50 Differential Diagnosis for PT: Hematological, Cardiovascular, Immune, and Digestive System Disorders: Summary
Melena : Black or tarry stools due to blood in stool • Caused by upper GI tract lesions such as ulcers or varices • If stool is melanotic, bleeding is from upper GI tract • If bright red, bleeding is coming from colon, rectum, or hemorrhoids Epigastric Pain with Radiation: Pain radiating to back occurs from chronic ulcers, usually occurs 30 to 90 minutes after eating • Musculoskeletal findings could support back dysfunction ○ Diagnostic interviewing is essential for proper diagnosis and treatment Early Satiety: Occurs when client feels hungry but gets full with only one or two bites of food • Full sensation out of proportion with time of previous meal and hunger experienced Constipation : Prolonged retention of fecal content in GI tract due to decreased motility of colon or difficulty expelling stool • May be due to diet, medications, personality, mood, stress, inactivity, prolonged bed rest, neurological diagnosis, or obstructions • Renal failure common cause of constipation: Fluid restriction Diarrhea : Abnormal increase in stool liquidity/ frequency, greater two times per day • May be accompanied by urgency, perianal discomfort, fecal incontinence, nausea, cramping • May be caused by alcohol, food, laxatives/ other drugs (antibiotics), or travel • Acute: Caused by enteric infection when accompanied by fever, cramps, and blood/ pus in stool • Chronic: Associated with weight loss; may indicate neoplasm or inflammatory bowel disease (IBD) • Occult blood: Not seen by naked eye; caused by bleeding ulcers in stomach/small intestine Fecal Incontinence : Inability to control evacuation of stool • Associated symptoms include urgency, diarrhea, cramping
• Caused by obstruction of rectum, colitis, radiation therapy, traumatic childbirth, hemorrhoids Peptic Ulcer: Loss of tissue lining in lower esophagus, stomach, or duodenum • Acute lesions: Don’t extend through mucosa; called erosions • Chronic lesions: Involve muscular coat and replacing muscle with scar tissue when healing occurs Hiatal Hernia : Part of stomach is elevated/ protrudes through opening (hiatus) in diaphragm • Sliding hernia: Most common type; occurs when lower esophageal sphincter (LES) moves above diaphragm, especially in supine position • Rolling hernia: Part of fundus of stomach moves up through enlarged/weak hiatus ○ Blood vessels may be compressed leading to ulcers: Compromised blood supply Gastroesophageal Reflux Disease (GERD): Usually seen in combination with hiatal hernia (reflux) • Severity depends on competence of LES or pressure on it • Factors: Caffeine, fatty foods, alcohol, smoking, spicy foods Gastritis : Inflammation of stomach; may be acute or chronic, with symptoms ranging from mild or severe • Acute gastritis: Inflammation of mucosa, ulceration, and bleeding if mucosa is severely damaged or with poor circulation ○ Usually self-limiting, with mucosa regenerating in a few days • Chronic gastritis: Atrophy of mucosa with loss of secretory glands ○ Problems with vitamin B12 absorption: Loss of parietal cell ○ Seen in individuals with chronic peptic ulcers, alcohol dependency, older adults, and those with autoimmune disorders
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