Differential Diagnosis for Physical Therapy: Hematological, Cardiovascular, Immune, and Digestive System Disorders: Summary 127
○ 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 Gastroenteritis : Stomach and intestinal inflammation (flu) • Usually due to a viral infection of the intestines but can be caused by food or drug allergy/foodborne infection Appendicitis : Inflammation of the appendix that occurs in adolescents and young adults • Usually requires surgery • Differential diagnosis: Crohn’s, perforated ulcer, gallbladder attack, kidney infection, ovarian cyst, ectopic pregnancy, right lower lobe pneumonia • Signs and symptoms ○ Peri-umbilical lower right quadrant pain • McBurney’s point: Located by palpating for tenderness between anterior superior iliac spine (ASIS) and umbilicus while client is supine ○ Must rule out iliopsoas abscess that can be associated with appendicitis/ peritonitis ○ Can refer pain to obturator also ○ Rebound tenderness • Iliopsoas abscess: Can be facilitated by appendicitis ○ + Psoas sign: Pain on passive extension of right hip with patient lying on left side Inflammatory Bowel Disease : Refers to two inflammatory conditions • Ulcerative Colitis (UC): Inflammation of the ○ Reduced appetite ○ Nausea/vomiting ○ Low-grade fever
• 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
inner lining of colon and rectum ○ Increases risk of colon cancer
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