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8

Gastrointestinal System

Jaime C. Paz

lntroduction

Disorders of the gastrointestinal (GI) system can have numerous

effects on the body, such as decreased ourridon, anemia, and fluid

imbalances. These consequences may, in turn, affect the activity tolerance of a patient, which will ultimately influence many physical therapy interventions. In addition, physical therapists must be aware of pain referral patterns from the GI system that may mimic musculoskeletal symptoms (Table 8-1). The objectives of this chapter are to provide the following:

I.

A basic understanding of the structure and function of the

G1 system

2. Information on the clinical evaluation of [he GI system,

including physical examination and diagnostic studies

3.

A basic understanding of the various diseases and disor-

ders of the GI system

501

502 AClITE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Table 8-1. Gastroinrestinal System Pain Referral Patterns

Segmenral

Structure

Innervation

Areas of Pain Referral

Esophagus

T'Hi

Substernal region

Upper abdomen

Sromach

T6-IO

Upper abdomen

Middle and lower thoracic spine

Small inrestine

T7-IO

Middle thoracic spine

Pancreas

T6-IO

Upper abdomen

Upper and lower thoracic spine

Gallbladder

T7-9

Right upper abdomen

Right, middle, and lower thoracic

spine

Liver

T7-9

Right, middle, and lower thoracic

spine

Right cervical spine

Common bile duct

T6-10

Upper abdomen

Middle lumbar spine

Large intestine

T1 1 -L1

Lower abdomen

Middle lumbar spine

Sigmoid colon

TII-12

Upper sacral region

Suprapubic region

Lefr lower quadrant of abdomen

Source: With permission from we Soissonault. C Bass. Pathological origins of trunk

and neck pain: part I. Pelvic and abdominal visceral disorders. J On hop Sports Phys

Thcr 1990;12,194.

4. Information on the management of GI disorders, including

pharmacologic therapy and surgical procedures

5. Guidelines for physical therapy intervention In patients

with GI diseases and disorders

Structure and Function

The basic strucrure of the GI system is shown in Figure 8-1, with the

primary and accessory organs of digestion and their respective functions described in Tables 8-2 and 8-3.