Esophogeal/Stomach Disorders

Question 1

What causes proximal dysphagia?

Answer 1

Neurological deficits from stroke, can lead to aspiration pneumonia

Question 2

What causes distal dysphagia?

Answer 2

Obstructive: Inflammation, tumor, Achalasia

Question 3

What is achalasia?

Answer 3

The smooth muscle fibers in esophagus cannot relax, so sphincter cannot open/close at proper times

Question 4

Distal dysphagia can also mimic what condition?

Answer 4

Angina

Question 5

S/S of GERD

Answer 5

Heartburn
Reflux
Dysphagia
Painful Swallowing
Chest pain (esp supine)
Coughing, asthma, wheezing
Sore throat
Hoarseness

Question 6

How is GERD Diagnosed?

Answer 6

History
Endoscopy
Barium Radiography
Presence of H. Pylori bacteria

Question 7

How is GERD treated?

Answer 7

Eat small, frequent meals
Acid-suppressing medications
Surgery

Question 8

What are PT implications for GERD?

Answer 8

Have pt lay on RIGHT side to let gastric juices flow, avoid supine position immediately after eating.

Question 9

What is barrett’s esophagus?

Answer 9

Damage of the esophageal lining by the stomach acid; damaged lining is replaced by one similar to the that in the stomach

Question 10

What are S/S of Barrett’s esophagus?

Answer 10

Dysphagia
Esophagitis
Ulceration
Bleeding
Adenocarcinoma

Question 11

How do you treat Barrett’s Esophagus?

Answer 11

Control GERD
Endoscopic ablation therapy
Proton pump inhibition to control acid secretion

Question 12

What are esophageal varices?

Answer 12

Abnormally large, swollen/distended veins in the lower part of the esophagus.

Question 13

How do you treat esophageal varices?

Answer 13

• 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

Question 14

What is a hiatal hernia?

Answer 14

Stomach pushes through the hiatus (opening in the diaphragm) when the cardiac sphincter becomes enlarged.

Question 15

Etiology of hiatal hernia

Answer 15

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)

Question 16

What are the risk factors for a hiatal hernia?

Answer 16

> 50 years old, obesity, smoking

Question 17

what are the s/s of a hiatal hernia?

Answer 17

heart burn, chest pain, reflux, belching, nausea

Question 18

How are hiatal hernias diagnosed?

Answer 18

Ultrasonography, barium swallow, endoscopy

Question 19

How are hiatal hernias treated?

Answer 19

Antacids, elevate the head of the bed

Question 20

PT Implications for hiatal hernias

Answer 20

Avoid lying supine, avoid anything that increases intra-abdominal pressure

Question 21

What is a peptic ulcer?

Answer 21

A break in the protective mucosal lining that exposes the submucosal areas to gastric secretions

Question 22

What are some problems involved with chronic peptic ulcers?

Answer 22

Muscular layer of stomach is damaged and replaced with scar tissue, blood vessels can be damaged and hemorrhage

Question 23

What are the different types of peptic ulcers? (3)

Answer 23

Gastric
Duodenal
Esophageal

Question 24

Etiology/risk factors of peptic ulcers

Answer 24

H. Pylori Infection (90% of time)
Long term NSAID use
Tobacco/alcohol
Physiologic changes
Genetics
Gastrinoma
Systemic mastocytosis
Malignant tumors

Question 25

S/S peptic ulcer

Answer 25

``` 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 ```

Question 26

Complications of peptic ulcer

Answer 26

Hemorrhage Perforation Obstruction Unremitting pain

Question 27

How are peptic ulcers diagnosed?

Answer 27

``` s/s and history Upper GI x-ray blood or breath test stool antigen test Gastroscopy ```

Question 28

Prevention and treatment of peptic ulcers

Answer 28

``` Avoid prolonged Nsaids Antimicrobials Acid blockers Cabbage Coffee Exercise Surgery ```

Question 29

Prognosis of peptic ulcers:

Answer 29

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