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Flashcards in GI Medicine - Swallowing Problems Deck (88)
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1
Q

what are the clinical signs of oropharyngeal disease?

A

drooling saliva (+/- blood)
halitosis
dysphagia
odynophagia

2
Q

what is ptyalism?

A

overproduction of saliva

3
Q

what may ptyalism be due to?

A

painful or diseased area of the mouth

4
Q

what is pseudoptyalism?

A

normal amount of saliva produced but it is leaving the mouth rather than being swallowed

5
Q

what are the non-oral causes of drooling/salivation?

A

nausea
mediaction
liver disease

6
Q

what are the main causes of halitosis?

A

dental disease

oral and non-oral causes (e.g. lung infection or anal sac disease)

7
Q

what is dysphagia?

A

difficulty eating or swallowing

8
Q

what is odynophagia?

A

pain on swallowing

9
Q

what is involved in the investigation of oral disease?

A
physical exam (sedation or GA may be needed)
radiographs
minimum database 
FNA and/or biopsy
special tests
10
Q

what must be considered about type and use of sedation/GA when patients have oral disease?

A

how feasible is intubation

11
Q

what may you be looking for in the mouth of a patient with suspected oropharyngeal issues?

A

oropharyngeal foreign bodies
oral ulceration
oropharyngeal inflammatory disease

12
Q

define chelitis

A

inflammation of the lips

13
Q

define glossitis

A

inflammation of the tongue

14
Q

define gingivitis

A

inflammation of the gums

15
Q

define stomatitis

A

inflammation of the oral mucosa

16
Q

define gingivostomatitis

A

inflammation of the gums and oral mucosa

17
Q

what oropharyngeal neoplasia is seen in dogs?

A

benign and malignant

18
Q

what oropharyngeal neoplasia is seen in cats?

A

almost all melignant

19
Q

what is an example of a benign tumor?

A

epulis

20
Q

what are examples of malignant oropharyngeal tumors?

A

squamous cell carcinoma
malignant melanoma
sarcomas

21
Q

where may malignant tumors have effect?

A

locally invasive

metastatic (LN and lungs)

22
Q

how is oropharyngeal disease treated?

A

depends on underlying cause

23
Q

how is oropharyngeal neoplasia treated?

A

surgery

cryosurgery, radiation, chemotherapy

24
Q

how is oropharyngeal foreign body treated?

A

remove

25
Q

how is oropharyngeal trauma treated?

A

wound management

surgery

26
Q

how is oropharyngeal inflammation treated?

A

anti-inflammatories

27
Q

how is oropharyngeal bacterial infection treated?

A

antibiotics

28
Q

what are the main nursing considerations for oral disease?

A

analgesia
nutritional considerations (oral with soft food or bypass/tube feeding)
barrier nursing if needed

29
Q

what analgesia may be given to oral patients?

A

opioids

NSAIDs - if eating

30
Q

what has an important role in any oral disease?

A

oral hygiene

31
Q

what can poor oral / dental hygiene lead to?

A

causative of infections

source of ongoing bacteria/oropharyngeal inflammation or infection

32
Q

how can oral hygiene be maintained?

A

oral rinses
tooth brushing
cat and dog specific enzymatic tooth paste
+/- dental extractions

33
Q

what is key about the oral hygiene of anorexic or ventilated patients?

A

mm will be dry to reduced production of saliva (either through not eating or unconsciousness) - saliva has protective antimicrobial functions so infection is a risk

34
Q

define dysphagia

A

difficulty swallowing

35
Q

define odynophagia

A

swallowing pain

36
Q

define regurgitation

A

passive return of food/water or saliva

37
Q

where is the problem located if dysphagia is seen?

A

oropharyngeal (occasionally oesophageal)

38
Q

where is the problem located if odynophagia is seen?

A

oropharyngeal and oesophageal

39
Q

where is the problem located if regurgitation is seen?

A

oesophageal

40
Q

what is regurgitation a hallmark of?

A

oesophageal disease

41
Q

define vomiting

A

active forceful, reflex ejection of gastric and upper intestinal content following stimulation of a neural reflex that has synaptic centres in the brainstem

42
Q

is vomiting a sign or a diagnosis?

A

sign

43
Q

what may vomiting be due to?

A

GI or extra-GI disease

44
Q

what will change depending on whether regurgitation or vomiting is present?

A

investigations

45
Q

when may regurgitation occur?

A

immediate or delayed

46
Q

what will products of regurgitation look like?

A

undigested food

+/- mucous or saliva covering

47
Q

what is the pH of regurgitated material?

A

neutral as no stomach acid

48
Q

when my fresh blood be seen in regurgitated material?

A

if ulceration present

49
Q

is regurgitated material solid or liquid?

