The Power is in Your Hands… · Perforation, peritonitis Adhesions Abscesses Increased risk of colorectal cancer Liver damage, jaundice, gallstones Ulcers in mouth, on lower legs

The Power is in Your Hands

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Digestive System

Introduction__________

Diseases of the UpperGastrointestinal Tract

Disordersof theLarge

Intestine

Disorders ofthe

AccessoryOrgans

OtherDigestiveSystem

Disorders

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Copyright HandsOn Therapy Schools 2009 APATH.8


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Digestive System

Copyright 2009 Walters Kluwers Health l Lippincott Williams & Wilkins

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Digestive SystemEasiest way to discuss structure of the Digestive System is to follow apiece of food through it.

Accessory Organs

Liver Gallbladder Pancreas

Hepatocytes have greatpower of regenerationHigh blood supply:hepatic artery andportal veinSugar storage, proteinsynthesis,detoxification, recyclingproducts of dead redblood cells (RBCs) intobile

Receives bile, storesand concentrates itReleases bile intoduodenum

Emulsifiesfats

Endocrineand exocrineDigestivejuices andbicarbonateto neutralizeacidic chimeCapable ofautodigestionif duct isblocked

Take a Bite

l

Food enters Mouth

l

then travels downEsophagus

l

then Stomach

l

then Small Intestine*

l

then Large Intestine

l

then Rectum

l

and then Anus

* Gallbladder andPancreas secretionsintro small intestine

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Problems and Massage

Autonomic imbalance can cause GI discomfort; this is relieved bymassage

Hard to tell whether symptoms are related to stress or more seriousdisease

Temporary relief from massage may delay an important diagnosis

If pain in a new pattern is present for 3 or more weeks, client shouldconsult a primary care physician

Red lights: severe local pain, blood in stool, anemia, bloating, fever




Disorders of the Upper Gastrointestinal Tract

Celiac disease

Crohn disease

Esophageal cancer

Gastroenteritis

Gastroesophageal reflux

Peptic ulcers

Stomach cancer

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Celiac Disease

Villi are flattened, destroyed as reaction to gluten ; Also calledceliac sprue, nontropical sprue, gluten-sensitive enteropathy

Etiology

Autoimmune or allergic reactionGluten is in wheat, rye, barley, spelt, some other grainsNormally broken down into amino acids, absorbedthrough villi into circulatory systemWith celiac disease: breaks down to gliadin, whichtriggers a mild to severe inflammatory responseVilli degenerate, can’t absorb anything: malabsorption,malnutritionOccurs frequently with other autoimmune disorders:type 1 diabetes, hypothyroidism, lupus, rheumatoidarthritisCan cause rash: dermatitis herpetiformis

DemographicsDiagnosed in 1:3,000

May be present in less severeform in 1:133

Mostly northern EuropeanGenetic: runs in families




more Celiac Disease

Signs andSymptoms Diagnosis Treatment Massage

MalabsorptionGI pain, vitamindeficiencyGas, bloating,diarrheaWeight loss, failure tothrive, anemia,irritability, depression,muscle cramps

ComplicationsAnemia, folic aciddeficiency, risk ofneural tube defect inpregnancyOsteomalacia,osteoporosisDelayed growth,development inchildrenChronic inflammationraises risk ofadenocarcinoma,lymphoma in smallintestine

Antibodies show in bloodtest; biopsy of jejunumCan resemble (or occurconcurrently with)

Irritable bowelsyndrome(IBS), pepticulcers,intestinalparasites,Crohndisease,ulcerativecolitis,gastroenteritis,chronic fatiguesyndrome,depression

Avoid all gluten: villigrow backNot treating celiacdisease → risk ofcancer, birth defects,nerve damage

No direct impactClients who manageceliac disease withdiet have nocontraindicationsAbdominal work withincomfort level, ofcourse

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Crohn Disease

Part of IBS with ulcerative colitis ; Disconnectedpatches of inflammation and damage all along theGI tract

Etiology

Usually begins at ileum, can affect upperand lower GI tractAreas are not continuousAffected areas are inflamed

Develop ulcers, may perforateScar tissue may block intestines(stenosis)Fistulas may form

