1.disorders of Mouth & Esophagus-1

1
SUB: ADULT HEALTH NURSING -

I
UNIT: I DISORDERS OF MOUTH

AND
ESOPHAGUS
By
Asif Ali Magsi
Nursing Lecturer
BCON,SMBBMU,Lrk
ESOPHAGITIS
2
Inflammation or irritation of the esophagus

Causes: Reflux of stomach contents, irritants, fungal
infections, trauma, malignancy, intubation
S/S: heartburn, pain, dysphagia
Treatment: treat underlying cause
Interventions: soft bland diet, administer meds,
elevate head of bed, observe for complications
Gerontological Nursing, Second Edition
Patricia A. Tabloski
CANCER OF THE ESOPHAGUS
3
Prognosis is very poor, diagnosed at late stages.

Causes- no known cause, predisposing factors;
irritation, poor oral hygiene.
S/S- Progressive dysphagia, painful swallowing,

weight loss, vomiting, hoarseness, coughing, iron
deficiency, anemia, occult bleeding or hemmorage

TREATMENT
4
 Palliative (analgesic) treatment is common.

 Radiation, chemotherapy
Surgery:
 Esophagectomy
 Esophagogastrostomy
 Esophagoenterostomy
 Gastrostomy
NURSING INTERVENTIONS
5
 Maintain NG tube after surgery

 Assess for signs of hemorrhage
 Monitor respiratory status
 Monitor adequacy of nutritional intake (high
protein, high calorie diet)
 Assess ability to swallow
 Allow patient to ventilate feelings
GASTROESOPHAGEAL REFLUX
6
DISEASE
 Caused by weakness of esophageal sphincter
 Increased incidence of hiatal hernia
 Risk factors
 Aging
 Thyroid disease
 Scleroderma or connective
tissue disorders
 Diabetes

Cont…
7
 Signs and symptoms

 Heartburn
 Indigestion
 Belching:(also known as burping) involves the
release of gas from the digestive tract (mainly

esophagus and stomach) through the mouth.
 Hiccups
 Regurgitation of gastric contents
 Voice hoarseness

GERD RISK FACTORS
8
 Primary
 Length and frequency of esophageal acid
exposure
 Others
 Thyroid disease
 Diabetes
 Connective tissue disorders

Cont…
9
 Triggers
 Eating large meals

 Certain medications
 High-fat foods
 High caffeine intake
 Alcohol and tobacco use
 Reclining after eating
 Obesity
Cont…
10
 Nursing assessment of GERD

 Diagnostic testing
 Barium swallow
 Endoscopy
 Esophageal contents pH
 Goals of treatment
 Symptom control
 Heal mucosal injury

Cont…
11
 Lifestyle modifications
 Elevate head of bed
 Avoid trigger foods
 Drink 6 to 8 ounces of water with medications
 Report all medications to physician
 Avoid tight-fitting clothes and girdles(belt-
shaped textile)
 Remain upright after meals for 1 to 3 hours

Cont…
12
 Lifestyle modifications
 Avoid right side-lying position
 Stop smoking
 Lose weight as appropriate
 Reduce alcohol, caffeine, and fat intake

Cont…
13
 Medications
 Antacids
 Aluminum-containing antacids
 Histamine 2 receptor agonists
 Proton pump inhibitors
 Combination drugs
 Surgery

NURSING DIAGNOSES OF GERD
14 PATIENT
 Impaired swallowing
 Impaired skin integrity
 Impaired social interaction (if appropriate)
 Sleep pattern disturbance (if appropriate)
 Acute or chronic pain

HIATAL HERNIA
15
 Protrusion of the lower esophagus and stomach upward

through the diaphragm into the chest
 SLIDING-gastroesophageal junction above the
hiatus
 ROLLING( paraesophageal)-junction in place
portion of stomach rolls up through diaphragm

 Causes; weakness in the lower esophageal sphincter,
related to increased abdominal pressure, long term bed

rest, trauma

SIGNS AND SYMPTOMS
16
 Feelings of fullness
 Dysphagia
 Eruption
 Regurgitation
 Heartburn
Complications: ulcerations, bleeding, aspiration

Seen in 50% of people over 60.

TREATMENT
17
 Drug therapy
 H2 receptor antagonists:Tagamet,Zantac,
Pepsid- reduce stomach secretions
 Urecholine- increase LES tone
 Antacids- neutralize stomach acids
 Reglan, Propulsid- increase stomach emptying
 Diet therapy- decrease caffeine fatty foods,
alcohol( reduce LES tone), acidic and spicy foods

Cont…
18
 SURGERY
 Nissen Fundoplication
 Angelclik prothesis
 NURSING CARE: assessment, pain relief,
watch for aspiration, nutrition, education

