GI Medicine - Swallowing Problems Flashcards
(88 cards)
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
how is oropharyngeal trauma treated?
wound management
| surgery
26
how is oropharyngeal inflammation treated?
anti-inflammatories
27
how is oropharyngeal bacterial infection treated?
antibiotics
28
what are the main nursing considerations for oral disease?
analgesia
nutritional considerations (oral with soft food or bypass/tube feeding)
barrier nursing if needed
29
what analgesia may be given to oral patients?
opioids
| NSAIDs - if eating
30
what has an important role in any oral disease?
oral hygiene
31
what can poor oral / dental hygiene lead to?
causative of infections
| source of ongoing bacteria/oropharyngeal inflammation or infection
32
how can oral hygiene be maintained?
oral rinses
tooth brushing
cat and dog specific enzymatic tooth paste
+/- dental extractions
33
what is key about the oral hygiene of anorexic or ventilated patients?
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
define dysphagia
difficulty swallowing
35
define odynophagia
swallowing pain
36
define regurgitation
passive return of food/water or saliva
37
where is the problem located if dysphagia is seen?
oropharyngeal (occasionally oesophageal)
38
where is the problem located if odynophagia is seen?
oropharyngeal and oesophageal
39
where is the problem located if regurgitation is seen?
oesophageal
40
what is regurgitation a hallmark of?
oesophageal disease
41
define vomiting
active forceful, reflex ejection of gastric and upper intestinal content following stimulation of a neural reflex that has synaptic centres in the brainstem
42
is vomiting a sign or a diagnosis?
sign
43
what may vomiting be due to?
GI or extra-GI disease
44
what will change depending on whether regurgitation or vomiting is present?
investigations
45
when may regurgitation occur?
immediate or delayed
46
what will products of regurgitation look like?
undigested food
| +/- mucous or saliva covering
47
what is the pH of regurgitated material?
neutral as no stomach acid
48
when my fresh blood be seen in regurgitated material?
if ulceration present
49
is regurgitated material solid or liquid?
either
50
is it possible to tell the difference between vomit and regurgitated material just by looking at it?
no - need to see the process happening to know
51
what are the secondary problems and complications associated with regurgitation?
```
malnutrition
dehydration
anorexia or perceived polyphagia
reflux pharyngitis or rhinitis
aspiration pneumonia
swallowing pain
```
52
what is polyphagia?
excessive appetite
53
what is reflux pharyngitis / rhinitis caused by?
regurgitation up into nose
54
what is the sign of reflux pharyngitis / rhinitis?
nasal discharge
55
what are the main signs of aspiration pneumonia?
cough
dyspnoea
pyrexia
56
how is oesophageal disease investigated?
physical exam
chest x rays (+/- fluoroscopy)
laboratory tests (haem and biochem)
oesophagoscopy
57
under what level of sedation must chest x rays be performed?
conscious so that oesophagus does not collapse and reflux risk is reduced
58
what are the main pathophysiologies associated with oesophageal disease?
megaoesophagus
oesophagitis
oesophageal obstruction
59
what are the types of oesophageal obstruction?
complete or partial
intraluminal or intramural
extraluminal
60
what is intraluminal oesophageal obstruction?
something in the lumen of the oesophagus
61
what is intramural oesophageal obstruction?
growth from oesophageal wall which reduces patancy
62
what is extraluminal oesophageal obstruction?
something outside of the oesophagus which is compressing it
63
what is mega oesophagus?
oesophageal dilation / dysfunction due to weakened muscles
64
what are the two types of megaoesophagus?
generalised (whole oesophagus)
| focal dilation
65
what are the causes of megaoesophagus?
```
idiopathic
myasthenia gravis (localised or systemic signs)
```
66
what is vascular ring anomaly?
ligament tethers oesophagus and makes it difficult for food to pass the heart apex leading it to build up
67
how is megaoesophagus treated?
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
what is involved in the nursing management of megaoesophagus?
postural feeding to use gravity to help function
| textured food is less likely to be regurgitated
69
how can postural feeding for megaoesophagus be managed?
stairs or worktop
| bailey chair is specifically designed to support
70
what are the main complications of megaoesophagus?
aspiration pneumonia
| loss of bodyweight and condition
71
how is aspiration pneumonia treated?
IV antibiotics and O2 therapy
72
what type of studies should be avoided in patients with oropharyngeal issues?
barium - may be aspirated and cause serious lung damage
73
what is oesophagitis?
oesophageal inflammation
74
what is oesophagitis caused by?
ingestion of caustics, hot liquids or foods, foreign bodies, irritants (e.g. doxycycline)
gastro oesophageal reflux
persistent vomiting
75
what may oesophagitis lead to?
oesophageal strictures
76
what are the causes of gastro-oesophageal reflux?
anaesthesia
persistent vomiting
hiatal hernia
GERD - heart burn (spontaneous)
77
what factors may predispose GERD - spontaneous reflux?
obesity
| BOAS
78
what happens during gastro-oesophageal reflux?
reflux of gastric acids and enzymes leading to inflammation
79
what are the signs of oesophagitis?
```
regurgitation
hypersalivatin
anorexia
pain
weight loss
```
80
how is oesophagitis managed?
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
what diet should oesophagitis patients be fed?
low fat - fat slow gastric emptying
82
where can oesophageal foreign bodies be lodged?
anywhere in the oesophagus
83
what are the signs of oesophageal foreign body?
obstruction
regurgitation
may be able to drink
84
what diets pose a risk of oesophageal foreign body?
raw or bone feeding
85
how are oesophageal foreign bodies removed?
endoscopically
fluroscopically
may need surgery (perf?)
86
what is the cause of oesophageal stricture?
fibrosis after severe ulceration of mucosa
87
how can oesophageal stricture be treated?
re-stretch oesophagus using balloon
88
why is surgery not an option to treat oesophageal stricture?
surgery likely to cause further stricture
