Common gastrointestinal tests
Gastroesophageal reflux disease (GERD)
Description: Backflow of stomach acid into the esophagus due to a weakened lower esophageal sphincter
Symptoms: Heartburn, regurgitation, chest pain, difficulty swallowing
PT implications: Avoid exercises that increase intra-abdominal pressure; encourage upright positions after eating
Peptic ulcer disease (PUD)
Description: Open sores in the stomach or duodenal lining, often caused by H. pylori infection or NSAIDs
Symptoms: Epigastric pain, nausea, bloating, bloody stool (if severe)
PT implications: Monitor for signs of GI bleeding (dark stool, fatigue, pallor)
Irritable bowel syndrome (IBS)
Description: Functional GI disorder with chronic abdominal pain and altered bowel habits (diarrhea, constipation, or both)
Symptoms: Cramping, bloating, diarrhea, constipation, mucus in stool
PT implications: Stress management, exercise to regulate bowel motility
Crohn’s disease
Description: Chronic inflammation of any part of the GI tract, often the small intestine
Symptoms: Abdominal pain, diarrhea, weight loss, fatigue, malnutrition
PT implications: Address fatigue, joint pain, and osteoporosis risks due to long-term steroid use
Ulcerative colitis
Description: Chronic inflammation and ulcers in the colon and rectum
Symptoms: Bloody diarrhea, urgency, abdominal cramping, weight loss
PT implications: Monitor for dehydration, anemia, and musculoskeletal complications
Diverticulitis
Description: Infection or inflammation of diverticula (pouches in the colon wall)
Symptoms: Lower left quadrant pain, fever, nausea, bowel habit changes
PT implications: Avoid increased intra-abdominal pressure (e.g., Valsalva maneuver)
Celiac disease
Description: Autoimmune disorder triggered by gluten, leading to villous atrophy in the small intestine
Symptoms: Malabsorption, diarrhea, bloating, fatigue, weight loss
PT implications: Monitor for signs of malnutrition, osteoporosis, and neurological symptoms (tingling, numbness)
Hepatitis (A, B, C, D, E)
Description: Inflammation of the liver, often viral
Symptoms: Jaundice, fatigue, dark urine, nausea, right upper quadrant pain
PT implications: Energy conservation techniques, avoid strenuous exercise during active infection
Cirrhosis
Description: Chronic liver disease with fibrosis and impaired liver function
Symptoms: Jaundice, ascites, hepatomegaly, fatigue, confusion (hepatic encephalopathy)
PT implications: Watch for bruising, bleeding, and fall risk due to balance deficits
Pancreatitis
Description: Inflammation of the pancreas, often due to gallstones or alcohol abuse
Symptoms: Severe epigastric pain radiating to the back, nausea, vomiting
PT implications: Monitor for signs of multi-organ failure, avoid activities that increase abdominal pressure
Key referred pain sites
Key clinical patterns:
Peptic ulcers → Epigastric pain that may radiate to the back
Pancreatitis → Pain in the mid-back and left shoulder
Gallbladder issues (Cholecystitis, Gallstones) → Right shoulder, right upper quadrant pain, worsens after fatty meals
Appendicitis → Periumbilical pain progressing to right lower quadrant (McBurney’s point)
Hepatic (liver) issues → Right upper quadrant pain, right shoulder pain, jaundice may be present
Esophagus → mid chest, mid- back
Stomach → epigastric region left upper quadrant, mid-back
Small intestine → periumbilical region
Large intestine → lower abdomen, sacral region
Rectum → sacral region, perineum
Image #92
https://upload.wikimedia.org/wikipedia/commons/a/a4/1506_Referred_Pain_Chart.jpg
Reproductive system
Male reproductive system
Anatomy and physiology
Primary Structures: Testes, epididymis, vas deferens, seminal vesicles, prostate gland, urethra, and penis
Function: Produces sperm and male sex hormones (testosterone)
Hormonal Regulation:
Hypothalamus → Gonadotropin-releasing hormone (GnRH)
Pituitary → Luteinizing hormone (LH) & Follicle-stimulating hormone (FSH)
LH stimulates testosterone production in testes.
FSH supports spermatogenesis
Definitions
Testosterone
Steroid hormone that stimulates development of male secondary sexual characteristics, produced mainly in the testes , but also in the ovaries and adrenal cortex.
