Care of Patient with Esophageal Problems Flashcards
GERD is the most common upper GI disorder in the US
Occurs most often in middle-aged and older adults but can affect people of any age
Gastroesophageal reflux (GER) occurs as a result of backward flow of stomach contents into the esophagus - causes pain and burning sensation
Most common cause of GERD is excessive relaxation of the lower esophageal sphincter (LES)
Risk Factors:
Pathophysiology/can result in
Gastroesophageal reflux disease (GERD)
GERD arises from persistent GERD
Gastroesophageal reflux (GER) occurs as a result of backward flow of stomach contents into the esophagus - causes pain and burning sensation - Gastroesophageal reflux disease (GERD)
Allows reflux of gastric contents into the esophagus and exposure of the esophageal mucosa to acidic gastric contents
Most common cause of GERD is excessive relaxation of the lower esophageal sphincter (LES) - Gastroesophageal reflux disease (GERD)
Overweight or obese patients are at highest risk
Hiatal hernias
Helicobacter pylori may contribute to reflux by causing gastritis and poor gastric emptying
Gastric distension
Risk Factors: - Gastroesophageal reflux disease (GERD)
Hyperemia (increased blood flow) and erosion (ulceration) occur in the esophagus secondary to the chronic inflammation
Minor capillary bleeding may occur
Fibrosis and scarring can produce esophageal strictures (narrowing of the esophageal opening)
Pathophysiology/can result in - Gastroesophageal reflux disease (GERD)
Caffeinated beverages, such as coffee, tea, and cola
Chocolate
Citrus fruits
Tomatoes and tomato products
Smoking and use of other tobacco products
Calcium channel blockers
Nitrates
Peppermint, spearmint
Alcohol
Anticholinergic drugs
High levels of estrogen and progesterone
Nasogastric tube placement
Factors that contribute to decreases les (lower esophageal sphincter) pressure
Dyspepsia (indigestion)
Regurgitation (may lead to aspiration or bronchitis)
Coughing, hoarseness, or wheezing at night
Water brash (hypersalivation)
Dysphagia
Odynophagia (painful swallowing)
Epigastric pain
Generalized abdominal pain
Belching
Flatulence
Nausea
Pyrosis (heartburn)
Globus (feeling of something in back of throat)
Pharyngitis
Dental caries (severe cases)
GERD key features
Definitive diagnostic test does not exist
Barium swallow:
Upper endoscopy/EGD:
pH monitoring examination:
GERD diagnostic assessment
Can not confirm GERD, but can be helpful when used in combination with other diagnostic procedures
Look for abnormalities
Barium swallow: - GERD diagnostic assessment
Look for abnormalities; biopsy can be taken; requires moderate sedation
Upper endoscopy/EGD: - GERD diagnostic assessment
Most accurate method of diagnosing GERD
pH monitoring examination:- GERD diagnostic assessment
Relieve symptoms
Treat esophagitis
Prevent complications such as strictures or Barrett’s esophagus
GERD purpose of treatment
Ulceration of the lower esophagus
Caused by exposure to acid and pepsin
Change in mucosa secondary to tissue injury
Considered premalignant and indicates an increased risk for cancer
Prevent complications such as strictures or Barrett’s esophagus: Barrett’s esophagus - GERD purpose of treatment
For most patients, GERD can be controlled by nutrition therapy, lifestyle changes, and drug therapy
Nutrition therapy:
Lifestyle changes
Drug therapy
Endoscopic: - less invasive than surgical
Surgery:
GERD interventions
Limit or eliminate foods that decrease LES pressure and that irritate inflamed tissue
Peppermint
Chocolate
Alcohol
Fatty foods (especially fried)
Caffeine
Carbonated beverages
Restrict spicy and acidic foods
Nutrition therapy: - GERD interventions
Eat 4-6 small meals a day
Limit or eliminate alcohol and tobacco
Do not snack in the evening, and do not eat 2-3 hours before going to bed
Eat slowly and chew food thoroughly
Remain upright for 1-2 hours after meals
Elevate the HOB by 6 to 12 inches or elevate your head
If you are overweight, lose weight
Do not wear constrictive clothing
Avoid heavy lifting, straining, and working in a bent-over position
Antacids followed with a glass of water
Decrease stress
Lifestyle changes - GERD interventions
Primary purposes:
Prokinetic drugs (metoclopramide-Reglan)
Proton pump inhibitors (omeprazole - Prilosec, pantoprazole – Protonix)
Drug therapy - GERD interventions
Inhibit gastric acid secretion
Accelerate gastric emptying
Protect the gastric mucosa
H2-receptor antagonists (famotidine - Pepcid, nizatidine - Axid) - histamine blockers
Antacids (Maalox, Mylanta)
Primary purposes:
Blocks gastric secretions
Long acting-less frequent dosing
Less side effects
H2-receptor antagonists (famotidine - Pepcid, nizatidine - Axid) - histamine blockers
Buffering agent
Increases LES pressure