CausesIdiopathic, multifactorialPathological invasion, geneticpredisposition, immune system dysfunction,environmental influences, dietary triggersExposure to paratuberculosis may be afactor; Crohn disease is not contagiousDuring flare, proinflammatory cytokines arevery high

Demographics500,000 in the United States

Men = women

Usually diagnosed between 15–30 or over 55 years oldMostly in urban areas of North America, Europe

Whites > other groups 4:1

Genetic susceptibility


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more Crohn Disease

Signs and Symptoms Treatment Massage

Flare and remission (impliesautoimmunity)During flare

Abdominal pain,cramping, diarrhea(may be bloody),bloatingWeight loss, fever,ulcers in mouth, onskin, anal fissures

Complications

MalnutritionBowel obstructionPerforation, peritonitisAdhesionsAbscessesIncreased risk of colorectalcancerLiver damage, jaundice,gallstonesUlcers in mouth, on lower legs

Steroids, immunosuppressantdrugsCytokine inhibitorsSurgery to remove strictures(may be repeated)Dietary adjustments

Indicated for comfort, supportduring remissionAvoid deep abdominal work;aim for parasympatheticsupport and improved digestionDuring flare: circulatory workmay be too intrusive

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Esophageal Cancer

Malignant cells in esophagus ; Squamous cell carcinoma atproximal end ; Adenocarcinoma at distal end

Etiology

Malignant cells at proximal end = squamousRelated to smoking, alcohol useMalignant cells at distal end = adenocarcinomaRelated to Barrett esophagus, gastroesophageal refluxdisease (GERD)Used to be rare; now more common than squamouscell carcinomaMetastasis through direct contact with other organs,lymphatics, bloodstream

Risk FactorsNot controllable: age, gender, raceControllable: tobacco, alcohol, GERD, obesityOthers: exposure to radiation at neck, toxic substances,human papillomavirus (HPV), drinking hot beverages

DemographicsMen > women 3–4:114,500 diagnoses/year13,700 deaths/year

New treatment options mayimprove life expectancy fornew cases




more Esophageal Cancer

Signs and Symptoms Diagnosis Treatment Massage

Early: no signsLater: dysphagia, painwith swallowing,hoarseness, weightloss, chronic cough

Barium swallow,positron emissiontomography (PET),computed tomography(CT), ultrasound

Surgery,chemotherapy,radiation,photodynamic therapy

Respect effects ofcancer and cancertreatments

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Gastroenteritis

Inflammation of the stomach or small intestine ; Related toinfection, can be hard to discern causes

Etiology

Some pathogens secrete toxins that damage GI liningSome pathogens invade healthy cellsWhen digestion is impaired, pathogens can becomemore aggressiveWhen GI tract is damaged:Absorption of water, nutrients disrupted

CausesViruses

Norwalk virus, rotavirus, hepatitis A, B, C(not flu!)50–70% cases in the United StatesBacteria: Salmonella, Shigella,Campylobacter, Escherichia coli: foodpoisoningHelicobacter pylori (peptic ulcers)15–20% cases in the United States

Dangerous bacterial infection: Clostridiumdifficile

Parasites

Giardia, cryptosporidium, and amebiasis

Others

Candidiasis, toxins, food allergies,medications, bile reflux, other diseases thatcan cause inflammation of the GI tract

Infectious forms are highly communicable

Oral-fecalContaminated water, ice

DemographicsMost dangerous for young and old210,000 hospitalizations/year in theUnited States

10,000 deaths/year in theUnited States

Worldwide: a leading cause of mortality,especially in children



Food prepared on contaminated surfaces




more Gastroenteritis


Abdominal pain,nausea, vomiting, anddiarrheaBloating, cramps, gas,mucous or blood instool

Can be difficult to get agood diagnosisTreating with wrongmedication can worsenPerson can carrypathogens afterinfection has subsided

Usually self-limitingAntibiotics can makesymptoms worseAntidiarrhea meds arediscouragedIntravenous fluids ifnecessaryPrevent throughrigorous hygiene

