NURS 5461 GI | UPDATED Questions with 100% Verified Answers
Question:
dysphagia
Answer:
Subjective sebsation of difficulty swallowing■ May be due to physiological or
anatomical abnormalities along any portion of the esophagus, including the upper and
lower sphincters ■ An alarm symptom that must prompt evaluation and should never be
attributed to normal aging without an appropriate evaluation
Question:
Dysphagia Types
Answer:
oropharyngeal (above the esophagus) and esophageal-->most common is achalasia-
disorder of esophageal nerves preventing food movement.
Structural starts with solids r/o malignancy (adenocarcinoma distal esophagus)
infection involves PAINFUL swallowing, viral (CMV usually immunosuppressed) or fungal
(candida-inhaled asteroid)
Question:
Chewing [mastication]
Answer:
involves CNV [trigeminal], CNVII [facial], CNIX [glossopharyngeal], and CNXII
[hypoglossal], in addition to muscles of jaw, cheeks, tongue and palate
Question:
Clinical characteristics of Dysphagia
Answer:
Problems in the oral phase include - Poor bolus control - Spillage from lips or into
pharynx - Dry oral membranes (xerostomia) - Pocketing of oral residue - Difficulty with
chewing
Pharyngeal dysphagia results from
weakness or poor coordination of pharyngeal
,muscles, which can cause→
- Delayed swallowing
- Failure of airway protection
- Nasal or oral regurgitation
- Residue remaining in pharynx after swallowing
manifested as coughing, choking or gurgling
Question:
Clinical Presentation
Answer:
- Short duration with weight loss suggests malignancy - Abrupt onset associated with
neuro changes suggests CVA ■¼ - ½ of new stoke patients will have dysphagia
gradual progressive onset-PD, ALS, MG
Question:
medications that can contribute to Dysphagia
Answer:
Antidepressants, Antihistamines, Fosamax, NSAIDS, K, Fe, Nitates, BB, CCB
Question:
diagnostics for dysphagia
Answer:
■ Cineesophagram (video swallow study or videofluoroscpy) ■ Modified barium
swallow, endoscopy NOT helpful, alone but may need to r/o other causes
Question:
DDx dysphagia
Answer:
Acute inflammation [infection; bone and mucosal disorders] Stroke syndromes and
vascular disorders Myasthenia Gravis Dementias Chemical agents Parkinson's disease
Neuromuscular esophageal disorders Multiple Sclerosis Medications Huntington's
disease Scleroderma Tuberculosis Muscle anomalies Tetanus Achalasia Syphilis
Pharyngoesophageal diverticulum ALS Diffuse spasm NeoplasmsCarcinoma Recurrent
,laryngeal neuropathies Degenerative disorders Irradiation Guillain-Barre' syndrome
Psychopathology Esophageal stenosis Diabetes Feeding phobias Esophageal webs, rings
or stricture Cerebral palsy Sensory deficits
Question:
Management of Dysphagia
Answer:
Medication review, particularly focusing on anticholinergic drugs ■ Oropharyngeal
dysphagia: Swallowing rehabilitation, dietary modifications such as thickening liquids, or
careful hand feeding ■ Achalasia: Surgical or endoscopic myotomy (SOE=A); injection
of the lower esophageal sphincter with botulinum toxin may provide months of
symptomatic relief in patients who are not surgical candidates ■ Spastic motility
disorders: Calcium channel blockers or phosphodiesterase inhibitors may provide relief
(SOE=B) ■ Strictures: Endoscopic dilation has a very high success rate, although patients
often require ongoing medical treatment of the underlying cause as well■ Aspiration
and Nonoral Feeding in Dysphagia of Functional Origin - Patients with severe aspiration,
which is not treatable with dietary or positional modifications, should receive nonoral
feedings to prevent aspiration ■ Head positioning, swallowing maneuvers and dietary
textural modifications seem to demonstrate clear evidence of benefit in treating
functional dysphagia - Refer to speech pathologist for evaluation
Question:
Indications for Hospitalization/Referral
Answer:
Dietary consultation GI consult Will need intervention if patient has structural problem
Speech therapy Neurology may be needed
Question:
Dyspepsia (heartburn)
Answer:
