GI Medicine 3 - Swallowing Disorders

Question 1

What is the key management tool for megaoesophagus after correcting the underlying cause?

Answer 1

Positional feeding - until function normal, regardless of cause.
(Elevated for feeding + 15-20 minutes thereafter)

Question 2

What is the key management tool for megaoesophagus after correcting the underlying cause?

Answer 2

Positional feeding - until function normal, regardless of cause.
(Elevated for feeding + 15-20 minutes thereafter)

Question 3

List 5 aspects of the management of GERD

Answer 3

LES (lower oesophageal sphincter) drugs (cisapride - increases sphincter tone)
Feeding regime
Dietary modification
Weight management
Acid blockers

Question 4

What should the feeding regime of a patient with GERD involve?

Answer 4

Postual feeding
Little and often
Avoid feeding closer then 2 hours to bedtime/exercise.

Question 5

How could you modify the diet of a patient with GERD?

Answer 5

Low fat - to facilitate gastric emptying
Concurrent chronic enteropathy? - low fat exclusion diet

Question 6

Which acid blocker should you use in cases of GERD and what is its mode of action?

Answer 6

Omeprazole - proton pump inhibitor
Irreversibly binds H+/K+ ATPase and so blocks gastric acid secretion.

Question 7

Name a lower oesophageal sphincter drugs and describe is mode of action.

Answer 7

Cisapride
Stimulates intestinal 5-HT4 receptors, increasing lower oesophageal sphincter tone and reducing pyloric tone, so there is propulisve peristaltic waves throughout the whole GI tract.

Question 8

State a drug that can be used in the management of oesophagitis for an acid blockade

Answer 8

Omeprazole

Question 9

State a drug that can be used in the management of oesophagitis as a coating agent to line the surface of an ulcer.

Answer 9

Sucralfate

Question 10

State a drug that can be used in the management of oesophagitis to improve lower oesophageal sphincter tone

Answer 10

Cisapride

Question 11

State a drug that can be used in the management of oesophagitis to facilitate gastric emptying.

Answer 11

Metaclopramide

Question 12

What is sucralfate and how should it be used?

Answer 12

Preciptates and binds ulcerated tissue (chemical diffusion barrier).
Give at leat 1 hour before feeding
Avoid direct co-administration with acid blockers (1-2 hours apart)

Question 13

List three complications of GERD

Answer 13

Aspiration pneumonia
Congenital diseases causing poor body condition
Strictures