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What is xerostomia?
Dry mouth
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What are some causes of xerostomia?
- Medication side effects(anticholinergics, antidepressants, antihistamines, antihypertensives, etc.)
- Sjogren's syndrome
- Poorly controlled diabetes metitus
- Radiation therapy
- Mouth breathing
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What are some of the consequences of dry mouth?
- Mouth infections
- Bad breath
- Dental diseases
- Taste diminishment
- Salty and/or spicy food might cause pain
Therefore, reduces energy intake, increasing the risk of malnutrition.
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What is the initial phase of swallowing?
What is the second?
- Oropharyngeal
- Esopharyngeal
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What is dysphagia?
Difficulty swallowing
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S/S of oropharyngeal dysphagia?
- Inability to swallow
- Coughing during or after swallowing(due to aspiration)
- Nasal regurgitation
- Gurgling noise after swallowing
- And/or a hoarse or "wet" voice
- Speech disorder
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What are some probable causes of oropharyngeal dysphagia?
Typically due to a neuromuscular disorder that inhibits the swallowing reflex or impairs the strength or coordination of the muscles involved in swallowing.
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Oropharyngeal dysphagia is common in . . .
Older adults and frequently follows a stroke
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A person had difficulty passing material through the esophageal lumen and into the stomach.
Complaints of a sensation like "sticking" of food in the esophageal tract.
What condition might this person be experiencing?
Esophageal dysphagia
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What are some causes of esophageal dysphagia?
An obstruction in the esophagus or motility disorder
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What is a stricture?
Abnormal narrowing of a passageway; often due to inflammation, scarring, or a congenital abnormality.
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Obstructions in the esophageal tract caused by narrowing(stricture), tumor, or compression by surrounding tissue will still allow what to pass?
Liquids
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___ disorder hinders the passage of liquids and solids.
Motility
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What is the most common motility disorder?
Achalasia
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An esophageal disorder characterized by weakening peristalsis and impaired relaxation of the lower esophageal sphincter?
Achalasia
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If aspiration occurs (concerning dysphagia), it may cause _____, airway obstructions, and or respiratory infections (such as _____)
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Concerning dysphagia, if a person lacks a ____ reflex, aspiration is more difficult to diagnose and may go unnoticed.
Cough
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Individuals with oral pharyngeal dysphagia can be taught exercises that strengthen the jaws, tongue, larynx, or they might learn techniques to facilitate swallowing
Who is responsible for these treatments?
Speech and language therapists responsible for teaching
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What are some of the causes of GERD?
- Sphincter muscles are weak or relax inappropriately.
- High stomach pressures
- Inadequate acid clearance
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What conditions put individuals at a high risk of GERD?
- Obesity
- Pregnancy
- Hiatal hernia
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What is hiatal hernia?
Portion of the stomach protrudes above the diaphragm
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What is gastric acid remaining in the esophagus long enough to cause damage to the lining, resulting in inflammation?
Reflux esophagitis
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A condition in which esophageal cells damaged by chronic exposure to stomach acid are replaced by cells that resemble those in the stomach or small intestine, sometimes cancerous.
Barrett's esophagus
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Severe and chronic inflammation may lead to ______, with consequential bleeding. After healing, the scar tissue may ____ the inner diameter of the esophagus, causing a stricture.
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What is the most effective antisecretory agent used in GERD?
What is another?
- Proton-pump inhibitors
- HIstamine-2 receptor blockers
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What refers to general symptoms of pain or discomfort in the upper ABD region, which may include stomach pain or burning, after-meal fullness, early satiation, nausea, and bloating?
Dyspepsia
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____ or ____ may mimic dyspepsia
- Intestinal conditions such as irritable bowel syndrome
- Lactose intolerance
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Although pinpointing the cause of gastric symptoms can be difficult, a complete examination is in order if the individual experiences _____, dysphagia, persistent _____, GI bleeding, anemia, which suggest the presence of serious illness.
- Unintentional weight loss
- Vomiting
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Concerning dyspepsia,
Substances often reported to cuase problems include _____, ____, ____, ____, _____, _____.
Fatty foods and high-fat meals, which ___ gastric emptying, may exacerbate symptoms in some individuals.
- Alcohol
- Chili peppers
- Chocolate
- Coffee
- Spices and spicy foods
- Citrus fruits
- Slow
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The feeling of bloating may be caused by excessive gas in the stomach, which accumulates when air is swallowed. Air swallowing companies ____, ____, ____, ____, ____.
What would be the corrective measure to prevent air swallowing?
- Gum chewing
- Smoking
- Rapid eating
- Drinking carbonated beverages
- Using a straw
Omitting these practices
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Prolonged vomiting can cause esophagitis and ______ imbalances. = Malnutrition and/or deficiences.
Fluid electrolyte
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Gastritis results from ______ infection or the use of NSAIDs, which are both primary causes of peptic ulcer disease as well.
Helicobacter pylori
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Pernicious anemia characterized by autoimmune destruction of the stomach cells that produce hydrochloric acid and intrinsic factor is a form of ______ that is usually associated with macrocytic anemia of vit. B12 deficiency.
Atrophic gastritis
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Terms
Low hydrochloric acid=
Absence=
- Hypochlorhydria
- Achlorhydria
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What is an open sore in the GI mucosa, may develop in the esophagus, stomach, or duodenum?
Peptic ulcer
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What is the primary factor in peptic ulcer disease?
Another major factor?
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Peptic ulcer disease increases by ____ and _____
- Cigarette smoking
- Psychological stress
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Physiological effects of stress vary among individuals but may include hormonal changes that impair immune responses and ______, increasing secretions of _____ and _____, and ____( which increases the acid load in the duodenum).
- Wound healing
- Hydrochloric acid
- Pepsin
- Rapid stomach emptying
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S/S peptic ulcers
- Hunger pain
- Sensation o grawing
- Buring pain in the stomach region
- Relieve by food and recurrence several hours after a meal.
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Complications of peptic ulcers
Severe bleeding is evidenced by ______ stools or occasional vomiting that resembles _____.
- Black, tarry
- Coffee grounds
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What is an obstruction that prevents the normal emptying of stomach contents into the duodenum?
Gastric Outlet Obstruction
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What is a surgery that removes diseased regions of the stomach?
What is the type of surgery that treats obesity?
Bariatric surgery
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What are the primary goals of care after gastrectomy?
- Meet nutritional needs
- Promote healing of tissue
- Prevent discomfort or nutritional deficiencies
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Gastrectomy PTs are at increased risk of _____
Dumpling syndrome
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What is a cluster of symptoms that result from a rapid emptying of an osmotic load from the stomach into the small intestine?
Dumping syndrome
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Concerning gasterectomy,
Dietary measures after procedure are determined by . . .
Name the 2
- Size of the remaining stomach which influences meal size
- Stomach emptying rate which affects food tolerance
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Concerning gasterectomy care,
PT should avoid ______ because they increase osmolarity in the small intestine and potentiate the dumping syndrome.
Sweets and sugars
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Concerning gasterectomy care,
_______ may be added to meals to slow stomach emptying and to reduce the risk of diarrhea
Soluble fibers
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Nutrition problems following gastrectomy.
Name the 3
- Fat malabsorption-food traveling too fast, not enough time for mixing with bile
- Bone disease
- Anemia-malabsorption of iron and vit. B12
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Bariatric surgery is most effective and durable Tx for ____
Morbid obesity
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What type of gastrectomy removes a large portion of the stomach leaving a gastric tube that holds only about 3-5 oz. ?
Sleeve
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Gastric bygass and sleeve gasterectomy are ____, whereas gastric banding is ____.
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