Lecture 10 Flashcards
what are the 4 main fxns of the GI tract?
motility, digestion, secretion, absorption
common disorders affecting the oral cavity:
xerostomia, mucositis (thrush), dysgeusia (altered taste), dysphagia (difficulty swallowing), odynophagia (pain related to swallowing)
phases of the normal adult swallowing process?
oral prep phase, oral transit phase, pharyngeal phase, esophageal phase
what is oral prep phase?
chewing, mixing food with saliva into bolus
what is oral transit phase?
food moved to back of mouth via tongue
what is pharyngeal phase?
food enter upper throat, soft palate elevates, epiglottis closes off trachea
what is esophageal phase?
food enters esophagus and propelled to stomach
common causes of dysphagia
neuro disease, muscle disorders, GI disease, malignancy, other
diagnostic methods (usually performed in this order):
bedside swallowing assessment, modified barium swallowing assessment, fiberoptic endoscopic evaluation of swallowing
dysphagia outcome and severity scale is a ___ point scale
7
in hospitalized pt , dysphagia is associated with:
^ LOS, ^ mortality
dysphagia is independent risk factor for:
malnutrition
types of thickening agents:
starch, guar gum, locust bean gum, xanthan gum, carageenan
esophagus coordinates movement of food by alternating contractions called ____
peristalsis
esophageal related conditions:
esophageal dysphagia, GERD, esophagitis, barrett’s esophagus, esophageal varices, strictures, achalasia
what is achalasia?
failure of smooth muscle and lower esophageal sphincter to relax so food not empty in to stomach
5-15% of esophagitis –> _____
barrett’s esophagus (normal tissue of esophagus starts to mimic tissue of intestine–>carcinoma)
pathophysiology of GERD:
transient relaxation of LES, v saliva, v LES pressure, impaired esophageal acid clearance, ^ esophageal sensitivity, ^ intraab pressure, delayed gastric emptying
etiology of GERD:
^ secretion of hormones that dcrease LES pressure, some med conditions, smoking, certain meds, diet
foods that may decrease LES pressure:
peppermint/spearmint, chocolate, high fat / fried foods, alcohol, coffee
foods that may increase gastric acid secretion
pepper, coffee, alcohol
common meds to treat UGIT disorders:
TUMS, tidines (H2 blockers), erythromycin (prokinetics), prazoles (PPI)
peptic ulcer disease caused by _____
H pylori
acid producing cells of stomach called ____
parietal cells
why mucus secreting glands in inner lining of stomach?
protect from acid
types of ulcerations of gut mucosa (PUD):
gastric (near antrum), duodenal (near pyloric sphincter)
why antrum and pyloric sphincter areas common to have ulcer:
areas of breakdown continuously exposed to gastric acid and pepsin (erosion–>perforation)
etiology of PUD
meds/substances, severe illness/stress, gastritis, H. pylori
how to diagnose PUD?
endoscopy
what is atrophic gastritis?
chronic inflammation with gradual deterioration of mucous membrane and glands (loss of production of IF)
meds that can cause PUD:
NSAIDS/aspirin (corrosive and inhibit prostaglandin synth), corticosteroids
substances that cause PUD:
tobacco, poor diet, ingestion of corrosive substances, alcohol
chief complaint of PUD:
ab discomfort (dull, burning, transient pain on empty stomach)
other symptoms of PUD:
vomiting/nausea, anorexia, burping, bloating (nonspecific)
nutr implications of PUD:
impaired oral intake, involuntary wt loss, nutr imbalances/deficiencies, atrophic gastritis (B12 deficiency, low acid state negatively influences absorption of Fe and Ca)
Gi tract is composed of :
upper GI (mouth, pharynx, esophagus, stomach), lower GI (small int, large int), accessory organs (liver, pancreas, salivary glands, gallbladder)
clinical manifestations of dumping include ___ and ___ symptoms
GI; vasomotor
two types of dumping
early (10-30min, GI and vasomotor, majority) and late (1-3hr, vasomotor, less common)
what is oral glucose provocation test?
rise in heart rate by 10bpm+ in first hour after the challenge following 10 hr fast is diagnostic
dumping symptoms scored by ___
Sigstad
if have dumping syndrome, avoid liquids for ___min after meal, should have at least ___ meals
30; 6
in dumping syndrome, reduce __ and avoid ___
simple CHO; dairy
this is effective in late dumping because of delayed CHO digestion by slowing conversion of starch to monosaccharides, blunting postprandial rise of serum glucose and insulin
acarbose