PrognosisMost resolve in 2–3days2–3 weeks mayindicate underlyingchronic disease

Contraindicated whileacuteLong-term situationsneed information onunderlying disorders

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Gastroesophageal Reflux Disease

Damage to the squamous epithelial lining of theesophagus ; Chronic exposure to gastric juices fromstomach ; Problems at lower esophageal sphincter(LES)

Etiology

Four problems

LES is too relaxedLES doesn’t allow esophagus toclear outHiatal herniaSlow stomach emptying, back-pressure at LES

Leads to several consequences

Respiratory injury : Contents maybe aspirated into lungsDecay of tooth enamel : Acidicjuices present in mouthUlcers : In esophagus: can bleedor become infectedStricture : thickening inesophageal wallBarrett esophagitis : Cells inesophagus begin to resemblestomach cells: precancerous foresophageal cancer

Risk FactorsPregnancyObesitySmokingDietConnective tissue diseasesHiatal herniaDelayed stomach emptying

Demographics8–10% in the United States have heartburn everyday

GERD is probably present in 40–60% ofthose who report heartburn symptomsmost days




Other risk factors: radiation forchest tumors, infection of theesophagus, some medications




more Gastroesophageal Reflux Disease


Heartburn, indigestion,bloating, pain in chestCan look like angina, heartattackAggravated by lying down,bending overAlso:

Dysphagia,coughing,wheezing,hemoptysis

Management

Lose weight;smaller portions;don’t lie down aftermeal; avoidcaffeine, alcohol,nicotine; raise headof bed; wear looseclothing; heatingpad on abdomen

Repair

Medication to blockreceptors thatstimulate acidproduction, increasemotility, etc.Surgery to repairLES, Barrettesophagitis, hiatalhernia

Caution not to exacerbatesymptomsShorter sessions, not lying flat?

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Peptic Ulcer

Damage to esophagus, stomach, and duodenum wall ; Opensore, invitation for infection

Etiology

Pepsin, a protein-digesting enzyme, contributes todevelopment in esophagus, stomach, duodenumTraditionally associated with stress, spicy food

Contributing Factors: StressAggressive features (acid, pepsin)Defensive features (blood supply, mucous lining,bicarbonate)Frequent fluctuations in stress can allow aggressivefeatures to outweigh defensive ones

Contributing Factors: Helicobacter pyloriH. pylori is a bacillus with spiral flagellaCan drill into stomach, duodenal wall, cause localinfection

Contributing Factors: NSAIDsAspirin, ibuprofen, naproxen sodiumInhibit the cyclooxygenase-1 pathwayImpede the production of prostaglandinsSlow production of protective mucousAcetaminophen does not affect stomach function

Other Contributing FactorsExacerbators: smoking, alcohol consumption, Crohndisease, others

Demographics10% of the United States population willprobably have an ulcer at some point

25 million diagnosed now

630,000 hospitalizations/year

6,500 deaths/year


bacillus with spiral flagella







more Peptic Ulcer


Gnawing burning painin chest, abdomenRelieved by antacids,eatingNausea, vomiting, lossof appetite, andbleeding into the GItract

ComplicationsBleeding, anemiaHemorrhagePerforation, peritonitisScar tissue,obstructionIncreased risk ofstomach cancer,lymphoma

Tests for H. pyloriRadiography,endoscopy, biopsy

Antibiotics (only for H.pylori)BismuthH blockers, protonpump inhibitorsSurgical correction

Parasympatheticresponse mayaggravate ulcer: adjustfor duration, position

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Stomach Cancer

Development of malignant tumors in the stomach

Etiology

Most are adenocarcinoma

Probably related to diets high in pickled,salted, preserved foodAlso related to H. pylori

Converts nitrates and nitrites into carcinogensAnything that impedes normal production of gastricjuices raises risk:H. pylori, gastritis, stomach surgery pernicious anemiaMetastasizes through portal system to liver, or throughlymph systemAdenomas = 90–95% stomach cancerOthers: non-Hodgkin lymphoma, carcinoid tumors,stromal cell tumors

Risk FactorsH. pylori infectionDietTobacco and alcohol useOther factors: previous stomach surgery, type A blood,being male, being 60–79 years old, having genesassociated with breast or colorectal cancer

