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155 > Unit 3 GERD > Flashcards

Unit 3 GERD Flashcards

1
Q

Gastroesophageal Reflux Disease (GERD)

Definition:

A

– backward flow of gastric contents thru the lower esophageal sphincter into the esophagus

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2
Q

Gastroesophageal Reflux Disease (GERD)

Physiologic Factors:

A

-Incompetent lower esophageal sphincter (LES)

-Transient relaxation of lower esophageal sphincter-
Substances that can relax the sphincter such as alcohol, tomato sauce, spicy food, chocolate can prevent LES from restricting properly

-Increase pressure in the stomach r/t overeating, delayed emptying.
(some drugs can delay emptying such as the diabetic drug Acarbose)

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3
Q

Gastroesophageal Reflux Disease (GERD)

Complications: -Erosive esophagitis

A

Can occur r/t exposure to the acid; the pt gets ulcerations then the tissue tears, bleeds and then scarring occurs; once scarred the function is decreases
~leads to difficulty swallowing,
~painful swallowing,
~horrible pain caused by stricture

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4
Q

Gastroesophageal Reflux Disease (GERD)

Complications: Barrett’s esophagus

A

– step before cancer; the epithelium changes and becomes more resistant to the acid

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5
Q

Gastroesophageal Reflux Disease (GERD)

Complications: -Esophageal stricture

A 
Lumen becomes narrow. Pt C/O food stuck in throat
TX with dilation of esophagus
           Problems:
    ~Dysphagia
    ~malnutrition
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6
Q

Gastroesophageal Reflux Disease (GERD)

Factors Contributing to Reflux

A

-Increase gastric volume
Position pushing gastric contents upwards (e.g., lying down, bending)
-Increase gastric pressure r/t tight clothing, obesity, pregnancy
-Hiatal hernia – medical condition that aggravates reflux

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7
Q

Gastroesophageal Reflux Disease (GERD)

Manifestations

A
  • Heartburn (dyspepsia) – especially after a HIGH FAT meal, bending over, reclining
  • Regurgitation
  • Dysphagia
  • Atypical chest pain – doesn’t follow MI symptoms
  • Sore throat – r/t pharynx damage, difficulty speaking
  • Hoarseness- r/t damage, may develop chronic cough r/t to the irritation
  • Water brash – hypersalivation
  • Odynophagia – painful swallowing
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8
Q

Gastroesophageal Reflux Disease (GERD)

Incidence

A
  • Affects 15-20% of adults (more than 50 million)
  • More common in people over 45 years old
  • 10% of people experience daily symptoms; interferes with life
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9
Q

Gastroesophageal Reflux Disease (GERD)

Diagnostic Tests

A

-Barium Swallow – X-ray records flow of barium thru esophagus

-EGD (esophagogastroduodenoscopy)
pt sedation
scope thru mouth, down esophagus, into stomach

-24° ambulatory pH monitoring
A catheter with a monitor attached is placed down the pt’s nose and into esophagus where the acid levels/pH are measured for 24°
After 24° the catheter/monitor is removed
Helps determine frequency and duration of episodes of reflux.
~Very uncomfortaple procedure
~Non compliance D/T nasal Catheter

-Bravo Capsule
attaches a capsule in the esophagus
sends messages to a monitor that the pt wears
falls off in 48° and is expelled with feces

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10
Q

Gastroesophageal Reflux Disease (GERD)

Medications: Antacids –

A

neutralize stomach acid
produce symptom relief; relieve pain that people refer to as heartburn
available in liquid suspension – shake well
available in chewable tablets – drink full glass of water

Magnesium compounds
Aluminum compounds
Calcium compounds
Sodium bicarbonate

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11
Q

Gastroesophageal Reflux Disease (GERD)

Medications: Antacids – Magnesium compounds

A

Milk of Magnesia
Riopan

A.E: Hypermagnesium

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12
Q

Gastroesophageal Reflux Disease (GERD)

Medications: Antacids – Aluminum compounds

A

Maalox
Mylanta
Amphogel
Rolaids

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13
Q

Gastroesophageal Reflux Disease (GERD)

Medications: Antacids – Calcium compounds

A

Tums

A.E: Hypercalcemia

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14
Q

Gastroesophageal Reflux Disease (GERD)

Medications: Antacids – Sodium bicarbonate

A

Baking soda

Alka Seltzer

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15
Q

Gastroesophageal Reflux Disease (GERD)

Medications: H2 Receptor Blockers “tidine”

A

-Histamine Blocker-
-These DO NOT neutralize the acid, they REDUCE acids by BLOCKING H2 histamine
H2 receptor blockers block the ability of histamine to stimulate acid secretions (hydrochloric acid),
- H2 receptor blocker stops the stimulation before it can start
-Less stimulation = less HCl acid = less GERD, reflux

H2 receptor blockers include:

  • Cimetidine (Tagamet)
  • Ranitidine (Zantac)
  • Famotidine (Pepcid)
  • Nizatidine (Axid)
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16
Q

