Esophogeal/Stomach Disorders Flashcards
What causes proximal dysphagia?
Neurological deficits from stroke, can lead to aspiration pneumonia
What causes distal dysphagia?
Obstructive: Inflammation, tumor, Achalasia
What is achalasia?
The smooth muscle fibers in esophagus cannot relax, so sphincter cannot open/close at proper times
Distal dysphagia can also mimic what condition?
Angina
S/S of GERD
Heartburn Reflux Dysphagia Painful Swallowing Chest pain (esp supine) Coughing, asthma, wheezing Sore throat Hoarseness
How is GERD Diagnosed?
History
Endoscopy
Barium Radiography
Presence of H. Pylori bacteria
How is GERD treated?
Eat small, frequent meals
Acid-suppressing medications
Surgery
What are PT implications for GERD?
Have pt lay on RIGHT side to let gastric juices flow, avoid supine position immediately after eating.
What is barrett’s esophagus?
Damage of the esophageal lining by the stomach acid; damaged lining is replaced by one similar to the that in the stomach
What are S/S of Barrett’s esophagus?
Dysphagia Esophagitis Ulceration Bleeding Adenocarcinoma
How do you treat Barrett’s Esophagus?
Control GERD
Endoscopic ablation therapy
Proton pump inhibition to control acid secretion
What are esophageal varices?
Abnormally large, swollen/distended veins in the lower part of the esophagus.
How do you treat esophageal varices?
- If they bleed, hemorrhage will stop on its own
- Prophylactic treatment
- Stent to reduce pressure (between hepatic and portal vein)
- Liver transplant
- AVOID ACTIVITES INCREASING INTRA-ABDOMINAL PRESSURE
What is a hiatal hernia?
Stomach pushes through the hiatus (opening in the diaphragm) when the cardiac sphincter becomes enlarged.
Etiology of hiatal hernia
Weakening of the diaphragm OR enlargement of the hiatus. Can be congenital (born with weak diaphragm) or acquired (trauma, aging, surgery, activities that increase intra-abdominal pressure)
What are the risk factors for a hiatal hernia?
> 50 years old, obesity, smoking
what are the s/s of a hiatal hernia?
heart burn, chest pain, reflux, belching, nausea
How are hiatal hernias diagnosed?
Ultrasonography, barium swallow, endoscopy
How are hiatal hernias treated?
Antacids, elevate the head of the bed
PT Implications for hiatal hernias
Avoid lying supine, avoid anything that increases intra-abdominal pressure
What is a peptic ulcer?
A break in the protective mucosal lining that exposes the submucosal areas to gastric secretions
What are some problems involved with chronic peptic ulcers?
Muscular layer of stomach is damaged and replaced with scar tissue, blood vessels can be damaged and hemorrhage
What are the different types of peptic ulcers? (3)
Gastric
Duodenal
Esophageal
Etiology/risk factors of peptic ulcers
H. Pylori Infection (90% of time) Long term NSAID use Tobacco/alcohol Physiologic changes Genetics Gastrinoma Systemic mastocytosis Malignant tumors
S/S peptic ulcer
Epigastric pain Midline pain in T/S Melena Nausea Vomitting blood Loss of appetite --> weight loss Bleeding Symptoms occur 3-4 days to weeks, subside, then reappear months later
Complications of peptic ulcer
Hemorrhage
Perforation
Obstruction
Unremitting pain
How are peptic ulcers diagnosed?
s/s and history Upper GI x-ray blood or breath test stool antigen test Gastroscopy
Prevention and treatment of peptic ulcers
Avoid prolonged Nsaids Antimicrobials Acid blockers Cabbage Coffee Exercise Surgery
Prognosis of peptic ulcers:
GU: heal in 3 months
DU and GU: chronic w/ remissions and exacerbations
- Massive hemorrhage or perforation may cause mortality
- Curing H pylori usually cures disease
