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My MNTII Test 1 > from 2. Upper GI Disorders > Flashcards

from 2. Upper GI Disorders Flashcards

1
Q

stages of swallowing

A
  1. preparatory
  2. oral
  3. pharyngeal
  4. esophageal
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2
Q

risks for dysphagia

A 
NEUROMUSCULAR DISORDERS, SURGERY, TRAUMA
Stroke–CVA
Multi-infarct dementia or Alzheimer’s
Brain aneurysms
Amyotrophic lateral sclerosis (ALS)
Parkinson’s disease
Diabetic neuropathy/gastroparesis
Cerebral palsy
Achalasia
Raynaud’s
Scleroderma
Closed head injury
Caustic ingestion
Burns
Facial/laryngeal trauma
Head and neck cancer
tracheostomy
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3
Q

dysphagia: s/s

A

anorexia and wt loss.
food sticking in throat.
choking on food, liquid or saliva.
Coughing or discomfort in throat or chest when swallowing.
heartburn or acid reflux.
pt finds fluids/solids difficult to swallow.
symptoms indicating aspiration, such as recurrent chest infection.
Need for repeated swallowing.
Drooling or rocking the tongue.
Pockets of food pooling in the mouth or throat.
Difficulty chewing.
Gurgling or wet voice quality.
Hoarse breathing.

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4
Q

dysphagia: Dx

A

bedside swallow evaluation.
MODIFIED BARIUM SWALLOW/ VIDEO FLUOROSCOPY SWALLOW STUDY.
various food consistencies for swallow test.

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5
Q

dysphagia: Dx recommendations

A
  1. NPO with re-eval if status improves
  2. Modified barium swallow
  3. Dysphagia diet
  4. Swallowing therapy
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6
Q

dysphagia: Tx

A

Swallowing therapy
Devices like special straws
Electrical stimulation
Modified food and beverage consistency

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7
Q

aspiration

A

Food or beverages enter the respiratory tract.
Can cause immediate respiratory distress, block the airway, or lead to aspiration pneumonia.
May occur only with certain consistency foods or all foods

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8
Q

National Dysphagia Diet (NDD)

A

level 1: pureed
level 2: mechanically altered
level 3: advanced
level 4: regular diet

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9
Q

achalasia

A

LES fails to relax (opp of GERD),

absence of esophageal peristalsis.

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10
Q

achalasia: possible cause

A

defective nerves or maybe a virus

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11
Q

achalasia: s/s

A 
Dysphagia for solids and liquids
Weight loss/ malnutrition
Substernal chest pain
Fullness in the chest
Nausea & vomiting
Regurgitation and burning
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12
Q

achalasia: Meds

A 
Calcium channel blockers Nifedipine (Adalat)
or nitrates (isordil) to relax the LES
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13
Q

achalasia: Management

A

intrasphincteric injection of botulinum toxin.
Pneumatic dilatation - A balloon is inflated at the level of the gastroesophageal junction.
laparoscopic Heller Myotomy -Surgery to divide some of the LES muscle fiber.
Worst case esophagectomy.

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14
Q

achalasia: MNT

A

help lessen discomfort.
disphagia diet,
freq small slow feedings,
fat to relax LES

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15
Q

achalasia: avoid

A

extreme temp, spicy, acid, hard fibrous foods

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16
Q

esophageal (Zenker) diverticulum

A

weakened esophageal wall causing a pouch in esophagus

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17
Q

esophageal (Zenker) diverticulum: s/s

A

dysphagia, fetid breath, GERD

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18
Q

esophageal (Zenker) diverticulum: Tx

A

laproscopic surgical removal

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19
Q

GERD

A

Gastroesophageal reflux disease. (low LES pressure, stays open, opp of achalasia)

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20
Q

long term GERD

A

lead to Barett’s esophagus - increase esophageal cancer risk (esp if genetically susceptible)

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21
Q

GERD: avoid

A

spicy, high fat food, eating too much, factors that lower LES pressure

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22
Q

GERD: s/s

A

Pyrosis (heart burn)
Dysphagia
Pulmonary symptoms /aspiration
Chest pain
Burning throat
bitter or sour taste of the acid in the back of the throat

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23
Q

GERD: Management

A

add factors that increase LES pressure, lower gastric acidity, surgery fundoplication

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24
Q

low LES pressure factors:

A 
High fat foods
Alcohol
Coffee/caffeine
Chocolate 
Smoking 
Peppermint/spearmint
Acid foods like citrus or tomatoes
Hot spicy foods
mustard
Pepper
Red wine
Carbonated beverages
Meds such as:
Estrogen
Progesterone
Valium
L-dopa
narcotics
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25
Q

higher LES pressure factors:

A

high protein intake,
Metoclopramide (reglan) - speed gastric emptying,
obesity, overeating, reclining, large fluid intake, constipation, running, aspirin. (aloe vera, deglycyrrhizinated licorice, apple cider vinegar, gum?)

