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30 Cards in this Set

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T or F: The entire esophagus functions as one tissue during swallowing?
True
Movement of a bolus of food into the stomach.
Mouth - Pharynx - (upper sphincter relaxes) - esophagus - (peristaltic waves and LES relaxes) - stomach.
Definition of dysphagia:
Difficulty in swallowing
Definition of GastroEsophageal Reflux Disease (GERD):
The backward flow of the stomach of duodenal contents into the esophagus; may occur normally or as a chronic pathologic condition
Common symptoms of GERD:
Reflux of gastric secretions, heartburn with episodes of substernal pain, belching, esophageal spasm. Children's symptoms may also include refusal to eat, vomiting, dysphagia, or c/o abdominal pain.
Prolong erosive disease (GERD) can result in:
esophagitis, esophageal erosions, ulceration, scarring, stricture, and even dysphagia.
What is Barret's esophagus (BE)?
A condition in which cells lining the distal esophagus become abnormal, even premalignant.
Acute esophagitis may be caused by:
ingestion of a corrosive agent, viral inflammation, or intubation.
Risk of reflux is increased with:
hiatal hernia, reduced LES pressure, tobacco use, increased abdominal pressure (as in obstructive lung disease), delayed gastric emptying, recurrent vomiting, pregnancy, or other factors.
GERD can cause esophagitis. The severity of esophagitis is influenced by:
the composition, frequency, and volume of the gastric reflux; the health of the mucosal barrier; rate of clearance from the esophagus; rate of gastric emptying.
T or F: Erosive and nighttime GERD are considered to be associated with more severe and prolonged symptoms.
True. Nighttime GERD is R/t altered phsyiology and anatomy during sleep from decreased salivary secretions and swallowing, decreased GI motility, prolonged exposure to acid, and the supine position.
Esophagitis, although mainly R/t GERD, can also be R/t:
Viral/Bacterial infection, reduced LES pressure, Hiatal hernia, intubation, ingestion of corrosive agents, radiation, smoking, large doses/chronic use of asprin or other nonsteroidal antiinflammatory drugs (NSAIDs) or other medications.
Proton pump inhibitors are considered most effective to treate GERD. How do they work?
Proton pump inhibitors decrease acid production by the gastric parietal cell.
Prokinetic agents may be used in person who
have delyaed gastric emptying.
Rather than using proton pump inhibitors for all cases of GERD, milder forms of reflux can be managed with what types of medications?
H2 receptor antagonists
antacids
What behavioral modifications are used to manage esophagitis?
Avoiding lying down after meals and eating within 3 hrs of retiring, wearing loose fitting clothing, avoiding cigarette smoking.
What is the nutrition management goals for esophagitis and how can they be achieved?
1 Decrease exposure to gastric contents by: avoiding large meals, dietary fat and alcohol.
2 Decrease acidity of gastric secretions by: avoiding coffee and fermented alcholic beverages.
3 Prevent pain and irritation by: avoiding acid pH foods and spices.
Definition of fundoplication:
A procedure in which the fundus of the stomach is wrapped around the lower esophagus to limit reflux.
For a person with severe esophagitis, what diet may be best tolerated initially?
Low-fat, liquid diet because it doesn't increase esophageal distention and it may pass more easily through any strictured areas.
LES pressure is lowered by:
carminatives (peppermint and spearmint), coffee, pregnancy, taking pregesterone-based birth control, .
Risk factors for esophageal cancer includes:
obesity, alcohol and its degradation into acetaldehyde, nitrities, a diet low in selenium/fruits/vegs/cereal fiber.
T or F: The presence of hiatal hernia is synonymous with reflux
False. It does prolong exposure to acid and increase risk of serious esophagitis. It also causes epigastric discomfort after large, energy-dense meals, laying down, or bending over.
What is the most common type of hiatal hernia?
The sliding hernia. The less common is the paraesophageal hernia.
MNT for hiatal hernias include:
weight reduction, decreasing meal sizes, omitting high-fat, high-kcal meals before reclining, minimizing alcohol consumption.
Why are tonsils removed?
To reduce the number and frequency of ear infections, tonsillitis, and sinusitis. Tonsils are considered lymphatic tissue and are therefore part of the immune system.
The best foods to eat after a tonsilectomy include:
cold, mild-flavored, soft, moist foods. The first day after surgery, chilled/frozen dairy or fruit slurries and noncitrus juices are tolerated. By day two the diet can be expanded to include warm fluids and soft foods. Within 3-5 days the a normal diet can be consumed.
MNT for oral cancer:
Nutrition support by tube feeding or gastrostomy if needed for total or supplemental support. If oral is possible - liquid/soft foods; moist foods for easy mastication and swallowing; small, frequent meals of high caloric density; complex carbs rather than simple carbs.
Use of artificial saliva, frequent consumption of fluids, and normal saline rinses may help the eating process.
What is functional dyspepsia (aka nonunlcer dyspepsia)?
unexpelained persistent or recurrent upper GI discomfort
What are symptoms of functional dyspepsia?
vague abdominal discomfort, bloating, early satiety, nausea, belching.
What is the dietary MNT for dyspepsia?
Reduce dietary fat intake, smaller meals, diets of low caloric density, and limiting alcohol. Non dietary MNT includes mild exercise and lowering stress levels.