■ Most commonly associated with peptic ulcer disease, GERD, biliary colic, or
medication-induced discomfort ■ Whether gastritis due to Helicobacter pylori can
cause symptoms of dyspepsia is debated ■ Consider prompt endoscopy in older adults
, because of the increased rate of organic disease, including malignancy ➢ Associated
with significant reduction in PPI use and improved qualify of life (SOE=B) ➢ Safe for older
adults who are otherwise healthy ➢
Question:
Differential Diagnoses Dyspepsia
Answer:
■ Heartburn is occasionally described as extreme—and may make if difficult to
differentiate from angina or MI ■ These folks describe pain as radiating to the back,
arms or jaw—which further complicates the diagnosis■ Medication induced gastritis -
Alcohol; salicylates; corticosteroids; NSAIDs; erythromycin; theophylline ■ Giardiasis -
This patient will have occasional bouts of diarrhea ■ Nonulcer Dyspepsia [NURD or
NERD] - From H. pylori ■ Gastric Cancer - Dyspepsia, anorexia, weight loss
Question:
Dyspepsia presentation
Answer:
Heartburn is common (7% w/qd complaints-usually GERD), Dyspepsia usually presents
with epigastric discomfort, postprandial fullness, early satiety, anorexia, belching, nausea,
vomiting, indigestion, bloating, borborygmi, dysphagia and abdominal bloating These
symptoms can have a functional or organic cause—organic causes increase with age, if
endocopy rules out structural dx=functional dyspepsia
Question:
Managing Dyspepsia
Answer:
■ Perform H pylori testing in all patients, with a 13C-urea breath test or fecal antigen
test along with biopsies at the time of endoscopy ➢ Treatment for H pylori in patients
with ulcers will result in healing and elimination of symptoms in a large majority of
patients ■ Patients with large or nonhealing ulcers: biopsy to exclude malignancy ■
Patients negative for H pylori: 2-month empiric trial of PPI (SOE=B) ■ Patients with a
normal upper endoscopy: consider further testing, including abdominal imaging and a
gastric emptying study ■ Patients with functional dyspepsia (no identified organic
Question:
dysphagia
Answer:
Subjective sebsation of difficulty swallowing■ May be due to physiological or
anatomical abnormalities along any portion of the esophagus, including the upper and
lower sphincters ■ An alarm symptom that must prompt evaluation and should never be
attributed to normal aging without an appropriate evaluation
Question:
Dysphagia Types
Answer:
oropharyngeal (above the esophagus) and esophageal-->most common is achalasia-
disorder of esophageal nerves preventing food movement.
Structural starts with solids r/o malignancy (adenocarcinoma distal esophagus)
infection involves PAINFUL swallowing, viral (CMV usually immunosuppressed) or fungal
(candida-inhaled asteroid)
Question:
Chewing [mastication]
Answer:
involves CNV [trigeminal], CNVII [facial], CNIX [glossopharyngeal], and CNXII
[hypoglossal], in addition to muscles of jaw, cheeks, tongue and palate
Question:
Clinical characteristics of Dysphagia
Answer:
Problems in the oral phase include - Poor bolus control - Spillage from lips or into
pharynx - Dry oral membranes (xerostomia) - Pocketing of oral residue - Difficulty with
chewing
Pharyngeal dysphagia results from
weakness or poor coordination of pharyngeal
,muscles, which can cause→
- Delayed swallowing
- Failure of airway protection
- Nasal or oral regurgitation
- Residue remaining in pharynx after swallowing
manifested as coughing, choking or gurgling
Question:
Clinical Presentation
Answer:
- Short duration with weight loss suggests malignancy - Abrupt onset associated with
neuro changes suggests CVA ■¼ - ½ of new stoke patients will have dysphagia
gradual progressive onset-PD, ALS, MG
Question:
medications that can contribute to Dysphagia
Answer:
Antidepressants, Antihistamines, Fosamax, NSAIDS, K, Fe, Nitates, BB, CCB
Question:
diagnostics for dysphagia
Answer:
■ Cineesophagram (video swallow study or videofluoroscpy) ■ Modified barium
swallow, endoscopy NOT helpful, alone but may need to r/o other causes
Question:
DDx dysphagia
