Differential Diagnosis for Physical Therapy: Hematological, Cardiovascular, Immune, and Digestive System Disorders: Summary 128
○ Signs and symptoms ■ Diarrhea, from only a few episodes to very frequently throughout the day (blood and mucus may be present) ■ Abdominal pain/cramping that usually disappears after a bowel movement ■ Abdominal sounds (a gurgling or splashing sound heard over the intestine) ■ Fever ■ Weight loss • Crohn’s Disease (CD): Inflammatory disease that attacks the terminal end of small intestine and colon most commonly ○ Slow and nonaggressive ○ Joint pain, no permanent joint deformity ○ Symptoms same as UC • Both UC and CD have unknown etiology: Unable to distinguish foreign from self- antigens; the body can’t regulate mucosal immune response, causing damage to this tissue Inflammatory Bowel Syndrome (IBS) : Functional motility disorder of small/large intestine; interferes with digestion and absorption • Most common GI disorder • Aggravated by stress, fatigue, or intake of fatty content • Signs and symptoms ○ Chronic and frequent diarrhea/ constipation, usually accompanied by pain ○ Abdominal pain or tenderness: Long back pain ○ Intermittent pain following meals, relieved by bowel movement ○ Abdominal fullness, gas, bloating ○ Loss of appetite, nausea, vomiting ○ Emotional distress/depression • Common therapies ○ Lifestyle modification: Diet, alcohol intake, stress reduction
○ Drugs: Antacids, laxatives, antidiarrheals, antibiotics, histamine antagonists Diverticulosis : Ballooning secondary to weak colon wall • Usually benign • Symptoms: Mild discomfort, flatulence, constipation, or diarrhea Diverticulitis : Infection/microperforations of wall • Can be due to non-steroidal anti- inflammatory drugs (NSAIDs) • Symptoms: Pelvic pain, bloody stools, nausea/vomiting, fever GI Screening Indications • History of serious GI disorder ○ Abdominal (epigastric), thorax, shoulder girdle pain ○ Abdominal (umbilical/hypogastric), lumbar, pelvic pain ○ Long-term use of NSAIDs, corticosteroids, or narcotics ○ Likelihood of abdominal symptoms being musculoskeletal in nature ■ If yes lifting, twisting, or turning over in bed make the pain feel worse? ■ If no : – Has there been any change in bowel habits since the start of symptoms? – Does eating certain foods make the pain feel worse? – Has weight changed since symptoms started? o Sensitivity = 0.67; Specificity = 0.86 – Does coughing, sneezing, or taking a deep breath make the pain feel worse? – Do activities such as sitting,
GI Signs and Symptoms • Abdominal pain
• Indigestion; heartburn • Difficulty swallowing • Nausea/vomiting; loss of appetite
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