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MS2 Exam 3 > GERD > Flashcards

GERD Flashcards

1
Q

Functions of the Digestive System

A
  • ingestion
  • mechanical processing
  • digestion
  • secretion
  • absorption
  • excretion
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2
Q

Stomach

A
  • holding tank for food
  • food is exposed to stomach acids and digestive effects of pepsin
  • saturates food with gastric juices
  • excretes HCL
  • Ph 2.0
  • Absorbs H2O, alcohol, sugars, salt, electrolytes, and some drugs
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3
Q

Alteration in Gastric Digestion

A
  • GERD (Gastroesophageal Reflux Dz)
  • Hiatal Hernia
  • PUD (Peptic Ulcer Dz)
  • Gastic Cancer
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4
Q

GERD

A
  • caused by gastric acid flowing upward into the esophagus
  • incompetent lower esophageal sphincter
  • acid becomes an irritant destroying esophageal lining
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5
Q

Degree of Reaction

A

-Heartburn

  • most common symptom
  • burning chest pain behind breast bone
  • moves upward toward throat
  • worse after eating, lying down, or bending down
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6
Q

Lifestyle Variables

A
  • relaxed lower esophageal sphincter (LES)
  • overweight
  • overeating
  • caffeine/alcohol
  • smoking
  • gastritis
  • ulcer dz
  • stress
  • NSAIDs
  • Certain foods (citrus, peppermint, chocolate, fatty and spicy food)
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7
Q

Upper GI Series

A
  • Diagnosis
  • Barium swallow
  • ingestion of barium followed by xrays
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8
Q

EGD

A

Esophagogastroduodenoscopy

  • endoscope used
  • direct visualization
  • can perform biopsy
  • oral anesthetic
  • observe for return of gag reflex
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9
Q

Esophageal Manometry

A
  • determine the strength of the muscles in the esophagus

- small nasal tube

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10
Q

PH monitoring

A
  • small nasal tube
  • rest above LES
  • last 12-24 hrs
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11
Q

Bernstein Test

A

-mild acid placed in the esophagus

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12
Q

GERD Tx determined by:

A
  • age, overall health and medical hx
  • extent of condition
  • tolerance to specific meds, procedures, and therapies
  • expectation for the course of the condition
  • patient opinion or preference
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13
Q

GERD Tx

A
  • diet and lifestyle changes
  • meds
  • quit smoking
  • observe food intake and food types
  • eat smaller portions
  • avoid overeating
  • watch alcohol consumption
  • do not lie down or go to bed right after eating
  • decrease fluid intake
  • Lie on left side, elevate HOB 30 degrees
  • Lose excess weight
  • Surgical correction (Nissen fundoplication)
  • Non-surgical correction (Stretta Procedure)
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14
Q

Stretta Procedure

A
  • done on the LES
  • use of radiofrequency
  • tiny cuts leading to scar tissue
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15
Q

Antacids

A
  • Sodium bicarb
  • calcium carbonate
  • aluminum hydroxide
  • magnesium hydroxide
  • neutralize stomach acid
  • OTC
  • tablet or liquid forms
  • fast pain relief
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16
Q

H2-Receptor Blockers

A
  • Zantac/ranitidine
  • Pepcid/famotidine
  • Tagment/cimetidine
  • Axid/nizatidine
  • OTC or by Rx
  • Blocks histamine
  • reduces acid and pain
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17
Q

Proton Pump Inhibitors

A
  • Prevacid (lansoprazole)
  • Aciphex (rabeprazole)
  • Prilocec (omeprazole)
  • Protonix (pantoprazole)
  • Nexium (esomeprazole)
  • blocks the enzyme in the stomach that produces acid
  • promotes healing of the stomach and esophagus
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18
Q

Prokinetic Agents

A

-Reglan/metoclopramide

  • Assists the stomach to empty more rapidly
  • May help tighten the LES
  • Rx
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19
Q

Antispasmotics

A
  • Bentyl, Dibent/dicyclomine
  • Levsin, Cystospaz/ hyoscyamine
  • relaxes smooth muscles of intestine
  • works to decrease digestion
  • Rx
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20
Q

Cytoprotective Agents

A
  • Prescription only: Carafate/sucralfate, cytotex/misoprostol
  • OTC (Pepto)
  • Protects lining of stomach and intestine
  • Does not decrease the amount of acid
  • Used to prevent ulcer formation
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21
Q

GERD Complications

A
  • Esophagitis
  • Esophageal stricture
  • Barrett’s Esophagus (considered precancerous)
  • Hiatal Hernia
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22
Q

GERD Patient Teaching

A
  • foods
  • smoking cessation
  • stress avoidance
  • medications and S/E
  • Importance of following medical regime
  • S/S to report to physician
  • Possible pre and post op care
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23
Q

Sliding Hiatal Hernia

A

stomach moves back and forth through hiatus of the diaphragm

24
Q

Paraesophageal Hiatal hernia

A

AKA Rolling

-greater curvature of the stomach move above diaphragm forming a pocket

25
Q

Primary Prevention of Hiatal Hernia

A

-unknown

26
Q

Hiatal Hernia

A

A condition in which part of the stomach pushes up through the diaphragm muscle.

