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Gastrointestinal/Genitourinary System - #23561


 

 

Jonathan C. Williams, MEd,DC, DABCI
4.50
75.0

3.0 + 1 Independent Study

1.0

Discussion of the presentation, diagnosis, and treatment of common gastrointestinal and genitourinary disorders and complaints. Students practice diagnostic and treatment procedures, and discuss how doctors of chiropractic can participate in the management of patients with these disorders.

Please select from the list on the right.

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  7. Critical Thought and Knowledge Acquisition
    Graduates will acquire, appraise and apply scientific information. Graduates will contextually organize and synthesize relevant information to address an issue or problem.
  8. Competence in one's Discipline
    Graduates will demonstrate competence of appropriate depth and scope for one's discipline.

Course Objectives
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  1. ability to take and interpret a GI/GU history;
  2. performance of an abdominal, genital and rectal examination;
  3. understanding of the pathophysiology and clinical characteristics of the disorders and diseases of the GI/GU system;
  4. ability to determine GI/GU diseases which have the potential to respond to conservative treatment;
  5. knowledge of spinal involvement associated with autonomic balance relative to the GI/GU system;
  6. knowledge and application of body wall reflex techniques and visceral manipulative techniques associated with the GI/GU system;
  7. knowledge of the adjunctive procedures that apply to problems of the GI/GU system and fall within the scope of chiropractic practice;
  8. ability to develop a treatment plan for GI/GU disorders amenable to conservative therapy; and
  9. appreciation for the limitations of conservative care and the need for referral to other health care practitioners.
  10. Develop thought processes in patient management from history through differential diagnosis and treatment.
Materials
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References:

  • Batch, P.A., Balch, J.F., Prescription for Nutritional Healing. 3rd Edition. Avery Publishing, Garden City, New York, 2000
  • Pederson, M., Nutritional Herbology A Reference Guide to Herbs. Wendell W. Whitman Co., Warsaw, IN, 1998
  • Calbom, C., Keane, M., Juicing for Life. Avery Publishing, Garden City, New York, 1992
  • Pizzorno, J. E., Murray, M. T., Textbook of Natural Medicine. 2nd Ed., Churchill Livingstone, 1999
A. Required Text(s):
  1. The Merck Manual - 18th Edition
  2. Class notes
  3. Lab notes

B. Recommended Text(s):
  1. Lawrence DL. ed. Fundamentals of Chiropractic Diagnosis and Management, Baltimore, MD Williams & Wilkins, 1991
  2. Human Physiology - From Cells to Systems, 5th Ed. Lauralee Sherwood, Thompson Books, 2004
  3. Chaitow L. Soft Tissue Manipulation
  4. Barral J-P, Mercier P. Visceral Manipulation, Seattle WA, Eastland Press, 1988
  5. An Endocrine Interpretation of ChapmanÆs Reflexes by The Interpreter, Reprinted by the Academy of Applied Osteopathy 1963
  6. Bennett TJ. Dynamics of correction of abnormal function. Sierra Madre, CA:Ralph Martin, 1977.
  7. Selye H. The stress of life, revised, New York: McGraw-Hill, 1976
  8. Gastrointestinal Physiology: Leon and Johnson, Mosby Physiology Monograph Series

C. Required Materials for Lab:

Module notes
Assignments
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  1. Reading assigned weekly from Merck
  2. Required class lecture notes will be available in the bookstore
  3. Lecture and lab materials
  4. Case study worksheets
Attendance
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  1. Class hours - 3 hours lecture per week - 1 hour practical lab per week
  2. Attendance is recommended. There will be take home case studies required during the term and inclass cases cannot be done outside of class time.
  3. Attendance and participation in male genital rectal exam is mandatory. Failure to participate will result in failure of course.
Grading Criteria
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  1. 125 points for self-study via case studies - 10 studies, 10 points content. (Paper will be typed in the designated format). Plus, 1-25 point project.
  2. 100 points: 10, 10-point quizzes will be given during the term on material gleaned from the reading assignments or lab material.
  3. Practical Examination - one practical examination will be given during a lab meeting, graded on a pass/fail basis with a failing effort requiring remediation and a retake.
  4. Final exam is a case history that the student will have to diagnose. The student will first have to determine the exam procedures required then order appropriate lab test & correctly fill out a request, third order x-rays then arrive at a diagnosis & outline a treatment plan. (50 points).
  5. Additional 50 points may be made available through in-class projects.
  6. 25 points for Interactive Case Studies.

