GI PART 2

Question 1

What is GERD?? What is the gastric pH?????

Answer 1

Gastroesophageal Reflux Disease where there’s back flow of GI contents into the esophagus!!!!
- Gastric pH: 1.5 - 3.5

Question 2

WHY or what causes GERD?????

Answer 2

1. DECREASED TONE/ Increased RELAXATION of the LES!
2. INCREASED gastric volume!
3. INCREASED intra-abdominal pressure!!
4. DELAYED gastric emptying => gastroparesis!

Question 3

WHAT CAUSES DECREASED LES PRESSURE IN GERD?????

Answer 3

1. Physiologic alterations
2. OVER-EATING
3. Obesity
4. PREGNANCY
5. ## ASCITES!
6. TIGHT clothing
7. SOME MEDS: NITRATES (like nitro-glycerin) & CALCIUM CHANNEL BLOCKERS!!!
8. SOME FOODS
9. ***NICOTINE AND ALCOHOL
10. ** NGT!!

Question 4

What PROBLEMS can GERD CAUSE????

Answer 4

1. Esophageal STRICTURE!
2. ## Esophageal ULCER (possible Hemmorrhage)
3. ASPIRATION PNEUMONIA!!
4. ## LINKED TO ADULT-ONSET of *ASTHMA, *LARYNGITIS, AND *DENTAL DETERIORATION
5. **BARRETT’S EPITHELIUM = Pre-Malignant!!! and really miserable!

Question 5

What are the clinical manifestations of GERD??????

Answer 5

1. REGURGitation (backing up of contents)
2. DYSPEPSIA (upset stomach)
3. WATER BRASH (hyper salivating)
4. ERUCtation (belching/ burping), BLOATING, and FLACTULENCE!!!
5. ## NAUSEA!!!
6. GLOBUS (feeling that smith is stuck)
7. DYSPHAGIA and ODYNOPHAGIA (painful swallowing)
8. RESPIRATORY symptoms!!!!!
9. CHEST PAIN !!!!!!!
   - diff than cardiac symptoms of chest pain bc cardiac: 1. pain from arm radiating up to jaw. 2. EKG!!!!!! 3. SOB & Low perfusion!!!

Question 6

WHAT ARE THE **Diet Modifications for GERD????

Answer 6

1. Eat SLOWLY, Chew THROUGHLY
2. ## 4-6 small meals, AVOID LATE DAY EATING (avoid eating before laying down basically)
3. ## Nothing that decreases LES pressure
4. AVOID MOST JUICES~ (APPLE IS OK!!!!!!!)
5. DECREASE FLUID INTAKE WITH MEALS!!!!

Question 7

What are the LIFESTYLE CHANGES for GERD???

Answer 7

1. HOB ELEVATED!!!
2. WEIGHT LOSS
3. NO TIGHT CLOTHES
4. NO SMOKING OR ALCOHOL!!

Question 8

WHAT ARE THE MEDS FOR GERD??? WHATS THE PURPOSE OF THESE???? EX for each??

Answer 8

• MEDICATIONS are NOT to fix the reflux problems!! BUT, to fix the pH levels (increasing it) so it’s not too acidic!!
  1. ANTACIDS!!!
  
  • Tums (Calcium Carbonate)
  • Mylanta (Magnesium Hydroxide)
    2. H2 BLOCKERS!!! (“-dine”)
  • CIMEtidine (TAGAMET)
  • FAMOtidine (PEPCID)
  • NITAtidine (AXID)
  • RANItidine (ZANTAC)
    3. PPI!!! (“-Prazole”)
  • ESOMEprazole (NEXium)
  • PANTOprazole (PROTONix)
  • LANSOprazole (PREVacid)
  • OMEprazol (PRILosec)