DemographicsHas become fairly rare in the UnitedStates23,000 diagnoses/year

14,000 deaths/year

Most in 60s and 70s

Men > women 2:1

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more Stomach Cancer


Feeling of fullness withlittle foodAbdominal pain abovenavelUnintentional weightlossHeartburnNausea, vomitingAscitesSmall amount of bloodin stool

Seldom found beforemetastasis unlessscreened foraggressivelyEndoscopy, biopsy,barium wash,ultrasound, CT, MRI

Chemotherapy,radiation therapy,surgeryChemotherapy beforeand after surgeryimproves prognosisTest nearby lymphnodes for signs ofmetastasis

As with other cancers:respect challenges ofcancer and cancertreatment

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Disorders of the Large Intestine

Colorectal cancer

Diverticular disease

Irritable bowel syndrome

Ulcerative coilitis




Colorectal Cancer

Development of tumors anywhere in the largeintestine

Etiology

Begins with development of adenomas:polypsIf present for long time

Oncogenes activatedTumor suppressor genesinactivatedCells replicate, don’t die offInvade deeper layers off thecolon, obstruct lumen, or both

CausesCause of polyps is unknown; 50% ofolder Americans have themTriggers for mutation:

High-fat foods

Risk Factors

Obesity, sedentary lifestyleFamily history

Familial adenomatouspolyposis (FAP)

Hereditary nonpolyposis colorectalcancer syndrome (HNPCC)These account for a small percentage ofdiagnosesInflammatory bowel diseaseAge

Demographics148,000 diagnoses/year in the United States

55,000 deaths/year

Number 2 cause of death by cancer in the United States90% of patients > 50 years old


Deep Layers of the Colon




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more Colorectal Cancer


Silent earlyLater: anemia(bleeding tumors),constipation, narrowedstools, feeling bowelmovements areincomplete,unintentional weightloss

Fecal occult blood testSigmoidoscopy, fullcolonoscopy, CT

Depends on stage atdiagnosisSurgery, with orwithout colostomyChemotherapy,radiation if necessaryBiological therapies indevelopment

Prevention5-a-day dietReduce fats in the diet,especially saturatedfatsGet calcium,magnesium, vitaminB , and folateLimit alcoholconsumptionDon’t smokeBe physically active,maintain a healthyweight

Can be helpful withinlimits set by cancerand cancer treatmentsColostomy bag needsadjustments

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Diverticular Disease

Bulge in colon forming diverticulum ; Diverticulosis:presence of bulges ; Diverticulitis: infection of bulges

Etiology

Multifactorial

Inefficient motilityPoor strength in colon wallLow-grade infectionImbalance in bacteriaHypersensitivity of neurons →uncoordinated contractions

Diverticula form during strong colon contraction

Mucosa, submucosa herniatedthrough muscularisMay be filled with fecal material20% eventually get infected

Usually at sigmoid flexure or descending colonCan be anywhere in GI tractRange in size: kernel of corn, walnut, larger

DemographicsHalf of 60- to 80-year-olds have diverticula

Men = women

300,000 diagnoses/year2.5 million people have diverticular diseaseMost common with eating habits with white flour,animal fats


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more Diverticular Disease


May be silentWith infection: fever, nausea,cramping, painMay have sudden or gradualonset

ComplicationsBleedingAbscessesPerforationBlockageFistulasNot associated with increasedrisk of colorectal cancer; canhide early signs

Prevent with high-fiber dietFor diverticulosis: no treatmentmay be necessaryFor diverticulitis: antibiotics,controlled diet; surgicalcorrection if necessary

If diagnosed, deep abdominalwork is contraindicatedAcute infection systemicallycontraindicates bodywork

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Irritable Bowel Syndrome

Digestive system dysfunction without structural changes ; Alsocalled spastic colon, irritable colon, mucus colitis, functionalbowel syndrome

Etiology

Colon is hyperreactive: small stimuli create bigresponsesPeristalsis is irregular, uncoordinatedHypersensitivity to pain, pressure in colonDysfunction in brain-gut axis

Serotonin secretion/uptake problemsAppears with chronic fatigue syndrome,fibromyalgia

