Week 6 - Gerd/hernia & esophageal CA

Question 1

What are the lifestyle strategies to prevent GERD & Hiatal Hernia symptoms?

Answer 1

CPAP for sleep apnea
Avoid smoking and drinking alcohol

Question 2

What are the nutritional strategies to prevent GERD and Hiatal Hernia symptoms?

Answer 2

Eat several meals a day
stop eating 3 hours before bed
avoid irritating foods (peppermint, chocolate, fatty foods, caffeine, carbonated drinks, spicy/acidic foods)

Question 3

What are the non-surgical interventions for esophageal cancer?

Answer 3

Nutritional & swallow therapy to help support chemo, radiation, surgery
soft food
daily weights
sit upright

Question 4

How do we care for someone pre-op for Nissen fundoplication surgery?

Answer 4

1. encourage weight loss
2. encourage smoking cessation

Question 5

How do we care for someone post-op for Nissen fundoplication surgery?

Answer 5

1. regular post op care
2. HOB up to reduce respiratory complications
3. Early ambulation
4. DB&C Q 1hr - pain control meds
5. NG
6. Gradual diet progression

Question 6

How do we care for someone pre-op esophagectomy surgery?

Answer 6

smoking cessation
nutritional support
excellent oral care
respiratory rehab (strengthen respiratory system for post surgery)

Question 7

What is the highest priority post-op esophagectomy surgery?

Answer 7

Respiratory care is highest priority

Question 8

what drugs do we use to control the symptoms of GERD & Hiatal hernia?

Answer 8

Antacids
PPIs
H2 receptor blockers

Question 8

What is GERD (Gastroespohageal Reflux Disease)?

Answer 8

Backward flow of gastric contents into esophagus

Question 9

What are the 4 things GERD results from?

Answer 9

1. LES incompetence d/t food/meds
2. Hiatal hernia
3. Increased intraabdominal pressure (preggers/obesity/ascities)
4. Inflammation

Question 10

GERD can lead to 5 other disorders (dx), what are they?

Answer 10

1. Barret’s esophagus (pre-cancerous d/t repeated acid)
2. Respiratory complications - aspiration (wheezes = bad)
3. Esophagitis
4. Dental decay
5. Hemorrhage

Question 11

What are the symptoms of GERD?

Answer 11

1. Dyspepsia
2. Regurgitation
3. Dysphagia
4. Odynophagia
5. Coughing
6. Chest pain
7. Pyrosis
8. belching

Question 12

What are the 2 types of Hiatal Hernia?

Answer 12

1. Sliding hiatal hernia (smaller)
2. Paraesophageal (rolling) Hiatal Hernia (large)

Question 13

What are the symptoms of Hiatal Hernia similar too ?

Answer 13

GERD
also can be asymptomatic

Question 14

What drugs do we want to avoid with GERD and hiatal hernia and why?

Answer 14

-drugs that lower LES pressure
- oral contraceptives
- anticholinergic drugs
- sedatives
- NSAIDs
- nitrates
- CCB (calcium channel blockers)

Question 15

What is typically a last resort for GERD & Hiatal Hernia ?

Answer 15

surgery - nissen fundoplication

Question 16

What is sliding hiatal hernia?

Answer 16

whole top part of stomach Slides up into thoracic cavity (laying down)
resolves when person sits/stands

Question 17

What is rolling hiatal hernia (paraesophageal)?

Answer 17

Stomach is in right position but a part of it has huge bulge that pokes through (herniated) through diaphragm

Question 18

How do we know if the fundoplication is too tight?

Answer 18

person can’t belch or has dysphagia for week/months (this is not normal)

Question 19

Should someone who just had Esophagesctomy be laid flat?

Answer 19

no never!
semi-fowlers or high-fowlers only

Question 20

What is a complication to monitor for post esophagesctomy?

Answer 20

Anastomoni leak - into mediastinis then causes mediastinitis = infection/shock

Question 21

How do we prevent mediastinitis post esophagesctomy ?

Answer 21

NG

Question 22

How is nutrition provided to someone post op esophagectomy typically?

Answer 22

Jejunostomy (GT) typically
If no anastomotic leak then we progress the diet.
If there is then rest and retest

Question 23

Why do we use large bore NG post-op Gerd and hiatal hernia surgery?

Answer 23

1. allows opening to stay open
2. helps us monitor drainage (we want yellowish green eventually)

Question 24

What is the FIRST sign of esophageal tumor-cancer?

Answer 24

Dysphagia

Question 25

What are the top 4 signs of esophageal tumor-cancer?

Answer 25

1. Dysphagia
2. Weight loss
3. odynophagia (pain when swallowing)
4. Hoarseness - with vocal cord invovlement

Question 26

Is esophageal tumor curative?

Answer 26

sometimes yes- with surgery
Often still terminal after surgery so palliative approach is necessary

Question 27

What things can we do as part of the palliative approach to esophageal cancer diagnosis?

Answer 27

assess for Anxiety and depression
Maximize quality of life
Realistic planning
Opportunity to grieve
Hospice care, etc

Question 28

Why do we insert NG post fundoplication?

Answer 28

to prevent closure of the LES

Question 29

How long must someone be on a liquid diet post fundoplication?

Answer 29

4-6 weeks

Question 30

Is a person required to be NPO post fundoplication?

Answer 30

No

Question 31

Is a person required to be NPO post esophagectomy?

Answer 31

YES!

Question 32

How long do we do NPO and jejunum feeding post esophagectomy before trying oral?

Answer 32

about 1 week

Question 33

Is fundoplication performed by laparotomy or laproscopic?

Answer 33

Laproscopic

Question 34

Is Esophagectomy performed laparotomy or laproscopic?

Answer 34

Laparotomy