 
 

Guaranteed grades are as follows:

A = 91 - 100%
B = 83 - 90.999%
C = 75 - 82.999%
D = 70 - 74.999%
F = 69 or below
Course Competencies
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Note: As an educational experience for those students interested, I may ask for a volunteer from the class. This person must have a medically diagnosed condition and that is still having difficulty maintaining normal function. For example: Crohn's Disease - currently having regular flare-ups of diarrhea and abdominal cramping. This person will be evaluated with a Metabolic Questionnaire, History, Physical examination and Laboratory studies. He/she will be prescribed and supplied with nutritional and dietary recommendations, and followed through the term. At the end of the term all evaluations will be repeated. There will be NO cost to the student, and there will be no affect on the student's grade. Those of the class who elect to partake (or not partake) in the collection of information and the formulation of a case report also will NOT have the grade affected.

COGNITIVE DOMAIN


Students will be able to construct and follow a rational diagnostic process in evaluating patients who present with the following symptoms:

a. abdominal pain f. vomiting
b. constipation g. jaundice
c. diarrhea h. blood with stool
d. gas i. heartburn
e. nausea  

In addition, students will be familiar with the following symptoms, which sometimes accompany certain gastrointestinal conditions as well as conditions related to other body systems:
a. altered mental status e. muscle aches
b. anorexia, weight loss f. skin changes
c. fever, chills, night sweats g. malaise, fatigue, prostration
d. headache  

Students will be able to explain the clinical utility and indications for the following laboratory, imaging and other diagnostic tests in patients with suspected gastrointestinal disease:

a. abdominal x-rays r. Hydrogen Breath test
b. abdominal pain s. Impotence
c. abdominal Examination t. Incontinence
d. Amylase & Lipase u. Liver Challenge Test
e. Bed wetting v. MRI & Ct-scan with barium
f. coenzyme panels w. Nocturia
g. CBC with differential x. Oliguria
h. Dysuria y. Parasitic tests
i. Endoscopy z. Perineal pain
j. ESR, Creactive protein, CPK, Ferritin aa. Ph testing for stomach & Intestine (hydelberg)
k. Flank pain ab. Polyuria
l. Frequency ac. Proctoscope
m. Genital change. ad. Stream abnormalities
n. Genital pain ae. Stool analysis
o. Hair Analysis af. thyroid panel
p. Hematuria ag. Urgency
q. Hesitancy ah. urinalysis

In addition, students will be familiar with the following symptoms, which sometimes accompany certain genitourinary conditions as well as conditions related to other body systems:
a. Anorexia, weight loss f. Skin changes
b. Edema g. Malaise, fatigue, prostration
c. Fever, chills, night sweats h. Breast enlargement
d. Headache i. Polydipsia
e. Muscle aches  

Students will be able to explain the clinical utility and indications for the following laboratory, imaging and other diagnostic tests in patients with suspected genitourinary disease:
a. The "Three Glass Test" g. Intravenous Urography
b. Antibody tests for Streptococcal Infections h. CT/MRI
c. ASO Titers i. Ultrasound
d. CBC with Differential j. Angiography
e. Urinalysis k. Radioisotope Scanning
f. KUB l. Lymphangiography


Conditions:
Students will be able to make case management decisions regarding common GI/GU conditions based on their understanding of the following information regarding each condition.

Clinical Condition Etiol. & Epidem Patho-
physiology		 Nat. History & course Exam & Dx Rx/Mgmt Weekly Reading
Merck Manual
Week 2
General abdominal pain
2
2
2
2
2
 Robins Ch 5/6
Handout
Sideropenic dysphagia - plumb vinson
2
2
2
2
2
 108-110
Aperistalsis - Achalasia
2
2
2
2
2
 110
Hiatal Hernia
2
2
2
2
2
 112-114
Diffuse Esophageal spasm
2
2
2
2
2
 111-112
Globus Hystericus & Rumination
2
2
2
2
2
 69-70
Heartburn-chest pain of esophogeal origin
2
2
2
2
2
 65-68 & 112-114
Week 3
Pyloric Stenosis
2
2
2
2
2
 2284-5, 2242
Megaduodenum
2
2
2
2
2
 155,-8, 2430-1
Mallory-Weiss syndrome
2
2
2
2
2
 90, 114
Diarrhea
2
2
2
2
2
 77-80
Constipation
2
2
2
2
2
 73-77
Irritable colon-spastic constipation
2
2
2
2
2
 82-84
Week 4
Intestinal obstruction Mechanical-vascular-neurogenic
2
2
2
2
2
 104-106
Diverticulosis
2
2
2
2
2
 159-160
Appendicitis
2
2
2
2
2
 101-102
Peritonitis, acute abdominal pain
2
2
2
2
2
 94-100
Ulcerative colitis
2
2
2
2
2
 155-159