Triggered by stress

Risk FactorsWomenAdolescence or early adulthoodLow birth weight, history of psychological trauma

Demographics10–20% of people in the United Stateshave symptoms at some pointWomen > men 3:1

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more Irritable Bowel Syndrome


Abdominal pain,cramps, bloating,constipation/diarrhea

IBS-D: withdiarrheaIBS-C: withconstipationIBS-M or A:mixed oralternating

No structural changesin colon

Rule out morethreatening conditions:diverticulosis,colorectal cancer,ulcerative colitis,Crohn disease,parasites, celiacdisease, food allergies,chronic infectionsSome patients showsigns of long-term low-grade inflammation:opens new treatmentoptionsColonoscope canreveal lack ofstructural changes,inefficient peristalsis

Depends on theindividualManage diet, stressEliminate nicotine,alcohol, caffeine,sorbitolSupplement fiberDrugs:antispasmodics,antidiarrheals,antidepressantsAlternative medicine:acupuncture,peppermint, probiotics

Can be useful forstress management ifwell tolerated

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Ulcerative Colitis

Inflammation, ulcers in large intestine ; Part of IBS (with Crohndisease)

Etiology

Probably autoimmunePoor tolerance for antigens in GI tractUsually begins in rectum, forms shallow ulcers

Chronic bloody diarrhea, risk of secondaryinfection

Classified by part of colon affected

Ulcerative proctitisLeft-sided colitisPancolitisFulminant colitis: full colon is inflamed andulcerated

Most patients reach plateau; half have mild form

DemographicsMen = womenMost diagnoses 15–25 or 55–651 million people in the United States havesome type of inflammatory bowel disease

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more Ulcerative Colitis


Depends on severity, flareversus remissionFlare: painful chronicdiarrhea, blood and pus instool, cramping, mild feverOther systems may beaffected

Hepatitis,inflammation ofgallbladder/ducts,arthritis,osteoporosis,anemia, kidneystones, uveitis,rashes

Blood tests foranemia,inflammationStool samplesScope, biopsyImportant todistinguish from IBSand Crohn disease

ComplicationsHigh risk ofcolorectal cancerToxic megacolon

Medications toreduce severity,frequency of flaresSteroids, nicotinepatchesSurgery: 20–40%have part of bowelremoved

Contraindicates localcirculatory massageDeep abdominalwork alwayscontraindicatedDuring remissiongentle abdominalwork may be helpfulif well toleratedAny work to balanceautonomic is useful

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Disorders of the Accessory Organs

Cirrhosis

Gallstones

Hepatitis

Liver Cancer

Pancreatic Cancer

Pancreatitis




Cirrhosis

Replacement of healthy hepatocytes with nonfunctioningscar tissue ; Can interfere with every liver function

Etiology

Hepatocytes usually replace themselves easily, butthey can lose that abilityChronic inflammation, irritation

Suppresses regenerationStimulates production of collagen, scartissue

Channels blocked, chemical production reduced,function lostHobnail liver functioning cells interspersed with scartissue

CausesAlcoholism; hepatitis C, B, D; autoimmune hepatitisNAFLD: nonalcoholic fatty liver disease

Deposition of fatty tissue in liver:obesity, type 2 diabetes, hightriglycerides

NASH: nonalcoholic steatohepatitis

Inflammation of fatty tissue in liver

Other causes: obstruction of bile duct, toxins, heartfailure, some congenital diseases

Demographics500,000 hospitalizations/year

26,000 deaths

Estimated to shorten lifespan by 22 years

Hobnail liver functioning cells interspersed with scar tissue


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more Cirrhosis

Signs and Symptoms Complications Treatment Massage

Silent or subtle earlyNausea, vomiting,weight loss, rashesLater: complicationslisted next

Portal hypertension:liver is congested,can’t accept bloodfrom major vesselsCan lead toSplenomegaly(enlarged spleen)AscitesInternal varicesBleeding, bruisingOsteoporosisMuscle wastingJaundiceSystemic edemaHormone disruptionEncephalopathyKidney failure,hepatorenal syndromeLiver failureLiver cancer