Gastroesophageal Reflux Disease (GERD)
Medications: H2 Receptor Blockers “tidine”
Cimetidine (Tagamet)

A 
oral or IV
not used often r/t drug interactions
cause Dilantin and Coumadin levels to rise
absorption of the drug is slowed down if taken with food 
Adverse affects: 
-decrease libido
-Impotence
-Confusion
-Hallucinations
17
Q

Gastroesophageal Reflux Disease (GERD)
Medications: H2 Receptor Blockers “tidine”
Ranitidine (Zantac)

A

Oral, IM and IV, also OTC

more potent than Tagamet, but far fewer drug interactions and side effects

18
Q

Gastroesophageal Reflux Disease (GERD)
Medications: H2 Receptor Blockers “tidine”
Famotidine (Pepcid)

A

Oral, IV push or drip

19
Q

Gastroesophageal Reflux Disease (GERD)
Medications: H2 Receptor Blockers “tidine”
Nizatidine (Axid)

A

Oral capsules

20
Q

Gastroesophageal Reflux Disease (GERD)
Medications: Proton Pump Inhibitors (PPIs)”prazole”
(Most effective)

A

-Most effective for suppressing gastric acid secretion
Used interchangeably (can substitute one PPI for another)
-Cost effective
-Block final pathway of acid production
-Affects last long after drug is cleared from the body
-Rare side effects
-Take on empty stomach
Types:
Omeprazole (Prilosec)

Lansoprazole (Prevacid)

Rabeprazole (AcipHex)

Pantoprazole (Protonix)

Esomeprazole (Nexium)

21
Q

Gastroesophageal Reflux Disease (GERD)
Medications: Proton Pump Inhibitors (PPIs)”prazole”
Types:

A

Omeprazole (Prilosec)
Oral

Lansoprazole (Prevacid)
Oral and IV

Rabeprazole (AcipHex)
Oral
Can increases Digoxin level by 20% = digitoxicity

Pantoprazole (Protonix)
Oral or IV
Use a filter with IV r/t precipitates that can leak out

Esomeprazole (Nexium)
Phlebitis complication
Not compatible with anything other than NS, LR, or D5W
Studies being done: drip vs IV push

Zegrid-
New drug. Combo Prilosec and Sodium Bicarbonate

22
Q

Gastroesophageal Reflux Disease (GERD): Procedures

Nissen Fundoplication “stomach wrap”

A

-Laparoscopic or open surgery
-no incision is made; the stomach is wrapped around the lower esophagus and sutured together
-pt can no longer belch or vomit
-pt can no longer drink soda pop r/t lack of ability to belch
-good surg. for PT suffering with daily GERD
ALSO:
-The Transoral Incisionless Fundoplication (TIF) is a surgical procedure performed through the mouth and without incisions

23
Q

Gastroesophageal Reflux Disease (GERD): Procedures

Nissen Fundoplication “stomach wrap” Post-op Care

A
  • NG tube, NPO, Important NOT MANIPULATE NG tube
  • Keep NG patent to prevent build up of pressure and nausea
  • Nausea = retching = ripping of sutures
  • Important- C&DB – will be painful for pt; splint with pillows Shallow breathing r/t pain
24
Q

Gastroesophageal Reflux Disease (GERD): Procedures

Nissen Fundoplication “stomach wrap” :Post-Hospital Care

A

Avoid food and fluid at bedtime which can put pressure on LES
Frequent small feedings (so as not to stretch sutured area)
Avoid gas in stomach (gas bloat syndrome)
-Carbonated beverages
-Gum chewing
-Drinking with a straw
-Gas-producing foods
-Avoid lifting and straining r/t increase in pressure on LES

25
Q

Gastroesophageal Reflux Disease (GERD)

Medications: Prokinetic drugs- Metoclopramide (Reglan)

A

-Enhances esophageal clearance and gastric emptying
-Causes tightening of LES
-Increase mobility of GI; stomach especially
-Speeds food thru
Prokinetic drug:
Metoclopramide (Reglan)
Oral and IV

26
Q

Gastroesophageal Reflux Disease (GERD): Procedures Stretta Procedure

A
  • Causes a stricture at the LES by radio frequency energy
  • Done thru endoscopy
  • Puts tiny holes in esophageal lining, as those heal they tighten and contract the LES
27
Q

Gastroesophageal Reflux Disease (GERD): Procedures

LINX System

A

a band of magnets that tighten around the sphincter

28
Q

Gastroesophageal Reflux Disease (GERD):

Lifestyle Modifications for GERD

A

-Eat smaller meals – 4-6 small feedings;  pressure on LES
-Avoid foods that aggravate symptoms:
~Alcohol
~Chocolate
~citrus fruits
~fatty foods
~mints
~coffee
~caffeine
~Avoid lying down within 3 hours of eating
-Elevate HOB (Head Of Bed); by 8-10”
-Smoking Cessation dramatically reduces LES pressure
-Lose weight – helps reduce pressure
-Avoid bending
-Avoid tight clothing

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