Acid-Peptic Disease and Gastritis

 
2
2
2
2
2
 115-123
Week 5
Milk Alkali syndrome, and disorders of calcium & Magnesium concentration
2
2
2
2
2
 1248-1263
Regional Enteritis Crohn's
2
2
2
2
2
 152-155
Liver Disease-jaundice, hepatitis, cirrhosis
2
2
2
2
2
 191-195,219-230,215-219
Gallbladder diseases stones, acute cholecystitis, chronic cholangitis
2
2
2
2
2

240-248

Anorectal disorders fissures, abscess, fistula, proctitis, stenosis, prolapse, incontinence
2
2
2
2
2
 162-4,166,167
Diseases of the pancreas
2
2
2
2
2
 128-133
Week 6
Malabsorption syndromes
2
2
2
2
2
 139-148
Gastrointestinal Cancer
2
2
2
2
2
 168-183
Benign Prostatic Hypertrophy 2 2 2 2 2
2042-2045
Trauma-urinary track 2 2 2 2 2
2589-2592
Cystitis-UTI 2 2 2 2 2
1968-1975
Diabetes Insipidus 2 2 2 2 2
1941
Week 7
Diabetes Mellitus 2 2 2 2 2
1274-1294
Dysuria 2 2 2 2 2
1935-1938
Enuresis 2 2 2 2 2
1960
Epididymitis 2 2 2 2 2
2037-2041
Erectile Dysfunction 2 2 2 2 2
1948-1950
Flank Pain 2 2 2 2 2
Robins Abd. Pn
Frequency 2 2 2 2 2
1929-1941
Week 9
Glomerular Disease 2 2 2 2 2
1996-2015
Groin Pain/Hernias 2 2 2 2 2
102-103
Scrotal Mass 2 2 2 2 2
1935-2041 & 2
Nephrotic Syndrome 2 2 2 2 2
2004-2015
Incontinence & Bladder & Prostate 2 2 2 2 2
1951-1960
Mets to bone 2 2 2 2 2
349
Week 10
Neurogenic Bladder 3 2 2 2 2
1960-1962
Orchitis/Epididymitis 2 2 2 2 2
2037-2039
Peyronie's disease 2 2 2 2 2
2039
Prostate Cancer 2 2 2 2 2
2052-2054
Prostatitis 2 2 2 2 2
2045-2047
Week 11
Pyelonephritis/Infections 3 2 2 2 2
1968-1975
Polycystic Kidney Disease & Renal Failure 2 2 2 2 2
1975-1989
Posterior Urethral Valves 2 2 2 2 2
2436
Renal Cell Carcinoma 2 2 2 2 2
2055-2056
Spermatic Cord Torsion 2 2 2 2 2
2042
Transitional Cell Carcinoma of the Bladder 2 2 2 2 2
2047-2049
Week 12
Vaginitis 2 2 2 2 2
2083-2087
Varicocele 2 2 2 2 2
1935-2041
Vesicoureteral Reflux 2 2 2 2 2
2434-2435
Wilm's Tumor 2 2 2 2 2
1929,2394-2395

Elaboration of Coding Definitions Regarding the Conditions/Topics:

The following codes refer to the depth of coverage for Etiology and Epidemiology; Pathophysiology, and; Natural History and Course.

0 No coverage or content
1 Introduction, without test items
2 Moderate class discussion and/or handout material, with test items
3 Extensive discussion and/or handout material, with test items

For Exam and Diagnosis, the following numbers indicate which aspects of exam and diagnosis of each condition are taught in this course.
1 Presenting SX: - Presenting symptoms related to condition are discussed.
2 History findings: - Relevant personal and family history are discussed.
3 Exam findings: - General physical exam findings are discussed.
4 Chiropractic findings: - Posture, subluxation, muscle tone and length, trigger points.
5 Lab findings: - Blood, urine, CSF.
6 Imaging findings: - Normal, CT, CAT, MRI.
7 Special test findings: - E.g., sweat test for cystic fibrosis, spirometry for asthma.

For Treatment/Management, the following numbers indicate which aspects of treatment and management of each condition are taught in this course.
1 Chiropractic: - Adjustments, soft tissue techniques.
2 Physical Therapy: - Physical therapy modalities of all types.
3 Nutrition/Supplements: - Diet and supplement recommendations.
4 Exercise: - Stretching, strengthening, aerobic exercise recommendations.
5 Lifestyle Management: - Stress reduction, smoking cessation, allergen avoidance, etc.
6 Medical: - Drugs, antibiotics, surgical procedures, radiotherapy, etc.
7 Other: - Acupressure/puncture, massage, homeopathic or herbal Rx.
8 Guidelines: - If published, do you refer to them regarding this condition?