Stop liver damage (quitdrinking)Meds to counteracteffects of disease,vitaminsHepatitis may betreated with interferonColchicine, milk thistlemay slow progressionLiver transplant:18,000 on list for 5,000procedures/yearLiving donor ispossible

Advanced diseasecontraindicatescirculatory massage(fluid movement)Noncirculatorybodywork can be safeand helpfulWork with health careteam

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Gallstones

Gallbladder = cholecyst ; Stones here = cholelithiasis ;Inflammation here = cholecystitis ; Stone lodged incommon bile duct = choledocholithiasis ; Inflammation ofducts = cholangitis

Etiology

Bile from liver drips into gallbladder via cystic ductGallbladder squeezes bile into duodenum viacommon bile ductPancreas shares a section of common bile ductBile emulsifies fats, made of water, bile salts,bilirubin, cholesterolCholesterol and/or bilirubin can crystallize ingallbladderMost gallstones = cholesterolOthers= bilirubin (indicates underlying disorders)

Contributing Factors

ObesityEstrogenRaceGenderCholesterol-lowering drugsDiabetesRapid weight lossFasting

Demographics42 million in the United States (most don’thave symptoms)

800,000 hospitalizations, 500,000surgeries/year

Women > men 2:1

Native Americans, MexicanAmericans > other groups


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more Gallstones

Signs andSymptoms Complications Treatment Massage

Symptoms developwhen a stone lodgesin a duct: biliary colicExtreme local painrises to peak, thensubsides as stonemovesRefers pain to midback, scapula, rightshoulder

Can obstruct duct,block liver orpancreasGallbladder infection,rupture

Surgery to removegallbladder; usuallylaparascopicEndoscopic retrogradecholangiopancreatography(ERCP): scope that maydislodge stones whilesparing gallbladder

Contraindicatedduring attackCostal angle on rightside a local caution ifclient knows stonesare presentHistory of stones orsurgery is fine formassage

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Hepatitis

Inflamed liver ; Usually a viral infection (hepatitis A–G) ;

Etiology

Viral attacks on hepatocytesExposure to one type confers no protection from othersFour basic phases

Phase 1New infection, viral replication: no symptoms

Phase 2

Prodromal stage: symptoms include food aversion,nausea, vomiting, malaise, itchy skin rashes

Phase 3

Icteric stage: yellowing skin (icterus), pale stools, darkurine, and hepatomegaly

Phase 4

Convalescence: liver heals, jaundice resolves,enzymes return to normal levels, health is restored

DemographicsEstimated 500,000–750,000 newinfections/year

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Hepatitis A

Also called infectious hepatitis ; Short-term, acute, lifelongimmunity

Communicability

Oral-fecal contaminationCan also be blood borne

DemographicsAll age groups90,000 infections/year in the UnitedStates30% adults have antibodies showingexposure

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more Hepatitis A


Like other varieties, butshortest durationIncubation is 2–6 weeks(contagious)May not fully recover forseveral months

Rest, fluidsGamma globulin shots maygive short-term protection afterexposureVaccine available

Contraindicated while acuteNoncirculatory work supportiveduring long recovery

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Hepatitis B

Long-term, subtle symptoms ; More risks of long-term damage ;About 5% develop chronic infections: long-term carriers

Communicability

Through body fluids, not digestive systemBlood, semen, vaginal secretionsSome particles in saliva, probably not enough to impartinfectionSturdy outside a host: can be active for 1 week, occursin high concentrations

DemographicsAnyone who comes in contact withintimate fluids

Live or work with hepatitis BpatientsBorn to mothers with hepatitisBImmigrants from countries withlots of hepatitis BIntravenous drug users

78,000 diagnoses/year (may not beaccurate)1.25 million U.S. people are long-termcarriers, can spread disease5,000-6,000 deaths/year

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more Hepatitis B

Signs and Symptoms Complications Treatment Massage

Incubates 2–6 months(communicable)Can stay in system formonths, yearsSymptoms are subtle;chronic infection maybe silent

5% develop chronicinfectionCan lead to varicoseveins on stomach,esophagusLiver failure, cirrhosis,liver cancer

