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Disorder of the esophagus (oesophagitis (causes (infection e.g candida,…
Disorder of the esophagus
Pathophisiology
The esophagus is the mucus lined muscular tube that carries food from the mouth to the stomach. its begin at the base of the pharynx and ends about 4cm below the diaphragm. theres upper esophageal sphincter and the lower esophageal sphincter. disorder of the esophagus include motility disorder (achalasia, diffuse spasm, foreign bodies, chemical burns,gastro esophageal reflux disease.
Achalasia
defination
is a chronic progressive condition in which the tone in the lower two thirds of the oesophageal musculature is increased.
Pathophisiology
there is increased tone of the lower oesophageal sphincter, due to the defective innervation increasing difficulty in swallowing both by the Auerbach plexus with the resultant failure of normal peristalsis in the two thirds of the oesophagus.
assessment findings
difficulty in swallowing
heart burn in the substernal region
regurgitation of undigested food
persistent cough at night
weight loss
Diagnostic test
chest Xray may show enlarged fluid filled oesophagus
barium swallow with chest Xray
Manometry to measure the inside of eosophagus
Oesophagascopy will show widening of the oesophagus with no obstruction
biopsy to check oesophageal cancer
management
patient should be given frequent doses of prescribed antacids to neutralise the gastric content
Small frequent, semi soft and warm meals fluids with to facilitate passage of food
no spicy foods
patient should be encourage to chew food properly
oesophagitis
defination
is an acute or chronic inflammation or sometimes ulceration of the mucosa or sub mucosa lining of the esophagus
causes
infection e.g candida, herpes, HIV and cytomegalovirus
medication such as doxycycline and potassium chloride
motility disorder such as achalasia, scleroderma and oesophegeal spasm
mechanical injury to the oesophageal mucosa caused by rough or sharp instrument
pathophisiology
in gastroesophageal reflux associated with an incompetent lower oesophegeal sphincter, the gastric acid flow regurgitate through the weak cardiac sphincter into esophagus.
assessment findings
burning pain in the chest sometimes accompanied with vommiting
dysphagia
heart burn without backflow of the gastric content into the mouth. occurs 30 to 60 minutes after meals
intolerance of spices, alcohol and caffaeine
Diagnostic test
A biopsy to confirm diagnose and rule out malgnancy
eosophageal manometry to measure the pressure of the lower segment sphincter
endoscopy to visualise the inflammation, lesion or erosion
barium oesophagography (barium swallow)
nursing and medical management
stop smoking and alcohol
drug therapy first line drug are 1 antacids to neutralise gastric acid
Histamine receptor blockers to reduce stomach acid and provide symptomatic relief
2nd high dose of histamine receptor blockers and prokinetic agent such as metochlopramide to promote gastric emptying and prevent reflux added
lifestyle changes like start a bland diet and avoid eating spicy food
health education
stop smocking and intake of alcohol
stress management should be discussed and coping machanism
encourage the patient to eat high protein and stop all food that contain caffeine
elavate the head about 15 to 20 cm blocks to enhance oesophageal emptying
Surgical management
vagotomy to reduce the acidity of the stomach content
Gastrostomy to assist with nutrition
Oesophageal deverticulum
defination
are sacs or pouches formed at weak points in the walls of the gastro intestinal tract
pathophisiology
a large pouch may fill with food that is regurgitated when the person bends over or lies down. this causes food to be inhaled into lungs during sleep resulting in aspiration pneumonia. if pouches enlarge may cause dysphagia
assessment and findings
a sour taste in the mouth
manifestation depend on the size and amount of food accumulated.. patient may complain of an odour caused by the stagnant food
regurgitation of stagnant food
dysphagia
halitosis
chest pain and weight loss
diagnostic studies
video Xray that produces a moving image maybe done during barium swallowing to diagnose a pouch
management
small frequent meals should encouraged
patient should maintain an upright position the upright position to prevent norcturnal reflux of food
a surgical excision of the diverticulum may be necessary if the symptom become severe
heatus hernia
definatioin
portion of stomach herniates through oesophageal opening of the diaphragm.
causes and risk factors
weakening muscle of the diaphram
pregnancy, abdominal tomours ,obesity
congenital muscle weakensss
pathohysiology
muscles in the diaphragm encircle the oesophageal junction and thus the stomach is prevented from ascending into the thoracic cavity. in a hiatus hernia the part of the stomach herniates upwards into the mediastinal cavity through a weakness in the diaphragm, caused by trauma or loss of muscle tone. The major clinical feature of hiatus hernia are the regurgitation of gastric content.
assessment findings and symptoms
heartburn
Flatulence and belching
dyspnoea and anorexia
dysphagia
/oesophagitis/ulceration
severe burining pain
management (nursing and surgical management)
administer of antacids after meals and bedtime
valvuloplasty
essential health education
eat small,frequent,bland meals
:wear loose under wear
avoid alcohol and smooking
after eating , patient should be sitted on upright posotion
avoiding bending, heavy lifting,
reduce weight and join weight support group