Achalasia
19
 Achalasia is absent or ineffective peristalsis of the

distal esophagus, accompanied by failure of the
esophageal sphincter to relax in response to
swallowing.
 Narrowing of the esophagus just above the stomach
results in a gradually increasing dilation of the
esophagus in the upper chest.
 Achalasia may progress slowly and occurs most often
in people 40 years of age or older.
Cont…
20
S/S: Primary symptom: difficulty in swallowing both liquids

and solids.
 Sensation of food sticking in the lower portion of the
esophagus.
As the condition progresses: regurgitated, either spontaneously
or intentionally by the patient to relieve the discomfort.
 Complain of chest pain and heartburn (pyrosis). Pain may or
may not be associated with eating.
 May be secondary pulmonary complications from aspiration
of gastric contents.
Diagnosis
21
 X-ray
 Barium swallow, CT scan
 Endoscopy may be used
Management
 Instructed patient to eat slowly and to drink fluids
with meals.
 As a temporary measure, calcium channel blockers
and nitrates have been used to decrease esophageal

pressure and improve swallowing.
Cont…
22
 May be treated conservatively by pneumatic dilation to

stretch the narrowed area of the esophagus.
 Surgical treatment: Sophagomyotomy

Diverticulum
23
 A diverticulum is an outpouching of mucosa and

submucosa that protrudes through a weak portion of the
musculature.
 Diverticula may occur in one of the three areas of the

esophagus—the pharyngoesophageal or upper area of
the esophagus, the midesophageal area, or the
epiphrenic or lower area of the esophagus—.

Cont…
24
 The most common type of diverticulum, which is found

three times more frequently in men than in women, is
Zenker’s diverticulum (also known as
pharyngoesophageal pulsion diverticulum or a
pharyngeal pouch).
S/S: difficulty swallowing, fullness in the neck, belching,

regurgitation of undigested food, and gurgling noises
after eating.

Diagnosis
25
 Barium swallow
 Manometric studies
 Esophagoscopy is contraindicated because of the
danger of perforation of the diverticulum.
 Blind insertion of a nasogastric tube should be
avoided.

Management
26
 The only means of cure is surgical removal of the

diverticulum.
 During surgery, care is taken to avoid trauma to the

common carotid artery and internal jugular veins.
 In addition to a diverticulectomy, a myotomy of the

cricopharyngeal muscle is often performed to relieve
spasticity of the musculature.

Cont…
27
 Postoperatively, the patient may have a nasogastric tube

inserted at the time of surgery.
 The surgical incision must be observed for evidence of
leakage from the esophagus and a developing fistula.
 Food and fluids are withheld until x-ray studies show
no leakage at the surgical site.
 The diet begins with liquids and progresses as tolerated.

REFERENCES
28
 Smeltzer. S. C., Bare. B.G., Hinkle. J. L & Cheever. K.

H. (2011). Textbook of Medical – Surgical Nursing. Vol
-I (12th Ed.). Wolters Kluwer. New Delhi.


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1

SUB: ADULT HEALTH NURSING -

UNIT: I DISORDERS OF MOUTH

Inflammation or irritation of the esophagus

Prognosis is very poor, diagnosed at late stages.

S/S- Progressive dysphagia, painful swallowing,

Gerontological Nursing, Second Edition

 Palliative (analgesic) treatment is common.

 Maintain NG tube after surgery

Gerontological Nursing, Second Edition

 Signs and symptoms

release of gas from the digestive tract (mainly

Gerontological Nursing, Second Edition

Gerontological Nursing, Second Edition

 Eating large meals

 Nursing assessment of GERD

Gerontological Nursing, Second Edition

Gerontological Nursing, Second Edition

Gerontological Nursing, Second Edition

Gerontological Nursing, Second Edition

Gerontological Nursing, Second Edition

 Protrusion of the lower esophagus and stomach upward

portion of stomach rolls up through diaphragm

related to increased abdominal pressure, long term bed

Gerontological Nursing, Second Edition

Complications: ulcerations, bleeding, aspiration

Gerontological Nursing, Second Edition

alcohol( reduce LES tone), acidic and spicy foods

Gerontological Nursing, Second Edition

 NURSING CARE: assessment, pain relief,

watch for aspiration, nutrition, education

Gerontological Nursing, Second Edition

 Achalasia is absent or ineffective peristalsis of the

S/S: Primary symptom: difficulty in swallowing both liquids

 Endoscopy may be used

and nitrates have been used to decrease esophageal

 May be treated conservatively by pneumatic dilation to

Gerontological Nursing, Second Edition

 A diverticulum is an outpouching of mucosa and

 Diverticula may occur in one of the three areas of the

Gerontological Nursing, Second Edition

 The most common type of diverticulum, which is found

S/S: difficulty swallowing, fullness in the neck, belching,

Gerontological Nursing, Second Edition

Gerontological Nursing, Second Edition

 The only means of cure is surgical removal of the

 During surgery, care is taken to avoid trauma to the

 In addition to a diverticulectomy, a myotomy of the

Gerontological Nursing, Second Edition

 Postoperatively, the patient may have a nasogastric tube

Gerontological Nursing, Second Edition

 Smeltzer. S. C., Bare. B.G., Hinkle. J. L & Cheever. K.

Gerontological Nursing, Second Edition

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