Interferon, lamivudine(only sporadicallysuccessful)

PreventionVaccine is available

Contraindicatescirculatory massagewhile acuteChronic disease maybe safe if clientresilience is goodNoncirculatorymassage has manybenefits without majorrisks

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Hepatitis C

Used to be called hepatitis non-A non-B ; Long-term chronicinfections ; 5–25% recover spontaneously; 75–85% havelifelong infection, high risk of complications ; Alcoholism,coinfection with hepatitis B or HIV raises risk

Communicability

Shared fluids, sexual activity

Demographics4 million U.S. people are infected

3 million as chronic infectionMain risk group = intravenousdrug users: 26,000 newinfections/yearSome sources say 150,000new infections/year10,000-20,000 deaths/year

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more Hepatitis C


Weakness, fever, nausea,jaundice80% have long delay (20–30years) between exposure andonset of symptoms

Rest, fluids, good nutrition,monitor for complicationsNo vaccine availableInterferon, ribavirinNumber 1 reason for livertransplant

As with other hepatitisinfections, circulatory massageis contraindicated in thepresence of acute disease.When the infection is chronic,judgments must be madebased on the overall health andcirculatory resiliency of theclient.

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Other Types of Hepatitis

Hepatitis D incomplete: only works with hepatitis B ; E, F, G rare in the United States ; Can be complicationof mononucleosis, reaction to meds, autoimmune disease

Massage

Same guidelines: contraindicated while acute, supportive during recovery

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Liver Cancer

Hepatocellular carcinoma (HCC): originates in liver ; (Asopposed to metastatic liver disease)

Etiology

Hepatocytes replicate out of controlHistory of hepatitis B or C, alcoholism, cirrhosiscontribute to replicationTumors may be single or in disconnected areas

Risk FactorsHepatitis B infection: especially if infection occurs inchildhoodHepatitis C infection: 5–10% hepatitis C patientseventually develop liver cancerAlcoholism: cessation of alcohol use may triggercellular mutation—healing process gone wrongHemachromatosisCirrhosisAflatoxin B1: from Aspergillus flavus, grows on peanutsand grains stored in hot, humid conditions

DemographicsWorldwide liver cancer is common anddeadlyFairly rare in the United States: 18,000diagnoses/year, 16,000 deathsOn the rise: doubled 1980–1998 (risinghepatitis C)

Men > women 3:1Mostly 60 years +

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more Liver Cancer


Tumors interfere withnormal liver functionSymptoms may be lostin cirrhosis, hepatitisVague abdominal pain,unintended weightloss, food aversion,muscle wasting,ascites, fever,abdominal mass,possibly jaundiceBlood test for alpha-fetoprotein (AFP) (+ in60% of cases)

CT, ultrasound, MRI,biopsyCan be difficult todiscern primary livercancer frommetastases fromelsewhere

Frequent recurrenceTends to beaggressive, appearwith other diseasesthat compromisehealthSurgery (problematicwith other healthconditions)Liver doesn’t toleratechemotherapy,radiation therapyOther options:Burn/freeze cellsthrough laparoscopicor percutaneousinstruments; injectethanol into tumor;block blood vesselsthat supply tumors

Same guidelines asother cancers: staywithin limits, respectchallenges of cancerand cancer treatments

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Pancreatic Cancer

Uncontrolled growth of cells in pancreas ; Usually exocrineducts, can affect hormone-producing cells ; Aggressive,metastasizes easily, number 4 cause of death by cancer in theUnited States

Etiology

Several mutations of genes in cells that line exocrineducts: adenocarcinomasIn islet cells: neuroendocrine tumorsBoth types grow quickly, invade tissues through directspreading:

Duodenum, stomach, peritoneal wallCells in blood or lymph usually go to liver

Risk Factors

Age (most are 60–80 years old)GenderRace (African Americans slightly more oftenSmokingHistory of type 2 diabetesChronic pancreatitis related to alcoholismOthers

