esophagus + stomach disorders (SG 2)

Question 1

dysphagia

Answer 1

motility disorder causing difficulty swallowing r/t mechanical obstruction or functional disorders
MECHANICAL:
intrinsic ➺ something inside the lumen
extrinsic ➺ something outside the lumen
FUNCTIONAL:
a neuro / muscular reason for difficulty ➺ myasthenia graves, stroke, MI, etc.,

Question 2

recognizing signs of dysphagia

Answer 2

stabbing pain
discomfort after swallowing
regurgitation
aspiration
weight loss

Question 3

achalasia

Answer 3

prevents lower end of esophagus from letting good enter the stomach because of loss of inhibitory neurons within the myenteric plexus and atrophy of the middle / lower esophagus

Question 4

recognizing signs of achalasia

Answer 4

chest pain, difficulty swallowing, heart burn,

Question 5

interventions for achalasia

Answer 5

assess for hx and functional disorders
what aggravates / relaxes their condition
swallow studies
soft food diet + liquids
collaboration with speech therapist

Question 6

gastroesophageal reflux disease

Answer 6

motility disorder that causes reflux of acid + pepsin from the stomach into the esophagus (esophagitis)

Question 7

risk factors for GERD

Answer 7

obesity
pregnancy
tight clothing
alcohol
smoking
acidic or spicy food intake

Question 8

recognizing signs of GERD

Answer 8

heartburn
acid regurgitation
dysphagia
coughing (chronic)
asthma attacks (may irritate lungs / trigger vagus nerve)
laryngitis
upper abdominal pain

Question 9

interventions and tx for GERD

Answer 9

MED TX:
PPIs!!!
INTERVENTIONS:
looser clothing, dec. intake of spicy / acidic foods, don’t lay down after eating (eat upright), no smoking or alcohol, exercise, managing stress

Question 10

hiatal hernia

Answer 10

a diaphragmatic hernia involving the protrusion of the upper portion of the stomach through the diaphragm and into the thorax
TYPE ONE: known as a sliding HH
TYPE TWO: known as a para-esophageal HH; this is where the upper portion of the stomach is located high, adjacent to the esophagus
mixed HH

Question 11

diagnosis and recognizing signs and symptoms of HH

Answer 11

DIAGNOSIS:
swallow test, endoscopy, chest x-ray
S+S:
can be asymptomatic; heartburn, dysphagia, epigastric pain

Question 12

interventions ad tx of HH

Answer 12

INTERVENTIONS:
smaller but more frequent meals, elevate head of bed (stay up minutes after meals), no tight clothes, exercise / weight control
MEDS:
antiacids

Question 13

gastroparesis

Answer 13

delayed gastric emptying d/t absence of mechanical gastric outlet obstruction
may be associated with DM, surgical vagotomy, fundoplication (strengthens the LES, prevention of acid backflow)

Question 14

recognizing signs of GP

Answer 14

NV, abdominal pain, postprandial fullness / bloating

Question 15

meds and interventions for GP

Answer 15

MEDS:
metroclopramide
INTERVENTION:
dietary management, taking the time to eat, drinking fluids in between meals

Question 16

pyloric obstruction

Answer 16

PYLORUS: part of the stomach that connects to the duodenum; valve opens / closes during digestion; obstruction narrows / blocks opening
CONGENITAL: seen in babies / infants commonly
ACQUIRED: r/t PUD, cancer

Question 17

recognizing signs of PO

Answer 17

epigastric pain / fullness
NV
succussion splash (sloshing sound in abdomen; sign of obstruction)
*may cause ulcers ➺ obstruction, inflammation ,edema, fibrosis

Question 18

tx for PO

Answer 18

NPO / IV fluids / TPN
PPIs / H2 antagonists

Question 19

gastritis

Answer 19

inflammatory disease of the gastric mucosa
ACUTE: caused by injury of protective mucosa, often caused by NSAID that prevent prostaglandin synthesis (cells that stimulate mucosa / establish proper lining)
CHRONIC:
chronic fundal gastritis ➺ type a, immune, rare; the immune system starts destroying stomach cells (inc. risk for cancer, anemia)
chronic acute gastritis ➺ type b, non-immune; caused by NSAIDS, H. pylori, smoking, alcohol

Question 20

recognizing signs of gastritis

Answer 20

anorexia
NV
fullness
epigastric pain
bleeding

Question 21

interventions and tx for gastritis

Answer 21

MEDS:
discontinue NSAIDS, use antiacids / H2 antagonists, AB for H. pylori
INTERVENTIONS:
vitamin B12 supplements, eat smaller meals

Question 22

peptic ulcer disease

Answer 22

ulceration in the protective mucosal lining, mainly in stomach / proximal duodenum and sometimes in esophagus; can create acute / deep ulcers
ACUTE: erosions, superficial
DEEP: cause / signs of zollinger-ellison syndrome (inc. acid production in stomach)

Question 23

helicobacter pylori relationship to ulcers

Answer 23

found in 90% with duodenal ulcers, 70% with gastric ulcers
treated with 10-14 day course of PPI / AB (clarithromycin / amoxicillin), metronidazole, bismuth subsalicytate, tetracycline

Question 24

risk factors for PUD

Answer 24

older age
smoking
alcohol
emphysema
DM
obesity
blood O type
elevated stress

Question 25

what to look for after tx for pt with PUD

Answer 25

dumping syndrome bile (alkaline) gastritis diarrhea weight loss anemia bile / mineral disorders

Question 26

duodenal ulcers + assessment

Answer 26

MOST COMMON; caused by h. pylori / NSAIDs S+S ➺ intermittent epigastric pain relieved with ingestion of food / antiacids we want to manage hyperacidity ASSESS: bleeding / hemorrhage (emesis / melena) severe epigastric pain (perforation) serum h. pylori levels

Question 27

gastric ulcers

Answer 27

develops mostly in antral region, closer to acid-secreting mucosa they have an increased mucosal permeability to H+ ions and have a lack of prostaglandins