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26
Q

OTC meds to decrease gastric acid:

A

Histamine receptor blockers, antacids

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27
Q

PRESC meds to decrease gastric acid:

A

proton pump inhibitors (work best)

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28
Q

histamine receptor blocker names

A

nizatidine (Axid)
ranitidine (Zantac)
famotidine (Pepcid)
cimetidine (Tagamet)

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29
Q

antacid names

A

Mylanta, Maalox, Tums, Rolaids, Gaviscon-foams and decreases acid reflux into esophagus

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30
Q

PPI’s names

A 
-work best to decrease gastric acid-
esomeprazole (Nexium)
lansoprazole (Prevacid)
omeprazole (Prilosec)
pantoprazole (Protonix)
rabeprozole (Aciphex)
dexlansoprazole (Dexilant)
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31
Q

antacids decrease absorption of:

A

iron, thiamin, phosphorus, vit A

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32
Q

PPI’s & Hist blockers decrease absorption of:

A

vit B-12

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33
Q

lower stomach acid decrease absorption of:

A

Ca, Mg, Fe

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34
Q

Magnetic Sphincter Augmentation (MSA)

A

surgical device to treat GERD. restore sphincter-like fcn, may cause dysphagia

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35
Q

nissen fundolication

A

transoral endoscopic fundoplication - lessens reflux

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36
Q

hiatal hernias

A

stomach protrudes through diaphragm up into thorasic cavity.

sliding & rolling (paraesophageal)

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37
Q

hiatal hernias: symptoms

A

none or similar to GERD (pyrosis, dysphagia, aspiration, chest pain, bitter burning throat)

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38
Q

ulceration of the herniated stomach may result in:

A 
bleeding & anemia, 
obstruction,
torsion,
gangrene,
perforation
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39
Q

gastric volvulus w/strangulation

A

stomach becomes twisted and angulated in its midportion. surgical emergeny if stomach cannot be decompressed.

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40
Q

gastric volvulus occurance

A

occurs post-prandially, seen in 30% of paraesophageal hernias

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41
Q

borchardt’s triad

A

chest pain,
retching w/out vomit, and inability to pass a nasogastric tube.

often requires emergency surgery

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42
Q

hiatal hernias: management

A

same as GERD (try to increase LES pressure), maybe surgery

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43
Q

esophagitis

A

infection like candida albicans, HIV, Epstein Barr virus, CMV, TB, etc.
can be acute or chronic

44
Q

esophagitis: symptoms

A

similar to heartburn, cough, dysphagia, hoarseness, sore throat

45
Q

causes of esophagitis

A 
Trauma
Bulimia/frequent vomiting
Chemotherapy or radiation exposure as in cancer therapy
Drug side effect
Ingestion of caustic materials
Crohn’s disease
Graph vs host disease
eosinophilic (may be related to food allergies)
Alcohol or smoking
46
Q

esophagitis: Plummer-Vinson syndrome

A

dysphagia, upper esophageal webs, difficulty swallowing, iron def anemia, glossitis, koilonychias (spoon nails), pallor

47
Q

Plummer-Vinson syndrome: Tx

A

iron sups

48
Q

Mallory Weiss Syndrome

A

led to from Barrett’s esophagus. tears in esophagus w/bleeding. a few cases require surgery.

49
Q

Mallory Weiss syndrome: common in

A

alcohol abusers,

those w/ hiatal hernias

50
Q

esophagitis: Management

A

treat condition causing it.
correct iron def in Plummer-Vinson syndrome.
otherwise, tx is similar to GERD

51
Q

esophageal cancer

A

squamous cell carcinoma or adenocarcinoma

52
Q

esophageal cancer: risks

A 
tobacco/alcohol use,
barrett's esophagus,
irritant exposure,
viruses,
high meat & low F&V intake
53
Q

esophageal cancer: stages

A

I (localized)

II (metastasized)

54
Q

esophageal cancer: s/s

A 
Difficult or painful swallowing.
Severe weight loss. 
Pain in the throat or back, behind the breastbone or b/w shoulder blades. 
Hoarseness or chronic cough.
Vomiting.
Coughing up blood.
55
Q

esophageal cancer: Management

A

esophagectomy,

may need radiation and/or chemo and/or laser therapy

56
Q

esophagectomy

A

removes the tumor along w/all or a portion of esophagus, nearby lymph nodes, and other tissues in the area. remaining healthy part is anastamosed to stomach or plastic tube, or part of intestine will be used to replace the esophagus.

