NURS 5461 GI – Questions With Appropriate
Solutions
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Terms in this set (171)
Subjective sebsation of difficulty swallowing⚫ May be
due to physiological or anatomical abnormalities along
any portion of the esophagus, including the upper and
dysphagia
lower sphincters ⚫ An alarm symptom that must
prompt evaluation and should never be attributed to
normal aging without an appropriate evaluation
oropharyngeal (above the esophagus) and esophageal-
->most common is achalasia-disorder of esophageal
nerves preventing food movement.
Structural starts with solids r/o malignancy
Dysphagia Types
(adenocarcinoma distal esophagus)
infection involves PAINFUL swallowing, viral (CMV
usually immunosuppressed) or fungal (candida-inhaled
asteroid)
involves CNV [trigeminal], CNVII [facial], CNIX
Chewing [mastication] [glossopharyngeal], and CNXII [hypoglossal], in
addition to muscles of jaw, cheeks, tongue and palate
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
Clinical characteristics of weakness or poor coordination of pharyngeal
Dysphagia 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
, - Short duration with weight loss suggests malignancy -
Abrupt onset associated with neuro changes suggests
Clinical Presentation
CVA ⚫¼ - ½ of new stoke patients will have dysphagia
gradual progressive onset-PD, ALS, MG
medications that can Antidepressants, Antihistamines, Fosamax, NSAIDS, K,
contribute to Dysphagia Fe, Nitates, BB, CCB
⚫ Cineesophagram (video swallow study or
videofluoroscpy) ⚫ Modified barium swallow,
diagnostics for dysphagia
endoscopy NOT helpful, alone but may need to r/o
other causes
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
DDx dysphagia 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
, 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)
Management of Dysphagia ⚫ 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
Dietary consultation GI consult Will need intervention if
Indications for
patient has structural problem Speech therapy
Hospitalization/Referral
Neurology may be needed
⚫ 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 ⚫
Dyspepsia (heartburn) 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 ➢
Solutions
Save
Terms in this set (171)
Subjective sebsation of difficulty swallowing⚫ May be
due to physiological or anatomical abnormalities along
any portion of the esophagus, including the upper and
dysphagia
lower sphincters ⚫ An alarm symptom that must
prompt evaluation and should never be attributed to
normal aging without an appropriate evaluation
oropharyngeal (above the esophagus) and esophageal-
->most common is achalasia-disorder of esophageal
nerves preventing food movement.
Structural starts with solids r/o malignancy
Dysphagia Types
(adenocarcinoma distal esophagus)
infection involves PAINFUL swallowing, viral (CMV
usually immunosuppressed) or fungal (candida-inhaled
asteroid)
involves CNV [trigeminal], CNVII [facial], CNIX
Chewing [mastication] [glossopharyngeal], and CNXII [hypoglossal], in
addition to muscles of jaw, cheeks, tongue and palate
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
Clinical characteristics of weakness or poor coordination of pharyngeal
Dysphagia 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
, - Short duration with weight loss suggests malignancy -
Abrupt onset associated with neuro changes suggests
Clinical Presentation
CVA ⚫¼ - ½ of new stoke patients will have dysphagia
gradual progressive onset-PD, ALS, MG
medications that can Antidepressants, Antihistamines, Fosamax, NSAIDS, K,
contribute to Dysphagia Fe, Nitates, BB, CCB
⚫ Cineesophagram (video swallow study or
videofluoroscpy) ⚫ Modified barium swallow,
diagnostics for dysphagia
endoscopy NOT helpful, alone but may need to r/o
other causes
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
DDx dysphagia 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
, 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)
Management of Dysphagia ⚫ 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
Dietary consultation GI consult Will need intervention if
Indications for
patient has structural problem Speech therapy
Hospitalization/Referral
Neurology may be needed
⚫ 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 ⚫
Dyspepsia (heartburn) 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 ➢
