Week 6 - GERD Flashcards
what is GERD
- a syndrome
- encompasses any host of GI disruptions that are noted to be secondary to a reflux of gastric cobtents into the LES (esopahgus)
GERD occurs when??
- when the defences of the lower esophagus are overwhelmed by the backflow or reflux of stomach acid into the esophagus = symptoms
what is the cause of GERD
- no single 1 cause
- caused by several factors that result in the dysfunction of the LES or when the LES defences become overhwhelmed by the stomach acid
what are predisposing conditions for GERD (6)
- hiatal hernia
- incompetent LES
- decreased esophagal clearance (ability to clear liquids/food into the stomach)
- impaired esophageal motility
- decreased gastric emptying
- increased intra abdominal pressure
what can cause an incompetent LES
- decrease in pressure in the distal portion of the esophagus
what can caused decreased LES pressure (3)
- caffeine
- chocolate
- anticholinergics
what type of symptoms are seen in gerd (5)
- heartburn (pyrosis)
- regurgitation
- resp symptoms
- otolaryngeal symptoms
- gastric symptoms
what is heartburn described as
- burning, tight sensation that is felt intermittently beneath the lower sternum & spreads upward towards the throat and jaw
what resp symptoms are seen in GERD (3)
- dyspnea
- wheezing
- coughing
what otolaryngeal symptoms are seen in gerd (3)
- sore throat
- hoarseness
- bolus sensation (lump in throat)
what is regurgitation r/t gerd
- effortless return of food or gastric contents from the stomach into the esophagus or mouth
- hot, bitter, sour liquid into the mouth
what gastric symptoms are seen in gerd (3)
- early satiety
- bloating after a meal
- NV
what symptoms in gerd would prompt endoscopic evaluation (5)
- dysphagia
- odynophagia
- bleeding & anemia
- weight loss
- persistent vomitting
what are complications of gerd and what causes them (3)
r/t to the direct local effects of gastric acid on the esophageal mucosa
- esophagitis
- barretts esophagus
- resp complications
what is esophagitis
- inflammation of the esophagus
what can esophagitis lead to
- repeated exposure = scar tissue formation = decreased distensibility = esophageal stricture = dysphagi
what is Barrett’s esophagus
- replacement of the normal squamous of the esophagus with columnar epithelium
what is the risk associated w barrets esophagus
- considered precancerous lesions
what are signs of barrets esophagus (4)
- range from none
- to mild
- to bleeding
- to perforation
what are resp complications of GERD (4)
- bronchospasm
- laryngospasm
- cricopharyngeal spasm
- pneumonia (r/t aspiration of gastric contents)
what diagnostic studies are used for GERD (6)
- endoscopy
- barium swallow
- biopsy and cytological specimens (to differentiate between barrets and a carcinoma)
- esophageal manometric studies
- ph
- radionuclide tests
what is an esophageal manometric study
test to determine pressure in the esophagus & LES
what do radionuclide tests detect r/t gerd (2)
- detect reflux
- rate of esophageal clearance
how are most patients w gerd managed (4)
- lifestyle mods
- drug therapy
- nutritional therapy
- surgery if these are ineffective
what is the goal of treatment for gerd
- prevent symptoms & complications
what lifestyle mods are initiatted for GERD (5)
- avoid factors that aggravate symptoms
- encourage weight loss
- encourage smoking cessation
- avoid wearing tight clothing around the waist
- sleep w HOB 30*
what nutritional therapy is initiated for a pt with GERD (7)
- food aggravates symptoms, does not cause*
- avoid foods that lower LES pressure
- avoid foods that slow rate of gastric emptying
- small, frequent meals (prevent overdistension)
- avoid late-evening & night snacking
- fluids between meals (prevent overdistension)
- avoid foods that irritate the acid-senstive esophagus
- dont lying down or bending over for 2-3 hrs after eating
what foods can lower LES pressure (6)
- fatty foods
- chocolate
- peppermint
- coffee
- tea
- alcohol
what foods can lower the rate of gastric emptying (2)
- high-fat foods
- milk products
when in particular should you avoid milk products for gerd
- at bedtime
what are 2 examples of foods that irritate the acid senstive esophagus (2)
- tomato based products
- orange juice
what is drug therapy for gerd focused on (4)
- improving LES function
- increasing esophageal clearance
- decreasing volume & acidity of reflux
- protect esophageal mucosa
what are the 2 approaches drug therapy for gerd
- step-up approach
- step-down appraoch
what does the step-up approach involve (3)
- begin with antacids and OTC H2R blockers
- progressing to prescription H2R blockers
- and finally PPIs
what does the step down approach involve (3)
- begin with PPI
- overtime titrate down to prescrption to H2R blockers
- and then OTC H2R blockers and antacids
what meds are used for gerd (6)
- antacids
- PPI
- H2R blockers
- cytoprotective drugs
- prokinetic drugs
- cholinergic drugs
what impact do antacids have on gerd (2)
- produce quick but short-lived relief of heartbirn
- neutralize HCl
when should antacids be taken for gerd
1-2 h after meals and bedtime
what is an example of an antacid for gerd (2)
- mylanta
- maalox
what do H2R blockers do
- decrease secretion of HCl
what are example of H2R blockers used for gerd(3)
- rantidine (zantac)
- famotidine (pepcid)
- nizatidine (axid)
what do PPIs do
- decrease HCl secretion by inhibiting the proton pump responsible for secretion of H+ ions
what are examples of PPIs used for gerd (3)
- omeprazole
- pantoprazole
- more -prazoles
what is a type of cytoprotective drug used for gerd
- sucralfate
what does sucralfate do
- antiulcer drug
how are cholinergic drugs helpful in treatment of gerd (3) what is a con to them
- increase LES pressure
- improve esophageal emptying into stomach
- increase gastric emptying
- ALSO stimulate HCl secretion
what is a prokinetic drug used for gerd
- metoclopramide
what does metoclopromide do
- promote gastric emptying
when is surgery for gerd indicated (3)
- if long-term conservative therapy fails
- if hiatal hernia present
- if complications exist
what is the goal of surgical interventions for gerd
- reduce reflux of gastric contents by enhancing integrity of LES
what are surgical interventions for gerd called
- antireflux procedures
what occurs in antireflux procedures
- the fundus of the stomach is wrapped around the lower portion of the esophagus in varying positions
what is the standard for antireflux surgeries
- the nissen fundoplication
what is the nissen fundoplication procedure (2)
- where the fundus of the stomach is wrapped around the dista esophagus
- and the fundus is sutured to itself
describe nursing care for a pt with gerd experiencing acute symptom (5)
- ensure HOB at 30*
- ensure dont lie down for 2-3 hr after eating
- encourage pt to follow drug & lifestyle regimen
- observe s/e of meds
- monitor for resp symptoms
describe pt teaching for gerd (4)
- teach to avoid behaviors that cause reflux
- explain nutritional therapy
- explain lifestyle mods
- explain drug regimen
describe post-op care for gerd (7)
- prevent resp complications –> resp assessment, deep breathing
- IV fluids and electrolytes until return of peristalsis
- maintain patency of NG tube
- prevent infection
- may get bloating and adminial discomfort r/t not being able to voluntarily vomit or burp
- once peristalsis returns, fluids only initially, gradually add solid foods
- record I&O
describe post-op teaching for gerd (6)
- should be no symptoms of gerd
- so report symptoms
- can return to normal diet
- avoid foods that are gas forming
- try to prevent gastric distension
- chew foods thoroughly