A

either

50
Q

is it possible to tell the difference between vomit and regurgitated material just by looking at it?

A

no - need to see the process happening to know

51
Q

what are the secondary problems and complications associated with regurgitation?

A
malnutrition 
dehydration
anorexia or perceived polyphagia
reflux pharyngitis or rhinitis
aspiration pneumonia
swallowing pain
52
Q

what is polyphagia?

A

excessive appetite

53
Q

what is reflux pharyngitis / rhinitis caused by?

A

regurgitation up into nose

54
Q

what is the sign of reflux pharyngitis / rhinitis?

A

nasal discharge

55
Q

what are the main signs of aspiration pneumonia?

A

cough
dyspnoea
pyrexia

56
Q

how is oesophageal disease investigated?

A

physical exam
chest x rays (+/- fluoroscopy)
laboratory tests (haem and biochem)
oesophagoscopy

57
Q

under what level of sedation must chest x rays be performed?

A

conscious so that oesophagus does not collapse and reflux risk is reduced

58
Q

what are the main pathophysiologies associated with oesophageal disease?

A

megaoesophagus
oesophagitis
oesophageal obstruction

59
Q

what are the types of oesophageal obstruction?

A

complete or partial
intraluminal or intramural
extraluminal

60
Q

what is intraluminal oesophageal obstruction?

A

something in the lumen of the oesophagus

61
Q

what is intramural oesophageal obstruction?

A

growth from oesophageal wall which reduces patancy

62
Q

what is extraluminal oesophageal obstruction?

A

something outside of the oesophagus which is compressing it

63
Q

what is mega oesophagus?

A

oesophageal dilation / dysfunction due to weakened muscles

64
Q

what are the two types of megaoesophagus?

A

generalised (whole oesophagus)

focal dilation

65
Q

what are the causes of megaoesophagus?

A
idiopathic
myasthenia gravis (localised or systemic signs)
66
Q

what is vascular ring anomaly?

A

ligament tethers oesophagus and makes it difficult for food to pass the heart apex leading it to build up

67
Q

how is megaoesophagus treated?

A

idiopathic - no cure, supportive therapy
myasthenia gravis - drugs to aid transmission of nerve impulses
vascular ring anomaly - surgery to cut ligament tethering oesophagus
nursing care to manage impact of oesophageal dysfunction

68
Q

what is involved in the nursing management of megaoesophagus?

A

postural feeding to use gravity to help function

textured food is less likely to be regurgitated

69
Q

how can postural feeding for megaoesophagus be managed?

A

stairs or worktop

bailey chair is specifically designed to support

70
Q

what are the main complications of megaoesophagus?

A

aspiration pneumonia

loss of bodyweight and condition

71
Q

how is aspiration pneumonia treated?

A

IV antibiotics and O2 therapy

72
Q

what type of studies should be avoided in patients with oropharyngeal issues?

A

barium - may be aspirated and cause serious lung damage

73
Q

what is oesophagitis?

A

oesophageal inflammation

74
Q

what is oesophagitis caused by?

A

ingestion of caustics, hot liquids or foods, foreign bodies, irritants (e.g. doxycycline)
gastro oesophageal reflux
persistent vomiting

75
Q

what may oesophagitis lead to?

A

oesophageal strictures

76
Q

what are the causes of gastro-oesophageal reflux?

A

anaesthesia
persistent vomiting
hiatal hernia
GERD - heart burn (spontaneous)

77
Q

what factors may predispose GERD - spontaneous reflux?

A

obesity

BOAS

78
Q

what happens during gastro-oesophageal reflux?

A

reflux of gastric acids and enzymes leading to inflammation

79
Q

what are the signs of oesophagitis?

A
regurgitation
hypersalivatin
anorexia
pain
weight loss
80
Q

how is oesophagitis managed?

A

oesophageal rest (starve or gastrotomy feeding)
analgesia (topical or systemic)
liquid antacid gels or coating agents
acid blockers (omeprazole)
drugs to reduce further reflux by closing sphincter

81
Q

what diet should oesophagitis patients be fed?

A

low fat - fat slow gastric emptying

82
Q

where can oesophageal foreign bodies be lodged?

A

anywhere in the oesophagus

83
Q

what are the signs of oesophageal foreign body?

A

obstruction
regurgitation
may be able to drink

84
Q

what diets pose a risk of oesophageal foreign body?

A

raw or bone feeding

85
Q

how are oesophageal foreign bodies removed?

A

endoscopically
fluroscopically
may need surgery (perf?)

86
Q

what is the cause of oesophageal stricture?

A

fibrosis after severe ulceration of mucosa

87
Q

how can oesophageal stricture be treated?

A

re-stretch oesophagus using balloon

88
Q

why is surgery not an option to treat oesophageal stricture?

A

surgery likely to cause further stricture

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