Gonadotropine- releasing hormone
Hormone produced in the hypothalamus that stimulates the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which in turn regulate the function of the gonads (testes and ovaries)
Luteinizing hormone
Hormone secreted by the anterior pituitary gland that stimulates ovulation in females and the synthesis of androgen in males
Follicle - stimulating hormone
Stimulates egg production in females, regulates menstrual cycle, supports sperm production in males
Common male reproductive disorders
Benign prostatic hyperplasia (BPH)
Non-cancerous enlargement of the prostate
Symptoms: Urinary frequency, nocturia, weak stream, incomplete bladder emptying
Treatment: Medications (alpha-blockers), surgery if severe
Prostatitis
Inflammation of the prostate, often bacterial
Symptoms: Painful urination, pelvic pain, flu-like symptoms
Treatment: Antibiotics, anti-inflammatories
Prostate cancer
Most common cancer in men
Symptoms: Often asymptomatic early, later includes urinary dysfunction and bone pain (metastasis)
Diagnosed with PSA levels, biopsy
Treatment: Surgery, radiation, hormone therapy
Erectile dysfunction
Inability to achieve/maintain an erection
Causes: Vascular disease, diabetes, psychological factors
Treatment: Medications, lifestyle modifications
Testicular cancer
Most common in men 15-35 years
Symptoms: Painless testicular lump, swelling
Treatment: Surgery (orchiectomy), chemotherapy, radiation
Female reproductive system
Anatomy and physiology
Primary Structures: Ovaries, fallopian tubes, uterus, cervix, vagina, external genitalia
Function: Produces eggs, sex hormones (estrogen, progesterone), supports fetal development during pregnancy
Hormonal Regulation:
Hypothalamus → GnRH
Pituitary → LH & FSH
Definitions
Estrogen
Any of a group of steroid hormones which promote the development and maintenance of female characteristics of the body.
Progesterone
Steroid hormone released by the corpus luteum that stimulates the uterus to prepare for pregnancy
Common female reproductive disorders
Polycystic ovarian syndrome (PCOS)
Hormonal disorder causing irregular ovulation, excess androgens, and ovarian cysts
Symptoms: Irregular periods, infertility, hirsutism, insulin resistance
Treatment: Hormonal therapy, weight management, insulin sensitizers
Endometriosis
Growth of endometrial tissue outside the uterus
Symptoms: Pelvic pain, dysmenorrhea, infertility
Treatment: Pain management, hormonal therapy, surgery
Uterine fibroids
Non-cancerous tumors of the uterus
Symptoms: Heavy menstrual bleeding, pelvic pain, infertility
Treatment: Hormonal therapy, surgery (hysterectomy, myomectomy)
Pelvic inflammatory disease (PID)
Infection of the female reproductive organs (often due to sexually transmitted diseases)
Symptoms: Pelvic pain, fever, abnormal vaginal discharge
Treatment: Antibiotics, hospitalization if severe
Ovarian cancer
Silent killer due to late detection
Symptoms: Abdominal bloating, pelvic pain, urinary urgency
Diagnosis: CA-125 marker, imaging
Treatment: Surgery, chemotherapy
Breast cancer
Most common cancer in women
Risk Factors: Family history, BRCA mutations, hormone exposure
Symptoms: Lump, nipple changes, skin dimpling
Treatment: Surgery, chemotherapy, radiation, hormone therapy
Pregnancy considerations for physical therapy
Physiological changes during pregnancy
Musculoskeletal changes
Increased lumbar lordosis and anterior pelvic tilt →low back pain
Increased ligamentous laxity due to Relaxin hormone → joint instability, risk of injury
Widening of the pelvis → sacroiliac (SI) joint pain, pubic symphysis dysfunction
Diastasis recti (separation of the rectus abdominis)
Definitions
Relaxin hormone
Hormone, primarily associated with pregnancy, that loosens ligaments and softens the cervix, preparing the body for childbirth
Cardiovascular changes
Increased blood volume (40-50%) and heart rate
Decreased blood pressure in the first and second trimesters (due to vasodilation)
Risk of supine hypotensive syndrome (compression of the inferior vena cava)
Respiratory changes
Increased oxygen consumption
Decreased lung expansion due to elevated diaphragm → shortness of breath
Metabolic changes
Increased caloric demands.
Gestational diabetes risk due to insulin resistance.
Other changes
Increased urinary frequency due to bladder compression
Weight gain (25-35 lbs is normal range)
Hormonal changes (progesterone, estrogen, relaxin) affect mood, joints, and metabolism
Safe exercise guidelines for pregnancy
Mode: Walking, swimming, cycling, low-impact aerobics.
Intensity: Moderate (should be able to talk while exercising)
Duration: 150 minutes per week (30 min/day, most days)
Avoid:
Supine exercises after 20 weeks (risk of supine hypotensive syndrome)
Overheating (hot yoga, saunas).
Valsalva maneuver (holding breath during exertion)
High-impact or contact sports
Contraindications to exercise during pregnancy:
Absolute:
Incompetent cervix
Placenta previa (after 26 weeks)
Preeclampsia
Multiple gestation with risk of preterm labor
Ruptured membranes
Persistent vaginal bleeding
Preterm labor
Relative:
Severe anemia
Unevaluated maternal cardiac disease
Chronic bronchitis
Poorly controlled diabetes or hypertension
Postpartum considerations
Pelvic floor dysfunction
Interventions: Kegels, biofeedback, bladder retraining
Postural syndromes
Due to breastfeeding, baby-carrying
Interventions: strengthening of upper back, postural correction, stretching
Return to exercise
Clearance from physician (typically 6 weeks post-vaginal, 8+ weeks post-C-section)
Progressive return to impact activities
Incontinence
Types of urinary incontinence and treatment
Urinary incontinence is the involuntary loss of urine due to dysfunction in the bladder, urethra, or pelvic floor muscles. There are several types, each with different causes and treatments.
