GI and Urinary Diseases Flashcards
what is the two types of swallowing disorders?
esophageal and oropharangeal
swallowing is super complex cause
it reuquires coordination of over 50 nerves and muscles
3 stages of swallowing
voluntary oral stage
involuntary pharyngeal stage
esopheageal stage
Food is chewed and the bolus (food) is forced into the pharynx
voluntary oral stage
Pharynx share respiratory tracts, where food bypasses respiratory passages when the soft palate closes the epiglottis, and food travels to the esophagus
involuntary pharyngeal stage
Bolus continues to move to the stomach through peristalsis action
Esophageal stage
refers to the sensation of food sticking in the esophagus/ base of throat/chest
Esophageal Dysphagia
what causes esophageal dysphasia?
Achalasia
Diffuse spasm
Esophageal stricture
Esophageal tumors
Foreign bodies
Esophageal ring
Gastroesophageal reflux disease (GERD)
Achalasia (esophageal dyspagia)
lower esophageal muscle (sphincter) doesn’t relax properly, can cause regurgitation of food, tends to get worse over time
Diffuse spams (esophageal dysphasia)
produces multiple, high-pressure, poorly coordinated contractions of esophagus after a swallow
affects the involuntary muscles of lower esophagus
Esophageal stricture (esophageal dysphasia)
Narrowing of esophagus stricture can cause large pieces of food to get caught
may result from scar tissue, acid reflux or tumors
Esophageal tumors (esophageal dysphasia)
Difficulty swallowing tends to get progressively worse when esophageal tumors are present
Foregn bodies (esophageal dysphasia)
may partially block the throat or esophagus by food
Older adults with dentures or those with difficulty chewing properly more susceptible
Children may swallow small objects, such as coins or toy pieces
Esophageal ring (esophageal dysphasia)
narrowing in the lower esophagus can intermittently cause difficulty swallowing solid foods
acid reflux (esophageal dysphasia)
Damage to esophageal tissues from gastric acid backing up (refluxing) into your esophagus
can lead to spasm or scarring and narrowing of lower esophagus, making swallowing difficult
Also referred to as acid reflux
What type of dysphasia is caused by gastroesophageal reflux disease (GERD)
Esophageal stricture
related to throat, nerve. and muscle problems
make it difficult to move food from mouth into your throat
cause may be from brain disorders
oropharyngeal dysphasia
Oropharyngeal Dysphagia Chief Manifestations is also called
“high” dysphasia
referring to an oral or pharyngeal location Difficulty initiating swallow Nasal regurgitation Coughing Nasal speech Diminished cough reflex Choking
refers to “high” dyspasia
swallowing disturbances are found frequently at
in nursing homes, 30–40% of patients have swallowing disturbances = aspiration complications
is the passage of food or liquid through the vocal folds into the lungs
aspiration
Persons who aspirate are at increased risk for serious respiratory problems
including
airway obstruction and aspiration pneumonia
aspiration caused by and may occur with…
often caused by impaired laryngeal closure
May occur with neurological disorders and swallowing dysfunction
overflow of food or liquids retained in the pharynx
gastroesophageal reflux
Aspiration precautions
Oropharyngeal dysphagia
Neurological disorders and damage
Pharyngeal diverticula
(collected food particles in the throat, leading to difficulty swallowing, gurgling sounds, bad breath, and repeated throat clearing or coughing
Cancer
Certain cancers and radiation, can cause difficulty swallowing
These symptoms are for? Pain while swallowing (odynophagia) Unable to swallow Sensation of food getting stuck in throat or chest Drooling Hoarseness Regurgitation Frequent heartburn Food or stomach acid backing up into your throat
swallowing disorders
Complications of swallowing disorders
Malnutrition and dehydration Respiratory problems aspiration pneumonia upper respiratory infections
food “sticks” after swallowing
esophageal dyspagia
difficulty intiating swallowing (may include coughing, choking, or regurgitation)
oropharygneal dysphagia
barium x-ray (fluroscopy)
Swallow a barium solution to coat the esophagus, allows the esophagus to show up better on X-rays
Able to see changes in the esophagus and assess muscle activity
Indications: dysphagia, globus sensation, and aspiration
Dynamic swallowing study.