27
Q

Hiatal Hernia Risk Factors

A
  • weakening of diaphragm muscles
  • increased intra-abdominal pressure
  • increased age
  • trauma
  • poor nutrition
  • forced recumbent positioning
  • congenital
  • obesity
  • large meals
  • alcohol
  • smoking
28
Q

Hiatal Hernia Degree of Rxn

A
  • may be asymptomatic
  • heartburn
  • nocturnal heartburn
  • dysphagia
  • mimics gallbladder dz
29
Q

Complications of Hiatal Hernia

A
  • GERD
  • Hemorrhage
  • Esophageal stenosis
  • Ulceration
  • Strangulation
  • Regurgitation with aspiration
30
Q

How to Diagnose Hiatal Hernia

A
  • EGD

- Barium Swallowing

31
Q

Hiatal Hernia Secondary Prevention

A

-conservative therapy: lifestyle modifications and meds

surgical therapy: Nissen fundoplication

32
Q

Nissen Fundoplication

A

sometimes known as laparoscopic fundoplication when performed via laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia.

33
Q

PUD

A

Peptic Ulcer Dz

  • erosion of the GI mucosa from the action of HCL and pepsin
  • Includes gastric and duodenal ulcers
34
Q

Phases of PUD

A
  • Erosion
  • Acute Ulcer
  • Perforated Ulcer
35
Q

Helicobacter Pylori

A
  • 80 to 90 percent of all ulcers
  • bacterium infection
  • weakens the stomach’s protective mucus
36
Q

PUD Manifestations

A
  • heartburn
  • gnawing/burning pain
  • acid, bitter, slimy taste in mouth
  • belching/indigestion
  • N/V
  • Weight loss and poor appetite
  • Feeling tired and weak
37
Q

PUD Complications

A

-all are emergencies
-hemorrhage most common
-Perforation most lethal
Gastric outlet obstruction

38
Q

Hemorrhage from PUD

A
  • most common
  • black, tarry stools (MELENA)
  • Occult blood
  • Emesis (coffee ground or fresh)
39
Q

Perforation from PUD

A
  • most lethal complication
  • requires sx
  • causes peritonitis
  • S/S onset sudden and dramatic (abdomen pain, muscles contract and board-like, RR shallow and rapid, absent bowel sounds)
40
Q

Gastric Outlet Obstruction from PUD

A

-narrowing of pylorus: scar tissue, pylorospasm, edema/inflammation

  • vomiting projectile
  • contains food particles
  • offensive odor
41
Q

PUD Secondary Prevention

A
  • endoscopy: direct visualization
  • H. pylori testing: sputum, urine, blood, tissue, breath, urea breath shows active infection
  • occult blood
42
Q

Lifestyle Modifications for PUD

A
  • bland diet and 6 small meals per day
  • protein neutralizes but stimulates gastric secretions
  • adequate physical/emotional rest
  • stop ASA and NSAIDs
  • Strict adherence to prescribed meds
  • Antibiotic therapy for H. Pylori (maybe two or more ABs)
43
Q

Carafate

A

Sucralfate

  • slurry
  • give on empty stomach 1 hour before meals and bedtime
44
Q

Pepto-Bismol

A
  • promotes healing
  • partially effective against H. Pylori
  • may blacken stools
45
Q

Cytotec

A

Misoprostol

  • for pts taking ASA or NSAIDs
  • prevents gastric ulcers induced by the above
46
Q

Surgical therapy

A
  • 20% of ulcer patients
  • indications: obstruction, perforation, hemorrhage, ulcers unresponsive to tx, multiple ulcer sites, possible malignancy
47
Q

Gastrojejunostomy

A
  • for gastric outlet obstruction

- food bypasses the obstruction

48
Q

Vagotomy

A
  • truncal (total)
  • selective
  • reduces acid
  • reduces gastric motility
  • often combined with Billroth 1 and 2
49
Q

Pyloroplasty

A
  • surgical enlargement
  • aids gastric emptying
  • can do balloon angioplasty
50
Q

Dumping syndrome

A
  • post op complication

- result of large portion of stomach and pyloric sphincter removal

51
Q

Postprandial Hypoglycemia

A
  • form of dumping syndrome

- large bolus of carbs dumps into small intestine resulting in decreased BS

52
Q

Bile Reflux Gastritis

A

related to sx on pyloric sphincter

53
Q

Pre-op Teaching

A
  • NPO
  • procedure teaching
  • C and DB, IS, incisional splinting
  • IV therapy
  • NG tube
  • pain relief
  • answer all questions
54
Q

Post-op Patient Care

A
  • promote comfort
  • promote effective airway management and gas exchange
  • monitor I and Os
55
Q

Monitoring I and O’s

A
  • NG drainage: amount, color, odor
  • bright red in beginning, then coffee-ground
  • becomes yellow-green after 36-48 hrs
  • do not irrigate or reposition
  • abdominal dressing
  • always at risk for ulcer redevelopment
  • adequate rest, nutrition with avoidance of stressors
  • emphasize avoidance of meds not prescribed MD, alcohol and smoking

MS2 Exam 3 (13 decks)

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