GERD Flashcards
What is gastroesophageal reflux?
Backward flow of gastric contents into esophagus causing heartburn
What is a sign of poor digestion?
GERD
What percentage of adults does GERD affect?
15-20%
Is GERD always symptomatic?
NO. Sometimes it is asymptomatic, or “silent pain”
What muscle at the top of the stomach is affected by GERD?
The sphincter muscle
True or false.
GERD increases with age.
True
What kind of cancer could GERD lead to?
Esophageal cancer.
What 3 things help maintain pressure differences between stomach and esophagus?
- diaphragm
- lower esophageal sphincter
- the location of gastroesophageal junction
What two organs help prevent back flow?
The diaphragm and sphincter.
What are the contributing factors to increased pressure in the stomach?
- increased gastric volume
- certain body positions
- pressure from obesity or tight clothing
What happens to the lower esophageal sphincter to cause GERD?
Transient relaxation and incompetency.
What are the risk factors for GERD?
Obesity, older age, Excessive alcohol, smoking, hiatal hernia (stomach hernia), diabetes, pregnancy, Diet: fatty/fried foods, chocolate, caffeine, citrus, peppermint, spicy foods
What are clinical manifestations of GERD in adults?
- heartburn after eating, bending over, reclining
- cough
- flatulence
- excessive belching
- hoarseness
- pain in swallowing, throwing up in mouth, atypical chest pain
What are the clinical manifestations of GERD in infants?
- spitting up
- forceful vomiting
True and false.
GERD is fairly common in infants.
True.
What are the clinical manifestations of GERD in children?
Poor weight gain, recurrent vomiting, irritability, poor eating, arching of the back (b/c of abdominal pain), sore throat, asthma, respiratory involvement
What are the complications of GERD?
- Erosive esophagitis
- esophageal strictures ( build- up of scar tissue)(may lead to dysphagia)
- Barrett’s esophagitis
Explain Barrett’s esophagitis.
Erosion of the esophageal lining.
What is erosive esophagitis?
Inflammation that damages the tube running from the throat to the stomach.
Explain esophageal strictures.
Narrowing of the esophagus due to inflammation from damage and scar tissue.
What are some ways to prevent GERD?
- 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
What is a barium swallow test?
Swallowing barium sulfate which is a metallic compound that shows up on x-rays and helps view abnormalities in esophagus and stomach.
What is a EGD?
Esophagogastroduodenoscopy or Upper Endoscopy
What are the diagnostic tests for GERD?
- barium swallow
- upper endoscopy or ECG
- Bernstein test
- 24-hr ambulatory ph monitoring
- esophageal manometry
What is the Bernstein test?
NG tube placed into the esophagus, lightly acidic substance is added, if it burns then you know there is erosion.
Explain the 24-hr ambulatory pH monitoring test.
PH monitors placed down nose measuring pH levels of esophagus.
Explain Esophageal manometry.
Measures the swallowing pressure.
What are the types of pharmacological therapy used for GERD?
Antacids, H2 receptor blockers, Proton pump inhibitors, pro-motility agents.
What do you take for mild to moderate symptoms of GERD?
Antacids: sodium bicarbonate
Name one H2 receptor blocker.
Famotidine.
What is the proton pump inhibitor that is used for severe GERD?
Omeprazole.
What pro-motility agents is used for GERD?
Metoclopramide.
In addition to GERD what is metoclopramide given for?
Nausea. (It promotes emptying of the stomach)
What letters to H2 receptor blockers end with?
“idine”
What letters do PPI’s end with?
“Prazole”
What is the prototype antacid drug?
Sodium bicarbonate.
What is the MOA of sodium bicarbonate?
Neutralizes stomach acid by raising pH of stomach contents.
What is the primary use of sodium bicarbonate?
Relief of upset stomach(hyperacidity)
What are the AE of sodium bicarbonate?
Metabolic alkalosis(“ANT-acid”), constipation or diarrhea
When is sodium bicarbonate given IV?
During a code.
How long is the onset of sodium bicarbonate?
Rapid: 30 minutes
Should you use antacids consistently?
No. You could be masking underlying symptoms.
What is the prototype drug of H2 receptor blockers?
Famotidine (Pepcid)
What is the MOA of famotidine?
It blocks H2-receptors in stomach to decrease acid production.
What is the primary use of famotidine?
To treat peptic ulcer disease, GERD
What are the pharmacokinetics of famotidine?
Liver and kidney
What are the AE of famotidine?
Dizziness, confusion, thrombocytopenia, increases BUN/creatinine
What is the PPI prototype drug?
Omeprazole (Prilosec)
What is the MOA of Omeprazole?
Reduces acid secretion in stomach by binding irreversibly to enzyme h1, k1-ATPase
What is the primary use of omeprazole?
Therapy for peptic ulcers and GERD (2-6 months)
What are the AE of omeprazole?
Headache, nausea, diarrhea, rash, abdominal pain
What is long-term use of omeprazole is associated with?
Increased risk of gastric cancer and hip fractures
Do infants outgrow GERD?
Infants may outgrow GERD.
What are the pediatric manifestations of GERD?
Coughing, difficulty swallowing, asthma symptoms, periods of apnea and frequent upper respiratory infections.
What is often chronic in adults?
GERD
What kind of changes help reduce symptoms and long-term effects?
Dietary and lifestyle.
When is surgery necessary for GERD?
When clients are unresponsive to pharmacologic, lifestyle interventions.
What is a laparoscopic fundoplication?
The treatment of choice for GERD.
What is Nissan fundoplication?
A surgery where part of the stomach is wrapped around the sphincter to help stop reflux
What should the nurse focus on for care of a pt with GERD?
Alleviating symptoms and client information.
What should the nurse include in the assessment of a GERD pt?
A complete health history, diet, clothing, heartburn, atypical chest pain, types of food intolerance, regurgitation,
What is the most important to rule out in symptoms of GERD?
Cardiac issues.
What should you focus on in the physical assessment of a GERD patient?
Epigastric tenderness.
