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This chapter will cover several topics, including the gastrointestinal, genitourinary, metabolic, and endocrine systems, and cover a few systematic issues, including cancer, obstetrics and gynecology, and psychiatric disorders. As a physical therapist assistant (PTA), these various systems are not within the scope of physical therapy in terms of diagnosis, but the PTA must be aware of all of the manifestations that dysfunction to any system can elicit. Also, the PTA must understand the impact on these conditions during exercise. Finally, understanding the physiology, pathology, and side effects of medications to treat these abnormalities is a prerequisite to determining the best treatment interventions, progression, and care.


The PTA must have a working knowledge of the function, causes, signs, and symptoms of systemic involvement so that prompt action can be taken on behalf of the patient.

As a typical patient will not be referred to physical therapy with a primary diagnosis of systemic involvement, the physical therapist’s initial examination includes taking the individual’s history, conducting a standardized system review, and performing selected tests and measures to identify existing movement-related disorders. During this examination, the physical therapist (PT) may receive information that points to systemic involvement that may or may not warrant referral for additional medical evaluation. In the vast majority of instances, the medical team will already be aware of such systemic involvement, but, on occasion, the patient may have one of these conditions that have remained undetected. Therefore, when reviewing a patient’s medical chart, numerous tests and procedures are documented by the medical team that the PTA must be aware of.


The gastrointestinal (GI) tract serves to transport food and absorb nutrients to sustain life. The GI tract’s main functions include the digestion of food, absorption of nutrients, and waste elimination. Pathologic conditions affecting the GI system, including malignancies, result from the impairment of these functions.


The GI system consists of three tracts:

  • Upper: Consists of the mouth, esophagus, and stomach

  • Lower: Consists of the small intestine (duodenum, jejunum, and ileum) and large intestine (cecum, colon, and rectum)

The anatomy of the GI system is shown in Figure 9-1. Table 9-1 summarizes the selected GI pathologies discussed in this chapter, and Table 9-2 identifies organs associated with abdominal quadrants.

Figure 9-1.

Gastrointestinal system. (Reproduced with permission from Ash R, Morton DA, Scott SA, eds. The Big Picture: Histology. 2013. Copyright © McGraw-Hill LLC. All rights reserved.

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TABLE 9-1 Selected Gastrointestinal Pathologies.
  • Gastroesophageal reflux disease (GERD)

  • Gastroenteritis

  • Diverticular disease

  • Appendicitis

  • Pancreatitis

  • Pancreatic cancer

  • Crohn disease

  • Colorectal cancer

Reproduced with permission from Burke-Doe A, Dutton M, eds. National Physical Therapy Examination and Board Review. 2019. Copyright © McGraw ...

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