PSYCHOMOTOR DOMAIN


Students will be able to conduct, in a patient presenting with gastrointestinal disease manifestations, an appropriate physical examination using the following procedures:

a. auscultation g. palpation for associated spinal subluxation
b. percussion h. prostatic examination standing & side lying
c. palpation of abdominal structures i. rectal examination standing & side lying
d. male genital examination j. examination for abnormal abdominal symmetry
e. lymph node palpation k. lesion culture sampling
f. palpation of abdominal muscles for hypertonicity and trigger points  

In addition, students will be able to seek and detect, during the visual inspection and listening and olfactory phase of the physical examination of a patient with gastrointestinal manifestations, the following signs:

a. abnormal respiratory rate, rhythm and depth g. arterial bruit
b. pallor h. venous humms
c. asymmetry of the abdominal wall i. body odors
d. aortic pulsations j. pain presentations for colicy & constant pain
e. peristaltic waves k. friction rubs
f. areas of altered skin color & texture l. normal & abnormal turbulence

Students will be able to select and properly employ the following treatment techniques (either singly or in condition specific treatment "packages") to male and female patients who have gastrointestinal disease:
a. prone, supine and sitting adjustments for superior first rib n. large intestine lymphatic reflex
b. prone cervical & lumbar adjustments o. closed ileocecal lymphatic reflex
c. trigger point techniques for diaphragm p. open ileocecal vascular reflex
d. general mobilization of the cervical area q. small intestine massage
e. general thoracic mobilization r. ileocecal valve massage
f. general lumbar mobilization s. Gallbladder technique
g. manual & electric therapy reflex procedures t. three point gluteal technique
h. wheel technique u. hiatal hernia technique
i. intestinal lift v. pitosis of abdominal content technique
j. bladder lift w. abdominal adhesion
k. diaphragm trigger points x. coccyx adjustments
l. pyloric valve lymphatic reflex y. pubic symphysis adjustments
m. angina vascular reflex z. treatment for enuresis

In addition, students will be able to advise and instruct patients regarding the following home care concepts and activities as they apply to specific gastrointestinal conditions:

a. nutrition and supplementation
b. aerobic exercise
c. the use of certain herbal remedies
d. vascular & lymphatic reflexes

AFFECTIVE DOMAIN


Students will demonstrate integrity, sensitivity, respect, courtesy, compassion and professionalism at all times, both in lectures and labs, and will be able to apply the history, physical examination and treatment techniques learned in this course to any patient while demonstrating those same qualities.
Weekly Calendar of Learning Objectives
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Week Dates Topics/Learning objectives
Week 1 -- Lec: Introduction: Review of course syllabus, conduct and goals. Review clinical anatomy.
Lab: Module 1
Week 2 -- Lec: Introduction: Review of course syllabus, conduct and goals. Review clinical anatomy.
Lab: Module 1
Week 3 -- Lec: GI/GU Neurology's
Lab: Module 1
Week 4 -- Lec: Vindicate and x-ray case studies
Lab: Module 1
Week 5 -- Lec: Laboratory Analysis for GI/GU
Lab: Module 1- - view Bates video. Male genital and rectal exam
Week 6 -- Lec: Fever, nausea, and vomiting
Lab: Module 2 - Live model, male exam = REQUIRED
Week 7 -- Lec: Epigastric pain
Lab: Module 2
Week 8 -- MIDTERM EXAMS AS SCHEDULED
Week 9 -- Lec: Supra pubic and rectal pain
Lab: Module 3
Week 10 -- Lec: Flank and testicular pain
Lab: Module 3
Week 11 -- Lec: GU specific
Lab: Module 3
Week 12 -- Lec: System Case
Lab: Module 4
Week 13 -- Lec: GI specific
Lab: Module 4
Week 14 --
--		 Final Exams as scheduled
Week 15 --
--		 Final Exams as scheduled
Please Note
This schedule of lecture and lab topics and quizzes and exams may be changed during the course of the trimester as circumstances require. Whenever possible, such changes will be announced in class before the date and time in question. You are responsible for anything that transpires during lectures and labs, even when you are unable to attend. In the event that you miss a class session, make sure you check with a classmate about any announcements or schedule changes which may have been made. Makeup exams are allowed only according to the policies described in the current student handbook, which is available in the Student Affairs office.
Maintained by Northwestern College of Chiropractic
Last updated: 5 April, 2007
 

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