GERD Flashcards
Functions of the Digestive System
- ingestion
- mechanical processing
- digestion
- secretion
- absorption
- excretion
Stomach
- 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
Alteration in Gastric Digestion
- GERD (Gastroesophageal Reflux Dz)
- Hiatal Hernia
- PUD (Peptic Ulcer Dz)
- Gastic Cancer
GERD
- caused by gastric acid flowing upward into the esophagus
- incompetent lower esophageal sphincter
- acid becomes an irritant destroying esophageal lining
Degree of Reaction
-Heartburn
- most common symptom
- burning chest pain behind breast bone
- moves upward toward throat
- worse after eating, lying down, or bending down
Lifestyle Variables
- relaxed lower esophageal sphincter (LES)
- overweight
- overeating
- caffeine/alcohol
- smoking
- gastritis
- ulcer dz
- stress
- NSAIDs
- Certain foods (citrus, peppermint, chocolate, fatty and spicy food)
Upper GI Series
- Diagnosis
- Barium swallow
- ingestion of barium followed by xrays
EGD
Esophagogastroduodenoscopy
- endoscope used
- direct visualization
- can perform biopsy
- oral anesthetic
- observe for return of gag reflex
Esophageal Manometry
- determine the strength of the muscles in the esophagus
- small nasal tube
PH monitoring
- small nasal tube
- rest above LES
- last 12-24 hrs
Bernstein Test
-mild acid placed in the esophagus
GERD Tx determined by:
- 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
GERD Tx
- 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)
Stretta Procedure
- done on the LES
- use of radiofrequency
- tiny cuts leading to scar tissue
Antacids
- Sodium bicarb
- calcium carbonate
- aluminum hydroxide
- magnesium hydroxide
- neutralize stomach acid
- OTC
- tablet or liquid forms
- fast pain relief
H2-Receptor Blockers
- Zantac/ranitidine
- Pepcid/famotidine
- Tagment/cimetidine
- Axid/nizatidine
- OTC or by Rx
- Blocks histamine
- reduces acid and pain
Proton Pump Inhibitors
- 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
Prokinetic Agents
-Reglan/metoclopramide
- Assists the stomach to empty more rapidly
- May help tighten the LES
- Rx
Antispasmotics
- Bentyl, Dibent/dicyclomine
- Levsin, Cystospaz/ hyoscyamine
- relaxes smooth muscles of intestine
- works to decrease digestion
- Rx
Cytoprotective Agents
- 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
GERD Complications
- Esophagitis
- Esophageal stricture
- Barrett’s Esophagus (considered precancerous)
- Hiatal Hernia
GERD Patient Teaching
- 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
Sliding Hiatal Hernia
stomach moves back and forth through hiatus of the diaphragm
Paraesophageal Hiatal hernia
AKA Rolling
-greater curvature of the stomach move above diaphragm forming a pocket
Primary Prevention of Hiatal Hernia
-unknown
Hiatal Hernia
A condition in which part of the stomach pushes up through the diaphragm muscle.
Hiatal Hernia Risk Factors
- weakening of diaphragm muscles
- increased intra-abdominal pressure
- increased age
- trauma
- poor nutrition
- forced recumbent positioning
- congenital
- obesity
- large meals
- alcohol
- smoking
Hiatal Hernia Degree of Rxn
- may be asymptomatic
- heartburn
- nocturnal heartburn
- dysphagia
- mimics gallbladder dz
Complications of Hiatal Hernia
- GERD
- Hemorrhage
- Esophageal stenosis
- Ulceration
- Strangulation
- Regurgitation with aspiration
How to Diagnose Hiatal Hernia
- EGD
- Barium Swallowing
Hiatal Hernia Secondary Prevention
-conservative therapy: lifestyle modifications and meds
surgical therapy: Nissen fundoplication
Nissen Fundoplication
sometimes known as laparoscopic fundoplication when performed via laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia.
PUD
Peptic Ulcer Dz
- erosion of the GI mucosa from the action of HCL and pepsin
- Includes gastric and duodenal ulcers
Phases of PUD
- Erosion
- Acute Ulcer
- Perforated Ulcer
Helicobacter Pylori
- 80 to 90 percent of all ulcers
- bacterium infection
- weakens the stomach’s protective mucus
PUD Manifestations
- heartburn
- gnawing/burning pain
- acid, bitter, slimy taste in mouth
- belching/indigestion
- N/V
- Weight loss and poor appetite
- Feeling tired and weak
PUD Complications
-all are emergencies
-hemorrhage most common
-Perforation most lethal
Gastric outlet obstruction
Hemorrhage from PUD
- most common
- black, tarry stools (MELENA)
- Occult blood
- Emesis (coffee ground or fresh)
Perforation from PUD
- 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)
Gastric Outlet Obstruction from PUD
-narrowing of pylorus: scar tissue, pylorospasm, edema/inflammation
- vomiting projectile
- contains food particles
- offensive odor
PUD Secondary Prevention
- endoscopy: direct visualization
- H. pylori testing: sputum, urine, blood, tissue, breath, urea breath shows active infection
- occult blood
Lifestyle Modifications for PUD
- 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)
Carafate
Sucralfate
- slurry
- give on empty stomach 1 hour before meals and bedtime
Pepto-Bismol
- promotes healing
- partially effective against H. Pylori
- may blacken stools
Cytotec
Misoprostol
- for pts taking ASA or NSAIDs
- prevents gastric ulcers induced by the above
Surgical therapy
- 20% of ulcer patients
- indications: obstruction, perforation, hemorrhage, ulcers unresponsive to tx, multiple ulcer sites, possible malignancy
Gastrojejunostomy
- for gastric outlet obstruction
- food bypasses the obstruction
Vagotomy
- truncal (total)
- selective
- reduces acid
- reduces gastric motility
- often combined with Billroth 1 and 2
Pyloroplasty
- surgical enlargement
- aids gastric emptying
- can do balloon angioplasty
Dumping syndrome
- post op complication
- result of large portion of stomach and pyloric sphincter removal
Postprandial Hypoglycemia
- form of dumping syndrome
- large bolus of carbs dumps into small intestine resulting in decreased BS
Bile Reflux Gastritis
related to sx on pyloric sphincter
Pre-op Teaching
- NPO
- procedure teaching
- C and DB, IS, incisional splinting
- IV therapy
- NG tube
- pain relief
- answer all questions
Post-op Patient Care
- promote comfort
- promote effective airway management and gas exchange
- monitor I and Os
Monitoring I and O’s
- 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