57
Q

esophageal replacement surgery

A

congenital anomalies, severe trauma/damage from swallowing caustic materials, stricture, cancer.
part of the colon, SI, or a tube may be used to replace the esophagus.

58
Q

esophageal replacement surgery: TF

A

jejunostomy tube often placed, pt is weaned from TF to oral food in freq small feedings. liquid sups are helpful, start w/water. may have to give TPN if pt needs aggressive tx.

59
Q

post esophageal replacement surgery complications

A 
dysphagia
lactose intolerance
GERD
poor taste
bad tastes
60
Q

3 components of vomiting

A

nausea, retching, emesis

61
Q

N&V: causes

A

virus, bacteria, motion/morning sickness, DKA, PUD, brain tumor, Meniere’s disease, bowel obstruction, chemo, meds, etc.

psychogenic - food aversions, self induced - manually or with ipecac, erotic.

62
Q

severe N&V: consequences

A 
aspiration,
Na, K depletion,
dehydration,
alkalosis
go to ER if vomit is black/coffee ground-like,
tears in esophagus, 
esophagitis, 
tooth deterioration
63
Q

N&V: Antiemetic meds

A 
antivert (Meclizine) and bonine (Cyclizine) - antihistamines.
Compazine (prochlorperazine),
Phenergan (promethazine),
Dramamine (dimenhydrinate),
scopolamine,
kytril (Granisetron),
reglan (metoclopramide), 
Marinol® (dronabinol),
Emend® (aprepitant),
tigan (Trimethobenzamide), 
Zofran (Ondansentron), anzemet (Dolasetron),
emete-con (benzquinamide)
64
Q

hyperemesis gravidarum (HG)

A

intractable N&V at 2% pregnancies. makes pg high risk.

40-90% of women experience morning sickness (mild, no wt loss or poor wt gain)

65
Q

hyperemesis gravidarum (HG): etiology

A

not clear, maybe: hormonal changes, allergies/immunological factors, stomach or metabolic abnormalities, psychosomatic as in AN/bulimia, genetic incompatibilities, GERD, Helicobacter pylori, vit def such as B6 or Mg?

66
Q

hyperemesis gravidarum: s/s

A

Severe N&V, dehydration, electrolyte depletion, ketosis, weight loss or poor weight gain, poor oral intake and appetite, multiple nutritional deficiencies, ptyalism (excessive salivation), esophagitis, esophageal tears, liver damage, kidney damage, encephalopathy, brain or retinal hemorrhage, injury or death of mother or baby

67
Q

HG: Tx

A

give anti-emetics that are safe for pg, restore fluid & electrolyte balance & nutr status.

if anti-emetics don’t work, pt will need jejunostomy or TPN until can have normal intake. may take wks to mos. good outcome if treated.

68
Q

gastritis: cause

A

inflammation of stomach lining.
caused by bacteria, , viruses, alcohol, allergies, autimmune reactions as in pernicious anemia, medications, chemical damage, bile reflux, Crohn’s, radiation gastritis, GVHD, Menetrier’s disease (hyperplastic hypersecretory gastropathy)

69
Q

gastritis: most common cause

A

Helicobacter pylori

70
Q

Helicobacter pylori causes:

A

PUD
gastritis
HG

71
Q

gastritis: s/s

A

Burning sensation, pain, N&V, burping, bloating, red or coffee ground vomit, melena (black stool due to blood), anorexia, weight loss, diarrhea

72
Q

bacterial gastritis Tx

A

antibiotics

73
Q

gastritis: management

A

avoid meds, etc that irritate stomach

74
Q

pernicious anemia gastritis Tx

A

give high dose of oral/IM B12

75
Q

Menetrier’s disease (hypertrophic gastritis) Tx

A

recommend high protein (20% kcal) as albumin is low

76
Q

Peptic Ulcer Disease

A

mucosal break in stomach (15% cases) /duodenum (85% cases)

77
Q

PUD: causes

A 
Helicobacter pylori
NSAIDS, aspirin, Alcohol
gastrinoma (Zollinger-Ellison syndrome)
severe stress (trauma, burns), Curling's ulcers
bile reflux
pancreatic enzyme reflux
radiation
staphylococcus aureus exotoxin
bacterial/viral infection
78
Q

Zollinger-Ellison Syndrome

A

cancerous/benign tumors of delta cells in islets of Langerhans in pancreas produce gastrin and cause parietal cells in stomach to over secrete acid.

