GERD Flashcards

1
Q

GERD

A

Common problem
Chronic manifestation of mucosal damage
Caused by reflux of gastric contents into lower esophagus
Not a disease, but a syndrome

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2
Q

Etiology and Patho

A

No one single cause
Results when:
-Defenses of lower esophagus are overwhelmed by reflux of gastric contents into esophagus
Reflux of HCl acid and pepsin secretions cause irritation and inflammation
Intestinal proteolytic enzymes and bile salts add to irritation

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3
Q

Predisposing factors

A
Hiatal hernia
Incompetent lower esophageal sphincter (LES)
-Antireflux barrier
Decreased esophageal clearance
Decreased gastric emptying
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4
Q

Incompetent LES

A

Primary factor in GERD
Results in decreased pressure in distal portion of esophagus
-Gastric contents move from stomach to esophagus
-can be due to certain drugs and foods

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5
Q

Risk factors

A

Obesity
Pregnant women
Cigarette and cigar smoking
Hiatal hernia

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6
Q

Heartburn (pyrosis)

A

Most common clinical manifestation
Burning, tight sensation felt beneath the lower sternum and spreading upward to throat or jaw
Felt intermittently

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7
Q

Dyspepsia

A

Pain or discomfort centered in upper abdomen

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8
Q

Regurgitation

A

Described as hot, bitter, or sour liquid coming into throat or mouth
Hypersalivation may also be reported

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9
Q

Most individuals have mild symptoms like

A

Heartburn after a meal
Occurs once a week
No evidence of mucosal damage

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10
Q

Healthcare provider should evalauate

A

Heartburn occurring more than once a week, rated as severe, or occurring at night and waking patient
Older adults w/ recent onset of heartburn

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11
Q

Heartburn occurs

A

Following ingestion of food or drugs that decrease LES pressure
Directly irritates esophageal mucosa

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12
Q

Potential respiratory symptoms

A

Wheezing
Coughing
Dyspnea
Nocturnal coughing w/ loss of sleep

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13
Q

Otolaryngologic symptoms include

A

Hoarseness
Sore throat
Lump in threat
Choking

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14
Q

Chest pain

A

Described as burning, squeezing, or radiating to back, neck, jaw, or arms
Can mimic angina
More common in older adults
Relieved w/ antacids

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15
Q

Esophagitis

A

*
*Related to direct local effects of gastric acid on esophageal mucosa
Inflammation of esophagus
Frequent complication
Repeated exposure: esophageal stricture (resulting in dysphagia)

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16
Q

Barrett’s esophagus (esophageal metaplasia)

A

Replacement of normal squamous epithelium w/ columnar epithelium
Precancerous lesion
Thought to be primarily due GERD
Diagnosed in 5%-15% of patients w/ chronic reflux
S/Sx: none to perforation
Must be monitored every 2-3 years by endoscopy

17
Q

Respiratory Complications

A

Due to irritation of upper airway by secretions
-Cough
-Bronchospasm
-Laryngospasm
-Cricopharyngeal spasm
Potential for asthma, bronchitis, and pneumonia

18
Q

Dental erosion complications

A

From acid reflux into mouth

Especially posterior teeth

19
Q

Diagnostic studies

A

History and physical exam
Barium swallow (can detect protrusion of gastric fundus)
Upper GI endoscopy (useful in assessing LES competence, degree of inflammation, scarring, strictures)
Biopsy and cytologic specimens (differentiate cancer from Barrett’s esophagus)
Esophageal manometric (motility) studies (measure pressure in esophagus and LES)

20
Q

Radionuclide Tests (diagnostic study)

A

Detect reflux of gastric contents

Demonstrate rate of esophageal clearance

21
Q

Monitoring pH

A

Laboratory or 24-hr ambulatory
Determine esophageal pH by using specially designed probes
4-5 region in stomach. Should be more basic than acidic

22
Q

Lifestyle modifications

A

Avoid triggers

23
Q

Nutritional therapy

A

Decrease high-fat foods
Take fluids between rather than with meals
Avoid milk products at night
Avoid late-night snacking or meals
Avoid chocolate, peppermint, caffeine, tomato products, orange juice
Weight reduction therapy
Chewing gum and oral lozenges can increase saliva production and help patients w/ mild symptoms

24
Q

Proton Pump Inhibitors (PPI)

A

Drug therapy
Promotes esophageal healing in 80%-90% f patients
Decrease incidence of esophageal strictures
Headache is most common side effect
Omeprazole
Long-term use or high doses of PPIs may increase the risk of fractures of hip, wrist, and spine
Associated w/ increased risk of C. difficile infection in hospitalized patients

25
Histamine-2 receptor (H2R) blockers
``` Drug therapy Decrease secretion of HCl acid Reduce symptoms and promote esophageal healing in 50% of patients Cimetidine Side effects are uncommon ```
26
Acid protective
Drug therapy Used for cytoprotective properties Sucralfate
27
Cholinergic
``` Drug therapy Increase LES pressure Improve esophageal emptying Increase gastric emptying Bethanechol ```
28
Prokinetic drugs
Drug therapy Promote gastric emptying Reduce risk of gastric acid reflux Meoclopramide
29
Antacids
``` Drug therapy Quick but short-lived relief Neutralize HCl acid Taken 1-3 hrs after meals/at bedtime Maalox, Mylanta ```
30
Surgical therapies when necessary
``` Failure of conservative therapy Medication intolerance Barrett's metaplasia Esophageal stricture and stenosis Chronic esophagitis *Nissen and Toupet fundoplications ```
31
LINX Reflux Management System
Titanium beads w/ magnetic core strung together and implanted laparoscopically into LES Under resting, nonswallowing conditions, the ring tightens When individual swallows, the ring opens
32
Endoscopic therapy
Endoscopic mucosal resection Photodynamic therapy Cryotherapy Radiofrequency ablation
33
Nursing Management
``` Elevation of head of bed 30 degrees Not lying down for 2-3 hrs after eating Avoidance of late-night eating Evaluating effectiveness of medications Observing for side effects of medications Stress reduction techniques Weight reduction, if appropriate Small, frequent meals ```
34
Avoidance of factors that cause reflux
Stop smoking Avoid alcohol and caffeine Avoid acidic foods
35
Focusing Postoperative Care
Prevention of respiratory complications Maintenance of fluid/electrolyte balance Prevention of infection
36
Respiratory assessment postoperative care
``` Respiratory rate/rhythm Pulse rate/rhythm Signs of pneumothorax -dyspnea -chest pain -cyanosis ```
37
Postoperative care
Deep breathing techniques Accurate I/O Observing for fluid/electrolyte imbalance Pain medication Medications to prevent N/V When peristalsis returns, only fluids given initially Solids added gradually Normal diet gradually resumed Pt must avoid gas-forming foods and must chew foods thoroughly First month after surgery, pt may report mild dysphagia; should resolve after edema subsides Pt should report persistent symptoms such as heartburn and regurgitation