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539

• Dehydration

• Tachycardia

Management of ulcerative colitis includes any of the following'9,54,57:

• Anti-inflammatory medications, including steroids and mesalamine suppositories

• Surgical resection of involved area with probable ileostomy

placement or, more recently, the development of the double-stapled

ileal reservoir and ileoanal anastomosis, called the J pouch, has

been very effective and favored, as this repair keeps the entire anal

canal intact and avoids an external bag.

• Dietary modification and suppOrt (possible total parenteral

nutrition use)

• Activity limitations

• Iron supplements, blood replacement, or both

• Antidiarrheal agents

Related manifestations of ulcerative colitis may include the

followingJ9•S4:

• Arthritis, ankylosing spondylitis

• lnflammation of the eyes, skin, and mucous membranes

• Hepatitis, bile duct carcinoma

• Colon cancer

Polyps

GI polyps are usually adenomas that arise from the epithelium above the

mucosal surface of the colon and rectum. Polyps are generally benign but

have the potential to proliferate intO carcinoma of the colon.J9,58

Signs and symptOms of polyps include the followingJ9,,,:

• Rectal bleeding (occult or overt)

• Constipation or diarrhea

540

AClITE CARE HANDBOOK FOR PHYSICAL THERAI'ISTS

• Lower abdominal crampy pain

Management of polyps includes the followingl9.S8:

• Modification of risk factors for colorectal cancer, such as obesity, smoking, and excessive alcohol consumption

• Colonoscopy, proctosigmoidoscopy, cndo copy, or barium enema

for detection of the polyp

• Tissue biopsy to determine its malignancy potential

• Polypectomy with electrocautery

• Surgical resection, if indicated, with or without ileosromy

Intestinal Tumors

Benign or metastatic neoplasms of the intestine include colonic adenomas (polyps), villous or papillary adenomas, lipomas, leiomyomas, and lymphoid hyperplasia. Tumors affect motility and absorption

functions in the intestine (see Cancers in the Body Systems in Chapter

5 for further details).

A'lOrectal Disorders

Disorders of the anus and rectum generally involve inflammation,

obstruction, discontinuity from colon, perforations, or tumors. The

most common disorders are (1) hemorrhoids, (2) anorectal fistula,

(3) anal fissure, (4) imperforate anus, and (5) rectal prolapse. Signs

and symptoms include pain with defecation and bloody stOols. Management is supportive according to the disorder, and surgical correction is performed as necessary.

Liver mId Biliary Disorders

Hepatitis

Hepatic inflammation and hepatic cell necrosis may be acute or

chronic and may result from viruses, toxins, alcohol, leukemias, lymphomas, and Wilson's disease (a rare copper metabolism disorder).

Viral hepatitis is the moSt common type of hepatitis and can be c1assi-

GASTROINTFSflNAL SYSTEM

541

fied as hepatitis A, B, C, 0, E, or G (i.e., HAV, HBV, HCV, HOV,

HEV, and HGV, respectively).

Hepatitides A, B, and C are the most common types of viral hepatitis, whereas hepatitis G has recently been discovered. Hepatitis A is transmitted via the fecal-oral route, mostly from contaminated water

sources. Hepatitis B is more common rhan hepatitis C, but both are

transmitted through blood and body fluids. Acute viral hepatitis generally resolves with appropriate medical management, but in some cases, hepatitis can become chronic and may ultimately require liver

transplantation.39,59-61

Signs and symproms of hepatitis include the following39•59-6I:

• Abrupt onset of malaise

•

Fever

• Anorexia

• Nausea, abdominal discomfort, and pain

•

Headache

• Jaundice

•

Dark-colored urine

Management of hepatitis includes any of the following39•59-6I:

• Adequate periods of rest

•

Vaccinations (only for HAV, HBV, HOV)

• Fluid and nutritional suppOrt

• Removal of precipitating irritants (e.g., alcohol and toxins)

• Anti-inflammatory agents

• Antiviral agents

Clinical Tip

• Health care workers who are exposed to blood and

body fluids during patient contact must ensure that rhey

542

AClITE CARE HANDOOOK "-OR I'HYSICAL THERAPISTS

are properly vaccinated against hepatitides B and C. This

includes receiving periodic measurements of antibody

titers to the viruses and supplementation with boo ter

shots as needed to maintain appropriate immunity against

these infections.

• The liver is the only organ in the body with regenerative

properries; therefore, patients with acure liver inflammation will heal well if given the proper rest and medical treatment. Physical therapists should aim not to overfatigue these patients with functional activities to help promote proper healing of the liver.

Cirrhosis

Cirrhosis is a chronic disease state that is characterized by hepatic

parenchymal cell destruction and necrosis, and regeneration and scar

tissue formation. The scarring and fibrosis that occur in the liver

reduce its ability to synthesize plasma proteins (albumin), clotting factors, and bilirubin. The primary complications that can occur from cirrhosis include porral hyperrension, ascites, jaundice, and impaired

clotting ability.H.52."

Cirrhosis may result from a variety of etiologies, including the

following3' .• ' :

• Alcohol or drug abuse

•

Viral hepatitis B, C, or D

•

Hemochromatosis

• Wilson's disease

• Alpha,-antirrypsin deficiency

• Biliary obstruction

•