swallow foods of different consistencies that have been coated with barium
helpful for diagnosing oropharyngeal dysphagia
Barium is an X-ray absorber and appears white on X-ray film.
barium coats the inside wall of the esophagus, stomach, or intestine
Makes visible on x-ray the inside wall lining, size, shape, contour, and patency (openness)
Fluoroscopy is often used during a barium study to study moving body structures—similar to an X-ray “movie”
Esophageal Dysphagia Treatment
Esophageal dilation
endoscope with balloon to gently dilate and expand the width of esophagus for tight esophageal sphincter (achalasia) or an esophageal stricture
Surgery
esophageal tumor, achalasia or pharyngeal diverticula, may require surgery
Medications
Difficulty swallowing associated with GERD can be treated with prescription oral medications to reduce stomach acid
Oropharyngeal Dysphagia OT Treatment
Speech or swallowing therapist (may be an OT)
Provide exercises to help coordinate swallowing muscles or re-stimulate the swallowing reflex
Teach swallowing techniques
simple ways to place food in mouth
or to position body and head
If someone has difficulty initiating swallowing, which type of dysphagia do they likely have?
Oropharyngeal
acid reflux is known as!
Gastroesophageal Reflux Disease
acid reflux happens when
gastric juice refluxes into the esophagus
acid reflux causes symptoms with or without
esophageal mucosal injury (esophagitis)
what is linked to GERD?
obesity (chronic) and esophagitis
Typical esophageal symptoms
for acid reflux
Heartburn
Regurgitation
Dysphagia
Abnormal reflux can cause atypical (extraesophageal) symptoms, such as:
Coughing and/or wheezing Hoarseness, sore throat Otitis media Noncardiac chest pain Enamel erosion or other dental manifestations
GERD Diagnosis is confirmed via
Upper gastrointestinal endoscopy /esophagogastroduodenoscopy
Esophageal manometry
small, flexible high-resolution manometry catheter through nose, down esophagus and into stomach
helps surgical planning by determining the lower esophageal sphincter (LES) pressure
helps identify esophageal motility disorders
GERD Treatment
antacids or PROTON PUMP INHIBITORS= decrease stomach acid production
many side effect risks
treatment based on lifestyle modification and control of gastric acid secretion
surgery w anti-reflux surgery
goal of acid reflux treatment
control symptoms
heal esophagitis
and prevent esophagitis
IBS is caused by
caused by changes in how the GI tract works
In IBS symyptoms may be
symptoms may be frequent but GI tract not damaged
common symptoms of IBS
abdominal pain or discomfort, often reported as cramping, along with diarrhea, constipation, or both
IBS is diagnosed when
abdominal pain or discomfort occurs at least 3x per month for the last 3 months
IBS affects 2x as many
women than men
Possible causes of IBS
Brain-gut interaction
- genetic
- intestinal infection
- chronic stressful life events or psychosocial factors
Abnormal motility (movement) Slow motility can lead to constipation and fast motility can lead to diarrhea
Psychological
anxiety, depression
Bacterial gastroenteritis
Infection stomach and intestines caused by bacteria
Food sensitivity
foods rich in carbs spicy or fatty foods, coffee, and alcohol
Visceral hypersensitivity
stretch on intestines from even small amounts of food may produce discomfort
diagnosis of IBS
Medical history questions to ask:
questions about symptoms, family history of GI disorders, recent infections, medications
stressful events related to the onset of symptoms
For IBS to be diagnosed
symptoms must have started at least 6 months prior
and must have occurred at least 3 days per month for the previous 3 months
IBS treatment
No cure
symptoms can be treated with a combination of the following:
changes in eating habits, diet, and nutrition
smaller more frequent meals, avoid high fat foods, increase or decrease fiber, eliminate other problematic foods
Medications
fiber supplements, laxatives for constipation, antidiarrheals, antispasmodics
antidepressants for those with moderate or severe IBS reduce IBS sx to include pain and to normalize GI motility
Probiotics
live microorganisms, usually bacteria, similar to microorganisms normally found in the GI tract
Bifidobacteria and certain probiotic combinations found to improve symptoms of IBS when taken in large enough amounts
Therapies for psychological issues to help reduce stress and improve symptoms
IBS
Antidepressants can be effective as analgesics
used to treat chronic pain conditions as migraine headaches, diabetic neuropathy and fibromyalgia
Similarly, antidepressants are effective in treating symptoms of IBS and other functional GI disorders
Patients who take antidepressants for IBS
report significant improvement in their abdominal pain and reduction in other IBS symptoms
colitis
inflammation of the colon
IBD is a term for what?