79
Q

Zollinger-Ellison Syndrome: s/s

A 
stomach/duodenal ulcers,
pain,
secretory diarrhea,
steatorrhea, malabsorption (due to inactivation of pancreatic enzymes by the excess acid),
wt loss/poor appetite/malnutr,
vomiting blood
80
Q

Zollinger-Ellison Syndrome: Management

A

surgical removal of tumors, PPI’s, if does not work, need a surgical resection or total gastrectomy

81
Q

gastric PUD: s/s

A

pain 1/2 - 1 hr after eating which is not relieved by food intake. vomit, hematemesis, gastric cancer (rare), wt loss

82
Q

duodenal PUD: s/s

A

pain 2-3 hrs after eating that is lessened by food intake. pain at night, vomiting (rare), melena, wt gain

83
Q

PUD: Dx

A

gastroscopy/endoscopy,

barium swallow/upper GI series

84
Q

PUD: Stop doing

A

stop taking NSAIDS, aspirin & other meds.

stop smoking.

85
Q

Helicobacter PUD: meds

A

flagyl, tetracycline, pepto bismol, PPI’s

86
Q

PUD PESC meds

A

PPI’s: esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), Dexlansoprazole (Dexilant), rabeprozole (Aciphex).

Carafate (Sucralfate) - coats ulcer & decreases its exposure to acid and pepsin

87
Q

PUD & GERD OCT meds

A

less effective

Histamine receptor blockers: nizatidine (Axid), ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet).

antacids: Mylanta, Maalox, Tums, Rolaids.
Gaviscon - foams and decreases acid reflux into esophagus

88
Q

PUD MNT

A

diet does not cause and cannot cause an ulcer.
avoid irritant and acid producing stimulants as for GERD.
avoid eating w/in 3 hr of bedtime.
avoid skipping meals/eating large meals.
check for anemia esp if pt had hematemesis/melena (may need iron).

89
Q

PUD vagotomy

A

cut vagus nerve to decrease stimulation, not very effective

90
Q

PUD antrectomy or partial gastrectomy

A

the lower half of stomach (makes most acid) is removed w/Billroth I, II, or Roux-en-Y gastrojejunostomy

91
Q

PUD pyloroplasty

A

opening up the valve at the outlet of stomach to speed gastric emptying

92
Q

PUD total gastrectomy

A

entire stomach is removed and esophagus is anastomosed to duodenum

93
Q

PUD partial gastrectomy

A

Billroth I: joining upper stomach to duodenum

Billroth II: joining upper stomach w/jejunum creating “Y” w/the bile drainage and the duodenum.

94
Q

post gastrectomy MNT

A

NPO the night before surgery. usually need TPN or jejunostomy after. start w/water and clear juices, soft bland foods 6 X a day, monitor pro and kcal intake, plasma proteins.

95
Q

post gastrectomy due to cancer or Zollinger-Ellison

A

best to have surgical jejunostomy inserted at time of surgery as at will have a slow recovery.

96
Q

steatorrhea post gastrectomy

A

decrease fat, try MCT oil, pancreatic enzyme capsule, give miscible forms or larger doses of fat sol vit if chronic condition.

97
Q

post gastrectomy: B12 absorption is

A

reduces since part of stomach that produces gastric intrinsic factor is removed.

98
Q

prevent macrocytic/megaloblastic anemia post gastrectomy

A

large doses PO (500 - 2000 mg/day) or IM B12.

folate will treat anemia but will not prevent nerve damage from cobalamin def, so critical that pt gets B12.

99
Q

post gastrectomy micocytic iron deficiency

A

due to blood loss prior/during surgery.
lower iron absorption due to low gastric acid secretion.
plasma iron & ferritin will be low and TIBC will be elevated.
give pt iron injections if does not tolerate PO.

100
Q

post gastrectomy osteomalacia

A

due to Ca & vit D malabsorption. check plasma 25-OH vit D levels. give Ca sup daily.

101
Q

post gastrectomy: detect osteomalacia

A

w/bone density test as plasma Ca levels are not good indicators of Ca status.

102
Q

post gastrectomy bezoar

A

increased fibrous blockages risk in GI.
avoid high fiber: orange, coconut, persimmon, berry, green bean, fig, apple, celery, psyllium, sauerkraut, brussel sprouts, potato peel, legume

103
Q

post gastrectomy early dumping syndrome

A

caused by high osmolarity of simple CHO and too much chyme entering SI too fast and rapid distension of SI.

104
Q

post gastrectomy late dumping syndrome

A

due to reactive hypoglycemia where BG rises quickly followed by an over response w/too much insulin production

105
Q

dumping syndrome s/s

A

flushing, sweating, syncope (fainting), ab fullness, diarrhea, N&V, weakness, tachycardia, hunger, tremors, anxiety

106
Q

post gastrectomy: Management

A

don’t drink fluids w/meals. Recline after eating.

small freq feedings, cut rapid acting CHO, try new foods in small amts to assess tolerance, avoid hot/cool liquids.

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