Answer:
Acute inflammation [infection; bone and mucosal disorders] Stroke syndromes and
vascular disorders Myasthenia Gravis Dementias Chemical agents Parkinson's disease
Neuromuscular esophageal disorders Multiple Sclerosis Medications Huntington's
disease Scleroderma Tuberculosis Muscle anomalies Tetanus Achalasia Syphilis
Pharyngoesophageal diverticulum ALS Diffuse spasm NeoplasmsCarcinoma Recurrent
,laryngeal neuropathies Degenerative disorders Irradiation Guillain-Barre' syndrome
Psychopathology Esophageal stenosis Diabetes Feeding phobias Esophageal webs, rings
or stricture Cerebral palsy Sensory deficits
Question:
Management of Dysphagia
Answer:
Medication review, particularly focusing on anticholinergic drugs ■ Oropharyngeal
dysphagia: Swallowing rehabilitation, dietary modifications such as thickening liquids, or
careful hand feeding ■ Achalasia: Surgical or endoscopic myotomy (SOE=A); injection
of the lower esophageal sphincter with botulinum toxin may provide months of
symptomatic relief in patients who are not surgical candidates ■ Spastic motility
disorders: Calcium channel blockers or phosphodiesterase inhibitors may provide relief
(SOE=B) ■ Strictures: Endoscopic dilation has a very high success rate, although patients
often require ongoing medical treatment of the underlying cause as well■ Aspiration
and Nonoral Feeding in Dysphagia of Functional Origin - Patients with severe aspiration,
which is not treatable with dietary or positional modifications, should receive nonoral
feedings to prevent aspiration ■ Head positioning, swallowing maneuvers and dietary
textural modifications seem to demonstrate clear evidence of benefit in treating
functional dysphagia - Refer to speech pathologist for evaluation
Question:
Indications for Hospitalization/Referral
Answer:
Dietary consultation GI consult Will need intervention if patient has structural problem
Speech therapy Neurology may be needed
Question:
Dyspepsia (heartburn)
Answer:
■ Most commonly associated with peptic ulcer disease, GERD, biliary colic, or
medication-induced discomfort ■ Whether gastritis due to Helicobacter pylori can
cause symptoms of dyspepsia is debated ■ Consider prompt endoscopy in older adults
, because of the increased rate of organic disease, including malignancy ➢ Associated
with significant reduction in PPI use and improved qualify of life (SOE=B) ➢ Safe for older
adults who are otherwise healthy ➢
Question:
Differential Diagnoses Dyspepsia
Answer:
■ Heartburn is occasionally described as extreme—and may make if difficult to
differentiate from angina or MI ■ These folks describe pain as radiating to the back,
arms or jaw—which further complicates the diagnosis■ Medication induced gastritis -
Alcohol; salicylates; corticosteroids; NSAIDs; erythromycin; theophylline ■ Giardiasis -
This patient will have occasional bouts of diarrhea ■ Nonulcer Dyspepsia [NURD or
NERD] - From H. pylori ■ Gastric Cancer - Dyspepsia, anorexia, weight loss
Question:
Dyspepsia presentation
Answer:
Heartburn is common (7% w/qd complaints-usually GERD), Dyspepsia usually presents
with epigastric discomfort, postprandial fullness, early satiety, anorexia, belching, nausea,
vomiting, indigestion, bloating, borborygmi, dysphagia and abdominal bloating These
symptoms can have a functional or organic cause—organic causes increase with age, if
endocopy rules out structural dx=functional dyspepsia
Question:
Managing Dyspepsia
Answer:
■ Perform H pylori testing in all patients, with a 13C-urea breath test or fecal antigen
test along with biopsies at the time of endoscopy ➢ Treatment for H pylori in patients
with ulcers will result in healing and elimination of symptoms in a large majority of
patients ■ Patients with large or nonhealing ulcers: biopsy to exclude malignancy ■
Patients negative for H pylori: 2-month empiric trial of PPI (SOE=B) ■ Patients with a
normal upper endoscopy: consider further testing, including abdominal imaging and a
gastric emptying study ■ Patients with functional dyspepsia (no identified organic
