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FNP Review 9

GI signs symptoms dysphagia

QuestionAnswerRationale
oropharyngeal dysphagia difficulty in swallowing
esophageal dysphagia difficulty having food pass from mouth down to the esophagus to the stomach
odynophagia painful swallowing
alarm symptom that requires immediate evaluation to determine cause and treatment odynophagia
orophagyngeal dysphasia nasal regurgitation
esophageal dysphasia sensation of food "sticking" after it is swallowed
clinical presentation of dysphagia difficulty swallowing solids or liquids, trouble initiating swallow; coughing, choking, chest pain
prevention and screening of dysphagia: identify at risk persons previous stroke, cervical spinal cord injury
symptoms associated with dysphagia heartburn, weight loss, hematemesis, coffee ground emesis, anemia & regurgitation
physical exam for dysphagia ENT, nueromuscular (CN V, VII, XII), pulmonary & cardiac exam
diagnostic workup for dysphagia CBC & stool for occult blood-evaulate bleeding; LFT-evaluate metastic process; BUN, albumin-evaluate nutritional status; thryoid function test- rule out hypothyroidism; ECG & cardiac workup-if chest pain is presenting symptom; esophageal pH-evaluate GERD
standard test for diagnosis & management of esophageal diseases endoscopy allows for biopsy & definitive tissue diagnosis
often done first to differentiate between mechanical lesion and esophageal motlitiy problems barium swallow or upper GI series if a motlity problem is suspected barium swallow should be done first; if a mechanical lesion is suspected, an endoscopy is often done first
differential diagnosis for dysphagia esophageal cancer, vascular rings, achalasia, radiation injury, scleroderma
achalasia failure of lower esophageal sphincter to relax
standard for detecting and evaluating swallowing abnormalities videofluroscopic swallowing studies
management of dysphagia outpatient-if patient not malnourished & not at high risk for aspiration; goal-treat underlying cause & maintain nutritional status during workup; elderly may have poor fitting dentures that contribute to the problem; use thickened liquids
dysphagia: when to consult, refer, hospitalize refer any patients with new symptoms and no obvious treatable cuase to GI, especially older patient, those with weight loss, bleeding, iron deficiency anemia, history of chronic GERD, heavy alcohol & tobacco use
etiology of dysphagia structural abnormalities, muscular weakness or incoordination of swallow, peristalis or empyting of esophagus
Created by: deleted user