Stress incontinence
Cause:
Weak pelvic floor muscles or urethral sphincter dysfunction
Common in postpartum women, postmenopausal women, and after prostate surgery in men
Triggered by increased intra-abdominal pressure (e.g., coughing, sneezing, laughing, jumping)
Treatment:
Pelvic floor muscle training (Kegels) to strengthen muscles
Bladder training to improve control
Biofeedback & electrical stimulation for muscle activation
Pessary or urethral inserts (in some cases)
Surgical options (e.g., sling procedures) for severe cases
Urge incontinence
Cause:
Detrusor muscle overactivity leads to sudden, strong urges to urinate
Can be related to neurological conditions (e.g., stroke, Parkinson’s, MS), infections, or idiopathic causes
Treatment:
Bladder retraining (scheduled voiding, delaying urination)
Pelvic floor exercises to control urgency
Behavioral modifications (reducing caffeine, alcohol, and bladder irritants)
Medications (anticholinergics, beta-3 agonists) to relax the bladder
Neuromodulation (e.g., tibial nerve stimulation) in severe cases
Overflow incontinence
Cause:
Incomplete bladder emptying due to obstruction (e.g., enlarged prostate, pelvic organ prolapse) or weak detrusor muscle (e.g., diabetes, spinal cord injury, multiple sclerosis)
Symptoms include dribbling, weak stream, and feeling of incomplete emptying
Treatment:
Double voiding technique (waiting and trying to urinate again)
Timed voiding to prevent overflow
Pelvic floor strengthening if related to muscle dysfunction
Catheterization (intermittent or long-term) for severe cases
Surgical intervention if caused by obstruction (e.g., prostate surgery)
Functional incontinence
Cause:
Physical or cognitive impairments (e.g., stroke, dementia, arthritis, Parkinson’s) prevent timely access to the bathroom
No direct bladder dysfunction, but mobility limitations or mental impairments lead to accidents
Treatment:
Environmental modifications (accessible bathrooms, commodes, grab bars)
Scheduled toileting based on routine
Mobility training & assistive devices
Caregiver education for dementia-related cases
Renal disorders
Common renal disorders
The kidneys play a vital role in filtering waste, regulating electrolytes, and maintaining fluid balance. Dysfunction can lead to serious systemic issues, including metabolic imbalances and cardiovascular complications
Acute kidney injury (AKI)
Definition: Sudden loss of kidney function due to ischemia, toxins, or trauma. It is often reversible if treated early
Causes:
Pre-renal: Hypovolemia, shock, heart failure.
Intra-renal: Acute tubular necrosis, nephrotoxic drugs, infections
Post-renal: Obstruction (kidney stones, tumors, BPH)
Signs and symptoms:
Oliguria (low urine output), fluid retention, electrolyte imbalances (increased potassium, increased BUN/Creatinine)
PT considerations:
Monitor for fatigue, altered mental status, and electrolyte imbalances
Avoid overexertion due to risk of hypotension and electrolyte shifts
Chronic kidney disease (CKD)
Definition: Progressive decline in kidney function, leading to end-stage renal disease (ESRD) if untreated
Causes:
Diabetes (leading cause), hypertension, glomerulonephritis, polycystic kidney disease
Stages (GFR-based):
Stage 1-2: Mild kidney damage, no major symptoms.
Stage 3: Moderate impairment, possible anemia, bone mineral disorders
Stage 4: Severe dysfunction, preparing for dialysis
Stage 5 (End Stage Renal Disease): Requires dialysis or kidney transplant
Signs and symptoms:
Fatigue, muscle cramps, edema, anemia, metabolic acidosis, hypertension, itching
Uremia (buildup of waste in blood) → nausea, confusion, neuropathy
PT considerations:
Monitor for fatigue, blood pressure changes, and electrolyte imbalances
Encourage low-to-moderate intensity exercise to improve functional capacity
Avoid excessive fluid loss (dehydration can worsen kidney function)
Be aware of bone mineral disease & risk of fractures
Nephrotic syndrome
Definition: A kidney disorder causing severe protein loss in urine due to damage to glomeruli
Signs and symptoms:
Severe edema (especially in the legs), proteinuria (>3.5g/day),hypoalbuminemia, hyperlipidemia.
Increased risk of thrombosis and infections
PT considerations:
Monitor for edema-related mobility restrictions
Be cautious of increased clotting risk during exercise
Hemodialysis (HD) considerations
Hemodialysis is used in ESRD to filter blood through a machine when the kidneys can no longer perform their function. It is typically done 3-4 times per week for 3-5 hours per session
Common complications:
Hypotension during or after dialysis (due to rapid fluid removal)
Fatigue, dizziness, cramping (electrolyte shifts)
Access site issues (fistula/graft infections, thrombosis)
PT considerations:
Avoid exercise immediately before or after dialysis due to fatigue and hypotension risk
Monitor blood pressure carefully – hypotension is common post-dialysis
Exercise should be performed on non-dialysis days or at least 4+ hours after treatment
Do not take blood pressure on the arm with an AV fistula/graft to prevent complications
Encourage low-impact aerobic and resistance exercises to improve endurance and prevent muscle wasting