Buffer acid in stomach
Protect gastric mucosa
Given for occasional episodes not long term use
Antacids (Maalox, Mylanta)
Increases gastric emptying
Moves things through GI tract faster
Take before meals
Prokinetic drugs (metoclopramide-Reglan)
Primary treatment for severe GERD
Suppress gastric acid secretion
Long acting-usually given once a day but can be increased to twice a day
Can interfere with calcium absorption and protein digestion
Reduces available calcium in bone
Proton pump inhibitors (omeprazole - Prilosec, pantoprazole – Protonix)
Stretta procedure
Gastroplication procedure
Endoscopic: - less invasive than surgical - GERD interventions
Radiofrequency energy decreases vagus nerve activity and decreases discomfort
Stretta procedure
Tighten LES through endoscope
Gastroplication procedure
Laparoscopic Nissen fundoplication (LNF)
Minimally invasive surgery
Surgical reinforcement of the LES to ensure stays closed
Surgery:
Protrusion of the stomach through the esophagus hiatus of the diaphragm into the chest
Asymptomatic or symptoms similar to those with GERD
Two types of hernias
Diagnostic testing
Hiatal hernia
Esophageal hiatus is the opening in the diaphragm through which the esophagus passes from the thorax to the abdomen
Protrusion of the stomach through the esophagus hiatus of the diaphragm into the chest - Hiatal hernia
Sliding type:
Large rolling type:
Two types of hernias - Hiatal hernia
Most common and treated medically
Moves up and down through hiatus
Sim symp to those with GERD
Sliding type:
Can become strangulated or obstructed
Early surgical repair is preferred
More serious
Herniated portion on top of diaphragm
Large rolling type:
Barium swallow study with fluoroscopy is the most specific diagnostic test and common - see where have abnormalities
EGD may be performed to visualize sliding hernias
Diagnostic testing - Hiatal hernia
See intervention for GERD - lifestyle and diet changes
Nutrition therapy:
Lifestyle changes
Provider typically prescribes antacids and a PPI
Hiatal hernia interventions - Nonsurgical:
Limit or eliminate foods that decrease LES pressure and that irritate inflamed tissue
Peppermint
Chocolate
Alcohol
Fatty foods (especially fried)
Caffeine
Carbonated beverages
Restrict spicy and acidic foods
Nutrition therapy:
Eat 4-6 small meals a day
Limit or eliminate alcohol and tobacco
Do not snack in the evening, and do not eat 2-3 hours before going to bed
Eat slowly and chew food thoroughly
Remain upright for 1-2 hours after meals
Elevate the HOB by 6 to 12 inches or elevate your head
If you are overweight, lose weight
Do not wear constrictive clothing
Avoid heavy lifting, straining, and working in a bent-over position
Antacids followed with a glass of water
Decrease stress
Lifestyle changes
Antacids (Maalox, Mylanta)
Proton pump inhibitors (omeprazole - Prilosec, pantoprazole – Protonix)
Provider typically prescribes antacids and a PPI
Buffering agent
Increases LES pressure
Protect gastric mucosa
Given for occasional episodes not long term use
Antacids (Maalox, Mylanta)
Primary treatment for severe GERD
Suppress gastric acid secretion
Long acting-usually given once a day but can be increased to twice a day
Can interfere with calcium absorption and protein digestion
Reduces available calcium in bone
Proton pump inhibitors (omeprazole - Prilosec, pantoprazole – Protonix)
Laparoscopic nissen fundoplication (LNF)
Open fundoplication - same as laparoscopic but just open = help reinforce LES to help keep hernia down with part of stomach
Paraesophageal repair (laparoscopic surgery)
Surgical
Mesh to keep hernia from going up
Patients having surgery are at risk for bleeding or infection
Complications related to fundoplication procedures: temporary dysphagia, gas bloat syndrome, atelectasis, pneumonia, obstructed nasogastric tube
Postoperative care: IS, deep breathing, pain control, nasogastric care, assess hydration, accurate I/O; NG tube - care with this; issues with swallowing
Paraesophageal repair (laparoscopic surgery)
Diet:
Remain on anti-reflux medications as prescribed for at least a month
Do not drive for at least a week; longer if taking opioid medications
Walk every day, but no heavy lifting
Remove small dressings 2 days after surgery, shower; do not remove Steri-Strips until 10 days after surgery
Wash incisions with soap and water, rinse well, pat dry, report any redness or drainage
Reportable symptoms:
Laparoscopic nissen fundoplication post op instructions
Soft diet for a week - not eat hard foods that move through esophagus
Avoid carbonated beverages, tough foods, raw vegetables
Diet:
Fever above 101
N/V - indic something wrong where surgery done
Uncontrollable bloating or pain - indic something wrong where surgery done
Reportable symptoms:
