increases with age.
• Can cause abscessing and perforations,
  necessitating surgery.
• Other treatment involves antibiotics, laxatives,
  diet and lifestyle changes.
• Rehabilitation
• May not be a concern if disease is well managed.
  
• Reduction of occupational stress is advisable to
  assist in treatment.

13
The Liver and Gallbladder

• Liver--largest organ in the body performs a
  variety of functions related to metabolism,
  digestion, elimination of body toxins.
• Gallbladder--An organ adjoining the liver that
  produces bile (important in metabolizing fats.

14
Gallstones and Cholecystitis

• Gallstones formations of solid structures in the
  gall bladder
• Many persons show no symptoms, others will have
  nausea, vomiting after eating.
• Cholecystitis Inflammation of the gall bladder
  caused by gallstones.
• Can lead to gangrene of gall bladder.
• Treatment usually calls for surgical removal of
  the gall bladder.
• Person can live essentially normal life after
  gall bladder removal, but low-fat diet is
  advisable.
• Rehabilitation considerations usually are not
  relevant.

15
Hepatitis

• Inflammation of the liver. Three types
• Infectious Hepatitis (Hepatitis A) Spread by
  germs in unsanitary conditions.
• Serum Hepatitis (Hepatitis B) Spread by contact
  with body fluids of carrier.
• Toxic Hepatitis Caused by toxic agents
  (hepatoxins), including alcohol.
• Symptoms
• Jaundice (yellowing of the skin)
• Malaise, loss of appetite, fever, liver
  enlargement
• Treatment
• Bed rest, medications, removal of hepatoxins.
• Hepatitis A usually resolves in a month
  Hepatitis B tends to become chronic.
• Rehabilitation concerns are only relevant if
  extensive liver damage results.

16
Cirrhosis of the Liver

• Replacement of liver cells with connective
  tissue/scar tissue.
• Caused by hepatitis, hepatoxins, untreated
  gallbladder disease, and (especially) extended
  alcohol abuse (Laennecs Cirrhosis).
• Most common in late middle-aged men.
• May begin with few or no symptoms.
• Eventually, person will lose appetite, become
  nauseous.
• Abdomen will swell with fluid deposits (ascites)
  and limbs will waste away.

17
Cirrhosis (continued)

• Numerous complications phlebitis, peritonitis,
  internal bleeding, liver infection.
• Death usually results from massive liver failure
  or from hemorrhage of the esophagus.

18
Cirrhosis, cont.

• Treatment
• Cessation of alcohol intake or exposure to other
  hepatoxins.
• Once damage to liver is done, it is permanent.
• Rehabilitation
• Depends on disease progress. If caught early and
  managed, may not be relevant.
• Alcoholism treatment figures prominently.