8 Gastrointestinal System
C H A PT E R
CHAPTER OUTLINE
Body Structure and Function
Clinical Evaluation
History
Physical Examination
Diagnostic Studies
Health Conditions
Esophageal Disorders
Stomach Disorders
Intestinal Disorders
Anorectal Disorders
Morbid Obesity
Liver and Biliary Disorders
Pancreatic Disorders
Management
Pharmacologic Therapy
Surgical Procedures
Physical Therapy Management
Guidelines for Physical Therapy
Management
Jaime C. Paz
CHAPTER OBJECTIVES
The objectives of this chapter are to provide the following:
1. An understanding of the structure and function of the gastrointestinal (GI) system
2. Information on the clinical evaluation of the GI system, including physical examination and diagnostic
studies
3. An overview of the various diseases and disorders of the GI system
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
PREFERRED PRACTICE PATTERNS
The most relevant practice patterns for the diagnoses discussed in this chapter, based on the
American Physical Therapy Association’s Guide to Physical Therapist Practice, second edition,
are as follows:
• Primary Prevention/Risk Reduction for Skeletal Demineralization: 4A
• Impaired Aerobic Capacity/Endurance Associated with Deconditioning: 6B
• Primary Prevention/Risk Reduction for Integumentary Disorders: 7A
Please refer to Appendix A for a complete list of the preferred practice patterns, as individual
patient conditions are highly variable and other practice patterns may be applicable.
Disorders of the gastrointestinal (GI) system can have numerous effects on the body, such as
decreased nutrition, anemia, and fluid imbalances. These consequences may, in turn, affect the
activity tolerance of a patient, which will ultimately influence many physical therapy interven-
tions. In addition, physical therapists must be aware of pain referral patterns from the GI
system that may mimic musculoskeletal symptoms (Table 8-1).
Body Structure and Function
The basic structure 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.
Clinical Evaluation
Evaluation of the GI system involves combining information gathered through history, physi-
cal examination, and diagnostic studies.
History
Before performing the physical examination, the presence or absence of items related to
GI pathology (Box 8-1) is ascertained through patient interview, questionnaire completion,
or chart review. Please see Chapter 2 for a description of the general medical record
review.
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