Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MS Module 2 > GERD > Flashcards

GERD Flashcards

1
Q

GERD

A

Common problem
Chronic manifestation of mucosal damage
Caused by reflux of gastric contents into lower esophagus
Not a disease, but a syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Etiology and Patho

A

No one single cause
Results when:
-Defenses of lower esophagus are overwhelmed by reflux of gastric contents into esophagus
Reflux of HCl acid and pepsin secretions cause irritation and inflammation
Intestinal proteolytic enzymes and bile salts add to irritation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Predisposing factors

A 
Hiatal hernia
Incompetent lower esophageal sphincter (LES)
-Antireflux barrier
Decreased esophageal clearance
Decreased gastric emptying
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Incompetent LES

A

Primary factor in GERD
Results in decreased pressure in distal portion of esophagus
-Gastric contents move from stomach to esophagus
-can be due to certain drugs and foods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Risk factors

A

Obesity
Pregnant women
Cigarette and cigar smoking
Hiatal hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Heartburn (pyrosis)

A

Most common clinical manifestation
Burning, tight sensation felt beneath the lower sternum and spreading upward to throat or jaw
Felt intermittently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dyspepsia

A

Pain or discomfort centered in upper abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Regurgitation

A

Described as hot, bitter, or sour liquid coming into throat or mouth
Hypersalivation may also be reported

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Most individuals have mild symptoms like

A

Heartburn after a meal
Occurs once a week
No evidence of mucosal damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Healthcare provider should evalauate

A

Heartburn occurring more than once a week, rated as severe, or occurring at night and waking patient
Older adults w/ recent onset of heartburn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Heartburn occurs

A

Following ingestion of food or drugs that decrease LES pressure
Directly irritates esophageal mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Potential respiratory symptoms

A

Wheezing
Coughing
Dyspnea
Nocturnal coughing w/ loss of sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Otolaryngologic symptoms include

A

Hoarseness
Sore throat
Lump in threat
Choking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Chest pain

A

Described as burning, squeezing, or radiating to back, neck, jaw, or arms
Can mimic angina
More common in older adults
Relieved w/ antacids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Esophagitis

A

*
*Related to direct local effects of gastric acid on esophageal mucosa
Inflammation of esophagus
Frequent complication
Repeated exposure: esophageal stricture (resulting in dysphagia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Barrett’s esophagus (esophageal metaplasia)

A

Replacement of normal squamous epithelium w/ columnar epithelium
Precancerous lesion
Thought to be primarily due GERD
Diagnosed in 5%-15% of patients w/ chronic reflux
S/Sx: none to perforation
Must be monitored every 2-3 years by endoscopy

17
Q

Respiratory Complications

A

Due to irritation of upper airway by secretions
-Cough
-Bronchospasm
-Laryngospasm
-Cricopharyngeal spasm
Potential for asthma, bronchitis, and pneumonia

18
Q

Dental erosion complications

A

From acid reflux into mouth

Especially posterior teeth

19
Q

Diagnostic studies

A

History and physical exam
Barium swallow (can detect protrusion of gastric fundus)
Upper GI endoscopy (useful in assessing LES competence, degree of inflammation, scarring, strictures)
Biopsy and cytologic specimens (differentiate cancer from Barrett’s esophagus)
Esophageal manometric (motility) studies (measure pressure in esophagus and LES)

20
Q

Radionuclide Tests (diagnostic study)

A

Detect reflux of gastric contents

Demonstrate rate of esophageal clearance

21
Q

Monitoring pH

A

Laboratory or 24-hr ambulatory
Determine esophageal pH by using specially designed probes
4-5 region in stomach. Should be more basic than acidic

22
Q

Lifestyle modifications

A

Avoid triggers

23
Q

Nutritional therapy

A

Decrease high-fat foods
Take fluids between rather than with meals
Avoid milk products at night
Avoid late-night snacking or meals
Avoid chocolate, peppermint, caffeine, tomato products, orange juice
Weight reduction therapy
Chewing gum and oral lozenges can increase saliva production and help patients w/ mild symptoms

24
Q

Proton Pump Inhibitors (PPI)

A

Drug therapy
Promotes esophageal healing in 80%-90% f patients
Decrease incidence of esophageal strictures
Headache is most common side effect
Omeprazole
Long-term use or high doses of PPIs may increase the risk of fractures of hip, wrist, and spine
Associated w/ increased risk of C. difficile infection in hospitalized patients

25
Q

Histamine-2 receptor (H2R) blockers

A 
Drug therapy
Decrease secretion of HCl acid
Reduce symptoms and promote esophageal healing in 50% of patients
Cimetidine
Side effects are uncommon
26
Q

Acid protective

A

Drug therapy
Used for cytoprotective properties
Sucralfate

27
Q

Cholinergic

A 
Drug therapy
Increase LES pressure
Improve esophageal emptying
Increase gastric emptying
Bethanechol
28
Q

Prokinetic drugs

A

Drug therapy
Promote gastric emptying
Reduce risk of gastric acid reflux
Meoclopramide

29
Q

Antacids

A 
Drug therapy
Quick but short-lived relief
Neutralize HCl acid
Taken 1-3 hrs after meals/at bedtime
Maalox, Mylanta
30
Q

Surgical therapies when necessary

A 
Failure of conservative therapy
Medication intolerance
Barrett's metaplasia
Esophageal stricture and stenosis
Chronic esophagitis
*Nissen and Toupet fundoplications
31
Q

LINX Reflux Management System

A

Titanium beads w/ magnetic core strung together and implanted laparoscopically into LES
Under resting, nonswallowing conditions, the ring tightens
When individual swallows, the ring opens

32
Q

Endoscopic therapy

A

Endoscopic mucosal resection
Photodynamic therapy
Cryotherapy
Radiofrequency ablation

33
Q

Nursing Management

A 
Elevation of head of bed 30 degrees
Not lying down for 2-3 hrs after eating
Avoidance of late-night eating
Evaluating effectiveness of medications
Observing for side effects of medications
Stress reduction techniques
Weight reduction, if appropriate
Small, frequent meals
34
Q

Avoidance of factors that cause reflux

A

Stop smoking
Avoid alcohol and caffeine
Avoid acidic foods

35
Q

Focusing Postoperative Care

A

Prevention of respiratory complications
Maintenance of fluid/electrolyte balance
Prevention of infection

36
Q

Respiratory assessment postoperative care

A 
Respiratory rate/rhythm
Pulse rate/rhythm
Signs of pneumothorax
-dyspnea
-chest pain
-cyanosis
37
Q

Postoperative care

A

Deep breathing techniques
Accurate I/O
Observing for fluid/electrolyte imbalance
Pain medication
Medications to prevent N/V
When peristalsis returns, only fluids given initially
Solids added gradually
Normal diet gradually resumed
Pt must avoid gas-forming foods and must chew foods thoroughly
First month after surgery, pt may report mild dysphagia; should resolve after edema subsides
Pt should report persistent symptoms such as heartburn and regurgitation

MS Module 2 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions