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FNP Review 9
GI signs symptoms dysphagia
| Question | Answer | Rationale |
|---|---|---|
| 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 |
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