Inflammatory bowel disease (IBD) is a generic term for three disorders associated with GI tract inflammation:
Crohn disease
Ulcerative colitis
Indeterminate colitis
Group of disorders in which the intestines become inflamed
Most common forms of IBD are ulcerative colitis and Crohn’s disease
IBD runs in families, with possible genetic factors
Thought that immune system may trigger IBD
Immune system seems to overreact to normal bacteria in the digestive tract and fails to “shut off,” causing inflammation
inflammatory bowel disease
Ulcerative colitis is slightly more common
males
Crohn’s disease is marginally more frequent
in women
IBD etiology
Etiology is unknown but is thought to involve genetic, immunologic, and environmental factors as evidenced by the following:
greatest relative risk of IBD disease is found among first relatives, suggesting a strong genetic component
Smoking is one of the more notable environmental factors
Ulcerative colitis is more prevalent among ex-smokers and nonsmokers
whereas Crohn’s disease is more prevalent among smokers
chronic inflammatory IBD condition of the gastrointestinal tract
most commonly affects the end of the small bowel (the ileum) and the beginning of the colon, but it may affect any part of the GI tract
less able to absorb food nutrients, so body may not get enough nutrients
Crohn’s Diease
undigested food that goes into the large intestine makes water absorption harder, causing diarrhea
can be both painful and debilitating, and sometimes may lead to life-threatening complications
no known cure, but therapies can greatly reduce symptoms and even bring about long-term remission
Crohn’s Disease
Ulcerative colitis
IBD disease that causes inflammation and sores (ulcers) in the lining of the large intestine (colon)
Most people are diagnosed before the age of 30
Cause is unknown, but may be immune system overreacting to normal digestive tract bacteria
Small intestine absorbs nutrients as it should, but inflammation in the large intestine keeps it from absorbing water, causing diarrhea
IBD Diagnostics
Health & family history, physical exam, and different tests Blood tests to find signs of inflammation and anemia Stool sample tested for blood and infection Colonoscopy or sigmoidoscopy unable to reach small intestine X-rays with barium (orally or as enema) Computerized axial tomography (CT or CAT scan) Capsule endoscopy
IBD treatment options
Cause unknown – no proven prevention
Medications
to reduce the inflammation, relieve symptoms, and prevent flare-ups, immune system suppressants, antibiotics (for Crohn’s)
Surgery
25-40% with ulcerative colitis will need surgery at some point. Surgery that removes the entire large intestine can completely cure ulcerative colitis
also reduces risk of colon cancer
65-75% with Crohn’s disease need surgery at some point
to relieve symptoms and correct problems like strictures, fistulae, or bleeding in the intestine
since Crohn’s disease occurs in patches, surgery cannot cure
Changes in diet and nutritional supplements Avoid greasy or fried foods Avoid cream sauces and meat products Avoid spicy foods Avoid foods high in fiber, such as nuts and raw fruits and vegetables Eat smaller, more frequent meals Reducing stress and getting enough rest stress does not cause IBD but stress can cause a flare-up
Probiotics is a form of treatment for which condition?
A. Ulcerative colitis
B. Crohn’s disease
C. Irritable bowel syndrome (IBS)
D. Inflammatory bowel disease (IBD)
