Lecture 10

Question 1

what are the 4 main fxns of the GI tract?

Answer 1

motility, digestion, secretion, absorption

Question 2

common disorders affecting the oral cavity:

Answer 2

xerostomia, mucositis (thrush), dysgeusia (altered taste), dysphagia (difficulty swallowing), odynophagia (pain related to swallowing)

Question 3

phases of the normal adult swallowing process?

Answer 3

oral prep phase, oral transit phase, pharyngeal phase, esophageal phase

Question 4

what is oral prep phase?

Answer 4

chewing, mixing food with saliva into bolus

Question 5

what is oral transit phase?

Answer 5

food moved to back of mouth via tongue

Question 6

what is pharyngeal phase?

Answer 6

food enter upper throat, soft palate elevates, epiglottis closes off trachea

Question 7

what is esophageal phase?

Answer 7

food enters esophagus and propelled to stomach

Question 8

common causes of dysphagia

Answer 8

neuro disease, muscle disorders, GI disease, malignancy, other

Question 9

diagnostic methods (usually performed in this order):

Answer 9

bedside swallowing assessment, modified barium swallowing assessment, fiberoptic endoscopic evaluation of swallowing

Question 10

dysphagia outcome and severity scale is a ___ point scale

Answer 10

7

Question 11

in hospitalized pt , dysphagia is associated with:

Answer 11

^ LOS, ^ mortality

Question 12

dysphagia is independent risk factor for:

Answer 12

malnutrition

Question 13

types of thickening agents:

Answer 13

starch, guar gum, locust bean gum, xanthan gum, carageenan

Question 14

esophagus coordinates movement of food by alternating contractions called ____

Answer 14

peristalsis

Question 15

esophageal related conditions:

Answer 15

esophageal dysphagia, GERD, esophagitis, barrett’s esophagus, esophageal varices, strictures, achalasia

Question 16

what is achalasia?

Answer 16

failure of smooth muscle and lower esophageal sphincter to relax so food not empty in to stomach

Question 17

5-15% of esophagitis –> _____

Answer 17

barrett’s esophagus (normal tissue of esophagus starts to mimic tissue of intestine–>carcinoma)

Question 18

pathophysiology of GERD:

Answer 18

transient relaxation of LES, v saliva, v LES pressure, impaired esophageal acid clearance, ^ esophageal sensitivity, ^ intraab pressure, delayed gastric emptying

Question 19

etiology of GERD:

Answer 19

^ secretion of hormones that dcrease LES pressure, some med conditions, smoking, certain meds, diet

Question 20

foods that may decrease LES pressure:

Answer 20

peppermint/spearmint, chocolate, high fat / fried foods, alcohol, coffee

Question 21

foods that may increase gastric acid secretion

Answer 21

pepper, coffee, alcohol

Question 22

common meds to treat UGIT disorders:

Answer 22

TUMS, tidines (H2 blockers), erythromycin (prokinetics), prazoles (PPI)

Question 23

peptic ulcer disease caused by _____

Answer 23

H pylori

Question 24

acid producing cells of stomach called ____

Answer 24

parietal cells

Question 25

why mucus secreting glands in inner lining of stomach?

Answer 25

protect from acid

Question 26

types of ulcerations of gut mucosa (PUD):

Answer 26

gastric (near antrum), duodenal (near pyloric sphincter)

Question 27

why antrum and pyloric sphincter areas common to have ulcer:

Answer 27

areas of breakdown continuously exposed to gastric acid and pepsin (erosion-->perforation)

Question 28

etiology of PUD

Answer 28

meds/substances, severe illness/stress, gastritis, H. pylori

Question 29

how to diagnose PUD?

Answer 29

endoscopy

Question 30

what is atrophic gastritis?

Answer 30

chronic inflammation with gradual deterioration of mucous membrane and glands (loss of production of IF)

Question 31

meds that can cause PUD:

Answer 31

NSAIDS/aspirin (corrosive and inhibit prostaglandin synth), corticosteroids

Question 32

substances that cause PUD:

Answer 32

tobacco, poor diet, ingestion of corrosive substances, alcohol

Question 33

chief complaint of PUD:

Answer 33

ab discomfort (dull, burning, transient pain on empty stomach)

Question 34

other symptoms of PUD:

Answer 34

vomiting/nausea, anorexia, burping, bloating (nonspecific)

Question 35

nutr implications of PUD:

Answer 35

impaired oral intake, involuntary wt loss, nutr imbalances/deficiencies, atrophic gastritis (B12 deficiency, low acid state negatively influences absorption of Fe and Ca)

Question 36

Gi tract is composed of :

Answer 36

upper GI (mouth, pharynx, esophagus, stomach), lower GI (small int, large int), accessory organs (liver, pancreas, salivary glands, gallbladder)

Question 37

clinical manifestations of dumping include ___ and ___ symptoms

Answer 37

GI; vasomotor

Question 38

two types of dumping

Answer 38

early (10-30min, GI and vasomotor, majority) and late (1-3hr, vasomotor, less common)

Question 39

what is oral glucose provocation test?

Answer 39

rise in heart rate by 10bpm+ in first hour after the challenge following 10 hr fast is diagnostic

Question 40

dumping symptoms scored by ___

Answer 40

Sigstad

Question 41

if have dumping syndrome, avoid liquids for ___min after meal, should have at least ___ meals

Answer 41

30; 6

Question 42

in dumping syndrome, reduce __ and avoid ___

Answer 42

simple CHO; dairy

Question 43

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

Answer 43

acarbose