Test 2 GERD Flashcards
What is the most common upper GI problem in adults
GERD
What causes GERD
Reflux of gastric contents into the lower esophagus
GERD happens when …
Defenses of lower esophagus are overwhelmed with gastric contents into the esophagus
Esophogitis
Irritation and inflammation of the esophagus of caused by gastric hydrochloride (HCL) acid and pepsin secretions
What are the two defenses for the esophagus
Pylorus and lower esophageal sphincter
What are the four things that cause irritation in the esophagus
HCL
Pepsin
Proteolytic enzymes
Bile salts
What does the les do????
Lower esophageal spinchter keeps everything from coming up
Predisposing factors for GERD
Hiatal hernia
Incompetent LES
Decreased esophageal clearance
Decreased gastric emptying
Gastroesophageal Reflux Disease is not a _____
Disease!!!!!! its a syndrome
Risk factors for GERD
Obesity
Pregnancy
Cigarette/cigar smoking
hiatial hernia
Symptoms of GERD
Heartburn (pyrosis)
Dyspepsia
Regurgitation
Pyrosis
its Heart Burn!!!!
- most common manifestation of GERD
- burning/tight pain lower sternum spreads to throat and jaw
Dyspepsia
Pain or discomfort centered in upper abdomen.
Symptom of GERD
-Discomfort from dyspepsia is felt mainly around midline
when should healthcare provider evaluate for GERD
Heartburn more then once per week
when it occurs at night waking the patient
-older adults with recent onset
patients with Gerd might also report having
Wheezing
Coughing
Dyspnea
nocturnal coughing and loss of sleep
Otolaryngologic symptoms include :
Hoarseness
sore throat
lump in throat
choking
GERD related chest pain
- mimics angina but can be relived with antacids
- burning, squeezing, radiates in back, neck, jaw and arms.
-can be confused with cardiac pain
Barretts esophagus is also. called
esophageal metaplasia
Barretts esophagus is
basically the replacement of you normal cells with precancerous lesions. -OR- squamous epithelium with columnar epithelium
–caused by GERD
Who is more at risk for barrette esophagus
White people more risk for complicated GERD, inc barrette esophagus
how often is barrette esophagus monitored
q 2-3years via endoscopy to check for cancer
Complications of GERD include
Barretts esophagus
Respiratory
dental erosion
Respiratory complications of GERD
Secretions irritate the upper airway
- cough
- bronchospasm
- laryngospasm
- cricopharyngeal spasm
*Potential for asthma, bronchitis, pneumonia
DIAGNOSITC STUDIES FOR GERD
H&P Barium swallow Upper GI Endoscopy Biopsy and cytologic specimens Esophageal manometric (motility) studies Radionuclide tests Monitoring pH
Biopsy and cytologic specimens
differentiates cancer from barrette esophagus
Esophageal manometric (motility) Studies
measure pressure in the esophagus and LES
Radionuclide Tests
Detect reflux of gastric contents
- Demonstrate rate of esophageal clearance
- Use this test in worst case scenario.
Monitoring pH
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
Nutritional therapy for GERD
- 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
First line drug therapy for GERD
Antacids
Why do ppl with GERD take PPI’s
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
What ate the two most common treatments for symptomatic GERD
Proton Pump Inhibitors (PPI)
Histamine-2 receptor (H2R) Blockers
DRUG ALERT for PPI’s
long term use/high dose may increase risk of fractures to hip, wrist, spine
Increases risk of C Diff
Why do people with GERD take H2R blockers
- decreases secretion of HCL acid
- reduces symptoms and promote esophageal healing in 50% of patients
- side effects are uncommon
Examples of H2R blocker medications
cimetidine (Tagamet)
ranitidine (Zantac)
famotidine (Pepcid)
nizatidine (Axid)
Examples of PPI medications
omeprazole (Prilosec)
why are we taking cholinergic meds for GERD
- increases LES pressure
- improve esophageal emptying
- increase gastric emptying
Examples of cholinergic meds
bethanechol (urecholine)
why take prokinetic drugs for GERD
- promote gastric emptying
* reduce risk of gastric acid reflux
Example of prokinetic meds
metoclopramide (reglan)
what do antacid meds do for GERD
- 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
Examples of antacid medications
Maalox, Mylanta
-not effective in patients with severe of frequent symptoms
when is surgery used to treat GERD
- failure of conservative therapy
- medication intolerance
- barretts metaplasia
- esophageal stricture and stenosis
- chronic esophagitis
what surgical procedure is down to treat GERD
- Nissen and Toupet fundoplications (Last ditch effort)
- (anti reflux surgeries from 1st ppt)
what is a Nissan fundoplication
the funds of the stomach is wrapped around the distal esophagus and then sutured to itself
LINX Reflux Management System
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
what are adverse S/E of LINX reflux management system
- difficulty swallowing
- vomiting
- nausea
- chest pain
NO MRI’s!!!!!!!!!!!
Endoscopic Therapy for GERD
- Endoscopic mucosal resection
- Photodynamic therapy (light)
- Cryotherapy (cold)
- Radiofrequency ablation
Nursing management for our GERD patients
- 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
Avoid these factors that can cause reflux
smoking
alcohol & caffeine
acidic foods
Postoperative Care
prevent respiratory complications maintain F&E prevent infection deep breathing tequniques accurate I&O pain meds, meds to prevent N/V
Surgery that messes with sphincters can
throw off F&E glance
complications after surgery fro GERD
gastric or esophageal injury, splenic injury, pneumothorax, perforation, bleeding, infection, bloating, and pneumonia
After surgery for GERD the patient should report
persistant symptoms of of heartburn and regurgitation.
