GERD Flashcards

1
Q

What is gastroesophageal reflux?

A

Backward flow of gastric contents into esophagus causing heartburn

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2
Q

What is a sign of poor digestion?

A

GERD

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3
Q

What percentage of adults does GERD affect?

A

15-20%

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4
Q

Is GERD always symptomatic?

A

NO. Sometimes it is asymptomatic, or “silent pain”

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5
Q

What muscle at the top of the stomach is affected by GERD?

A

The sphincter muscle

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6
Q

True or false.

GERD increases with age.

A

True

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7
Q

What kind of cancer could GERD lead to?

A

Esophageal cancer.

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8
Q

What 3 things help maintain pressure differences between stomach and esophagus?

A
  • diaphragm
  • lower esophageal sphincter
  • the location of gastroesophageal junction
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9
Q

What two organs help prevent back flow?

A

The diaphragm and sphincter.

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10
Q

What are the contributing factors to increased pressure in the stomach?

A
  • increased gastric volume
  • certain body positions
  • pressure from obesity or tight clothing
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11
Q

What happens to the lower esophageal sphincter to cause GERD?

A

Transient relaxation and incompetency.

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12
Q

What are the risk factors for GERD?

A

Obesity, older age, Excessive alcohol, smoking, hiatal hernia (stomach hernia), diabetes, pregnancy, Diet: fatty/fried foods, chocolate, caffeine, citrus, peppermint, spicy foods

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13
Q

What are clinical manifestations of GERD in adults?

A
  • heartburn after eating, bending over, reclining
  • cough
  • flatulence
  • excessive belching
  • hoarseness
  • pain in swallowing, throwing up in mouth, atypical chest pain
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14
Q

What are the clinical manifestations of GERD in infants?

A
  • spitting up

- forceful vomiting

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15
Q

True and false.

GERD is fairly common in infants.

A

True.

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16
Q

What are the clinical manifestations of GERD in children?

A

Poor weight gain, recurrent vomiting, irritability, poor eating, arching of the back (b/c of abdominal pain), sore throat, asthma, respiratory involvement

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17
Q

What are the complications of GERD?

A
  • Erosive esophagitis
  • esophageal strictures ( build- up of scar tissue)(may lead to dysphagia)
  • Barrett’s esophagitis
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18
Q

Explain Barrett’s esophagitis.

A

Erosion of the esophageal lining.

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19
Q

What is erosive esophagitis?

A

Inflammation that damages the tube running from the throat to the stomach.

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20
Q

Explain esophageal strictures.

A

Narrowing of the esophagus due to inflammation from damage and scar tissue.

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21
Q

What are some ways to prevent GERD?

A
  • eat smaller, more frequent meals
  • no acid-producing foods
  • no bed time eating
  • elevate HOB to reduce lower esophageal sphincter pressure
  • no tight fitting clothes
  • no smoking or alcohol
  • maintain healthy body weight
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22
Q

What is a barium swallow test?

A

Swallowing barium sulfate which is a metallic compound that shows up on x-rays and helps view abnormalities in esophagus and stomach.

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23
Q

What is a EGD?

A

Esophagogastroduodenoscopy or Upper Endoscopy

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24
Q

What are the diagnostic tests for GERD?

A
  • barium swallow
  • upper endoscopy or ECG
  • Bernstein test
  • 24-hr ambulatory ph monitoring
  • esophageal manometry
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25
Q

What is the Bernstein test?

A

NG tube placed into the esophagus, lightly acidic substance is added, if it burns then you know there is erosion.

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26
Q

Explain the 24-hr ambulatory pH monitoring test.

A

PH monitors placed down nose measuring pH levels of esophagus.

27
Q

Explain Esophageal manometry.

A

Measures the swallowing pressure.

28
Q

What are the types of pharmacological therapy used for GERD?

A

Antacids, H2 receptor blockers, Proton pump inhibitors, pro-motility agents.

29
Q

What do you take for mild to moderate symptoms of GERD?

A

Antacids: sodium bicarbonate

30
Q

Name one H2 receptor blocker.

A

Famotidine.

31
Q

What is the proton pump inhibitor that is used for severe GERD?

A

Omeprazole.

32
Q

What pro-motility agents is used for GERD?

A

Metoclopramide.

33
Q

In addition to GERD what is metoclopramide given for?

A

Nausea. (It promotes emptying of the stomach)

34
Q

What letters to H2 receptor blockers end with?

A

“idine”

35
Q

What letters do PPI’s end with?

A

“Prazole”

36
Q

What is the prototype antacid drug?

A

Sodium bicarbonate.

37
Q

What is the MOA of sodium bicarbonate?

A

Neutralizes stomach acid by raising pH of stomach contents.

38
Q

What is the primary use of sodium bicarbonate?

A

Relief of upset stomach(hyperacidity)

39
Q

What are the AE of sodium bicarbonate?

A

Metabolic alkalosis(“ANT-acid”), constipation or diarrhea

40
Q

When is sodium bicarbonate given IV?

A

During a code.

41
Q

How long is the onset of sodium bicarbonate?

A

Rapid: 30 minutes

42
Q

Should you use antacids consistently?

A

No. You could be masking underlying symptoms.

43
Q

What is the prototype drug of H2 receptor blockers?

A

Famotidine (Pepcid)

44
Q

What is the MOA of famotidine?

A

It blocks H2-receptors in stomach to decrease acid production.

45
Q

What is the primary use of famotidine?

A

To treat peptic ulcer disease, GERD

46
Q

What are the pharmacokinetics of famotidine?

A

Liver and kidney

47
Q

What are the AE of famotidine?

A

Dizziness, confusion, thrombocytopenia, increases BUN/creatinine

48
Q

What is the PPI prototype drug?

A

Omeprazole (Prilosec)

49
Q

What is the MOA of Omeprazole?

A

Reduces acid secretion in stomach by binding irreversibly to enzyme h1, k1-ATPase

50
Q

What is the primary use of omeprazole?

A

Therapy for peptic ulcers and GERD (2-6 months)

51
Q

What are the AE of omeprazole?

A

Headache, nausea, diarrhea, rash, abdominal pain

52
Q

What is long-term use of omeprazole is associated with?

A

Increased risk of gastric cancer and hip fractures

53
Q

Do infants outgrow GERD?

A

Infants may outgrow GERD.

54
Q

What are the pediatric manifestations of GERD?

A

Coughing, difficulty swallowing, asthma symptoms, periods of apnea and frequent upper respiratory infections.

55
Q

What is often chronic in adults?

A

GERD

56
Q

What kind of changes help reduce symptoms and long-term effects?

A

Dietary and lifestyle.

57
Q

When is surgery necessary for GERD?

A

When clients are unresponsive to pharmacologic, lifestyle interventions.

58
Q

What is a laparoscopic fundoplication?

A

The treatment of choice for GERD.

59
Q

What is Nissan fundoplication?

A

A surgery where part of the stomach is wrapped around the sphincter to help stop reflux

60
Q

What should the nurse focus on for care of a pt with GERD?

A

Alleviating symptoms and client information.

61
Q

What should the nurse include in the assessment of a GERD pt?

A

A complete health history, diet, clothing, heartburn, atypical chest pain, types of food intolerance, regurgitation,

62
Q

What is the most important to rule out in symptoms of GERD?

A

Cardiac issues.

63
Q

What should you focus on in the physical assessment of a GERD patient?

A

Epigastric tenderness.