Demographics34,000 diagnoses/yearLife expectancy after diagnosis = 4–6months

Men >women; women arecatching up

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more Pancreatic Cancer


Early signs are subtle:abdominal discomfort,loss of appetite,unintended weight lossIf tumor obstructs thebile duct: jaundiceLater: itchy rashes, GIpain, ascites, enlargedliver, spleenIf cancer affects isletcells: dysregulation ofblood glucose

Can be difficult toaccurately diagnoseand stageMost procedures carryrisk of spreading cells

Resection if possible(usually not)Chemotherapy andradiation therapy toslow progress; may beable to shrink tumor forsurgery

May be helpful forpain, anxiety, fearRespect challenges ofcancer and cancertreatments

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Pancreatitis

Inflammation of the pancreas ; Triggered by : Gallstones, toxicexposures, blunt trauma ; Chronic pancreatitis related to long-term alcohol abuse

Etiology

If ducts are blocked or if cysts or abscesses develop,pancreas will autodigestAcute pancreatitis

Sudden onset of symptoms show blockageof ductsAlcohol use, blunt trauma, malformation,infection, gallstones, toxins, cystic fibrosisUsually short-lived, can be severeCysts, abscesses, necrosis, circulatoryshock, renal failure

Chronic pancreatitis

Long-term wear and tear lead to permanentdamageUsually related to alcohol abuseMay lead to pancreatic stonesComplicationsPain, malabsorption, steatorrhea, bleeding,secondary diabetes

Demographics80,000 diagnosed with acutepancreatitis/year

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more Pancreatitis


Upper abdominal painAcute: may havesudden-onset nausea,fever, rapid pulseChronic: pain isepisodic withincreasing frequency;refers to backOther: unintendedweight loss,dysregulation of bloodglucose, jaundice

CT, MRI, radiography,biopsyBlood tests forenzymes, othermarkers

Depends on causeRemove gallstones,abscesses, deadtissue, repair ductsSever sensory neuronsif necessary

Unexplainedabdominal/back pain:necessitates diagnosisAvoid abdominal work;other supportive workwith caution

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Other Digestive System Conditions

Candidiasis

Peritonitis




Candidiasis

Candida albicans = yeastlike fungi in digestive tract; Live inbalance with intestinal bacteria ; When balance is disturbed andthey overgrow: candidiasis

Etiology

Disruption in flora/fauna balance in GI tractCandida becomes aggressive fungus, reproduces andspreadsEspecially a risk for immunocompromised

Candidiasis triggersAntibiotic use, immune system dysfunction, thymustumor, hormonal imbalances

DemographicsHard to track, as not all agree aboutwhen overgrowth is pathologicalCan look like allergies, chronic fatiguesyndrome, hypothyroidism, otherdisorders

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more Candidiasis


Mouthlesions(thrush)EsophagitisAnal lesionsIntertrigo:yeastinfection atskin foldsOther skinlesionsVaginalinfections:also calledvulvovaginalcandidiasis(VVC)Systemicsymptoms(severeinfection):Fever andchills that donot respondto antibioticsSystemicsymptoms(chronic,low-gradeyeastinfection):food andchemicalsensitivities,headaches(withmigraines),chronicvaginal and

Challenging; manyclinicians don’trecognize as aproblemSkin biopsies, stoolsamples

Topical antifungals forskin outbreaksInternal antifungals:can take a long time tobe effective

Depends on health ofskin, general resilienceMay support effort todetoxify



urinary tractinfections,fatigue,reducedresistanceto infection,acne, manyothers

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Peritonitis

Infection in peritoneal space; Good growth medium

Etiology

Bacteria enter peritoneum

Rupture of an organPelvic or abdominal abscessMechanical perforationSpontaneous peritonitisPeritoneal dialysis

Bacteria promote scar tissue: severe adhesions, cysts(hiding places for bacteria)


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more Peritonitis


Vary with causeAbdominal pain, nausea,vomiting, dehydrationAbdomen may swell as painsubsides: intestinal paralysis,medical emergency

Antibiotics, surgery Any form of acute peritonitissystemically contraindicatesmassage until all signs ofinfection have passed

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The Power is in Your Hands… · Perforation, peritonitis Adhesions Abscesses Increased risk of colorectal cancer Liver damage, jaundice, gallstones Ulcers in mouth, on lower legs