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Med Surg Block 3 > Test 2 GERD > Flashcards

Test 2 GERD Flashcards

1
Q

What is the most common upper GI problem in adults

A

GERD

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2
Q

What causes GERD

A

Reflux of gastric contents into the lower esophagus

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3
Q

GERD happens when …

A

Defenses of lower esophagus are overwhelmed with gastric contents into the esophagus

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4
Q

Esophogitis

A

Irritation and inflammation of the esophagus of caused by gastric hydrochloride (HCL) acid and pepsin secretions

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5
Q

What are the two defenses for the esophagus

A

Pylorus and lower esophageal sphincter

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6
Q

What are the four things that cause irritation in the esophagus

A

HCL
Pepsin
Proteolytic enzymes
Bile salts

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7
Q

What does the les do????

A

Lower esophageal spinchter keeps everything from coming up

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8
Q

Predisposing factors for GERD

A

Hiatal hernia
Incompetent LES
Decreased esophageal clearance
Decreased gastric emptying

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9
Q

Gastroesophageal Reflux Disease is not a _____

A

Disease!!!!!! its a syndrome

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10
Q

Risk factors for GERD

A

Obesity
Pregnancy
Cigarette/cigar smoking
hiatial hernia

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11
Q

Symptoms of GERD

A

Heartburn (pyrosis)
Dyspepsia
Regurgitation

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12
Q

Pyrosis

A

its Heart Burn!!!!

  • most common manifestation of GERD
  • burning/tight pain lower sternum spreads to throat and jaw
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13
Q

Dyspepsia

A

Pain or discomfort centered in upper abdomen.
Symptom of GERD
-Discomfort from dyspepsia is felt mainly around midline

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14
Q

when should healthcare provider evaluate for GERD

A

Heartburn more then once per week
when it occurs at night waking the patient
-older adults with recent onset

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15
Q

patients with Gerd might also report having

A

Wheezing
Coughing
Dyspnea
nocturnal coughing and loss of sleep

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16
Q

Otolaryngologic symptoms include :

A

Hoarseness
sore throat
lump in throat
choking

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17
Q

GERD related chest pain

A
  • mimics angina but can be relived with antacids
  • burning, squeezing, radiates in back, neck, jaw and arms.

-can be confused with cardiac pain

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18
Q

Barretts esophagus is also. called

A

esophageal metaplasia

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19
Q

Barretts esophagus is

A

basically the replacement of you normal cells with precancerous lesions. -OR- squamous epithelium with columnar epithelium
–caused by GERD

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20
Q

Who is more at risk for barrette esophagus

A

White people more risk for complicated GERD, inc barrette esophagus

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21
Q

how often is barrette esophagus monitored

A

q 2-3years via endoscopy to check for cancer

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22
Q

Complications of GERD include

A

Barretts esophagus
Respiratory
dental erosion

23
Q

Respiratory complications of GERD

A

Secretions irritate the upper airway

  • cough
  • bronchospasm
  • laryngospasm
  • cricopharyngeal spasm

*Potential for asthma, bronchitis, pneumonia

24
Q

DIAGNOSITC STUDIES FOR GERD

A 
H&P
Barium swallow
Upper GI Endoscopy
Biopsy and cytologic specimens
Esophageal manometric (motility) studies
Radionuclide tests
Monitoring pH
25
Q

Biopsy and cytologic specimens

A

differentiates cancer from barrette esophagus

26
Q

Esophageal manometric (motility) Studies

A

measure pressure in the esophagus and LES

27
Q

Radionuclide Tests

A

Detect reflux of gastric contents

  • Demonstrate rate of esophageal clearance
  • Use this test in worst case scenario.
28
Q

Monitoring pH

A

determines esophageal pH by using probes.
-can be one time thing with a probe or they may take a sample every 24 hours to measure the levels. 1=extremely acidic. 14=extremely base.
pH should be around 4-5 in the stomach. in esophagus should be base

29
Q

Nutritional therapy for GERD

A
  • Avoid triggers
  • Decrease high fat foods
  • take fluids between meals, not with
  • avoid milk products at night
  • no late night snacking/meals
  • dont eat/drink for 2 hours before bed
  • Avoid chocolate, caffeine, peppermint, tomato products, orange juice
  • weight reduction therapy
  • chewing gum and oral lozenges can increase saliva and help patients with mild symptoms
30
Q

First line drug therapy for GERD

A

Antacids

31
Q

Why do ppl with GERD take PPI’s

A

Proton Pump Inhibitors (PPIs)

  • promotes esophageal healing 80-90% pf ppl
  • decreases incidence of strictures
  • must take before the 1st meal of the day.
  • headache most common symptom
32
Q

What ate the two most common treatments for symptomatic GERD

A

Proton Pump Inhibitors (PPI)

Histamine-2 receptor (H2R) Blockers

33
Q

DRUG ALERT for PPI’s

A

long term use/high dose may increase risk of fractures to hip, wrist, spine

Increases risk of C Diff

34
Q

Why do people with GERD take H2R blockers

A
  • decreases secretion of HCL acid
  • reduces symptoms and promote esophageal healing in 50% of patients
  • side effects are uncommon
35
Q

Examples of H2R blocker medications

A

cimetidine (Tagamet)
ranitidine (Zantac)
famotidine (Pepcid)
nizatidine (Axid)

36
Q

Examples of PPI medications

A

omeprazole (Prilosec)

37
Q

why are we taking cholinergic meds for GERD

A
  • increases LES pressure
  • improve esophageal emptying
  • increase gastric emptying
38
Q

Examples of cholinergic meds

A

bethanechol (urecholine)

39
Q

why take prokinetic drugs for GERD

A
  • promote gastric emptying

* reduce risk of gastric acid reflux

40
Q

Example of prokinetic meds

A

metoclopramide (reglan)

41
Q

what do antacid meds do for GERD

A
  • quick but short lived relief
  • neutralize HCL acid
  • taken 1-3 hours after meals/at bedtime
  • antacids that contain aluminum can cause constipation, and ones with magnesium can cause diarrhea
42
Q

Examples of antacid medications

A

Maalox, Mylanta

-not effective in patients with severe of frequent symptoms

43
Q

when is surgery used to treat GERD

A
  • failure of conservative therapy
  • medication intolerance
  • barretts metaplasia
  • esophageal stricture and stenosis
  • chronic esophagitis
44
Q

what surgical procedure is down to treat GERD

A
  • Nissen and Toupet fundoplications (Last ditch effort)

- (anti reflux surgeries from 1st ppt)

45
Q

what is a Nissan fundoplication

A

the funds of the stomach is wrapped around the distal esophagus and then sutured to itself

46
Q

LINX Reflux Management System

A

Titanium beads with magnetic core strung together and implanted laparoscopically into LES

  • when not swallowing the ring tightens due to magnetic attraction of the beads
  • when swallowing the ring opens
47
Q

what are adverse S/E of LINX reflux management system

A
  • difficulty swallowing
  • vomiting
  • nausea
  • chest pain

NO MRI’s!!!!!!!!!!!

48
Q

Endoscopic Therapy for GERD

A
  • Endoscopic mucosal resection
  • Photodynamic therapy (light)
  • Cryotherapy (cold)
  • Radiofrequency ablation
49
Q

Nursing management for our GERD patients

A
  • Elevate head of bed to at least 30%
  • No laying down for 2-3 hours after eating
  • avoid late night eating
  • Evaluate effectiveness of meds
  • Observing for S/E of meds
  • stress reductions techniques
  • weight reduction is appropriate
  • small referent meals
50
Q

Avoid these factors that can cause reflux

A

smoking
alcohol & caffeine
acidic foods

51
Q

Postoperative Care

A 
prevent respiratory complications
maintain F&E
prevent infection
deep breathing tequniques
accurate I&O
pain meds,  meds to prevent N/V
52
Q

Surgery that messes with sphincters can

A

throw off F&E glance

53
Q

complications after surgery fro GERD

A

gastric or esophageal injury, splenic injury, pneumothorax, perforation, bleeding, infection, bloating, and pneumonia

54
Q

After surgery for GERD the patient should report

A

persistant symptoms of of heartburn and regurgitation.

Med Surg Block 3 (4 decks)

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