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MS2 Exam 3 > GERD > Flashcards

GERD Flashcards

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1
Q

Functions of the Digestive System

A
  • ingestion
  • mechanical processing
  • digestion
  • secretion
  • absorption
  • excretion
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2
Q

Stomach

A
  • holding tank for food
  • food is exposed to stomach acids and digestive effects of pepsin
  • saturates food with gastric juices
  • excretes HCL
  • Ph 2.0
  • Absorbs H2O, alcohol, sugars, salt, electrolytes, and some drugs
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3
Q

Alteration in Gastric Digestion

A
  • GERD (Gastroesophageal Reflux Dz)
  • Hiatal Hernia
  • PUD (Peptic Ulcer Dz)
  • Gastic Cancer
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4
Q

GERD

A
  • caused by gastric acid flowing upward into the esophagus
  • incompetent lower esophageal sphincter
  • acid becomes an irritant destroying esophageal lining
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5
Q

Degree of Reaction

A

-Heartburn

  • most common symptom
  • burning chest pain behind breast bone
  • moves upward toward throat
  • worse after eating, lying down, or bending down
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6
Q

Lifestyle Variables

A
  • relaxed lower esophageal sphincter (LES)
  • overweight
  • overeating
  • caffeine/alcohol
  • smoking
  • gastritis
  • ulcer dz
  • stress
  • NSAIDs
  • Certain foods (citrus, peppermint, chocolate, fatty and spicy food)
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7
Q

Upper GI Series

A
  • Diagnosis
  • Barium swallow
  • ingestion of barium followed by xrays
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8
Q

EGD

A

Esophagogastroduodenoscopy

  • endoscope used
  • direct visualization
  • can perform biopsy
  • oral anesthetic
  • observe for return of gag reflex
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9
Q

Esophageal Manometry

A
  • determine the strength of the muscles in the esophagus

- small nasal tube

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10
Q

PH monitoring

A
  • small nasal tube
  • rest above LES
  • last 12-24 hrs
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11
Q

Bernstein Test

A

-mild acid placed in the esophagus

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12
Q

GERD Tx determined by:

A
  • age, overall health and medical hx
  • extent of condition
  • tolerance to specific meds, procedures, and therapies
  • expectation for the course of the condition
  • patient opinion or preference
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13
Q

GERD Tx

A
  • diet and lifestyle changes
  • meds
  • quit smoking
  • observe food intake and food types
  • eat smaller portions
  • avoid overeating
  • watch alcohol consumption
  • do not lie down or go to bed right after eating
  • decrease fluid intake
  • Lie on left side, elevate HOB 30 degrees
  • Lose excess weight
  • Surgical correction (Nissen fundoplication)
  • Non-surgical correction (Stretta Procedure)
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14
Q

Stretta Procedure

A
  • done on the LES
  • use of radiofrequency
  • tiny cuts leading to scar tissue
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15
Q

Antacids

A
  • Sodium bicarb
  • calcium carbonate
  • aluminum hydroxide
  • magnesium hydroxide
  • neutralize stomach acid
  • OTC
  • tablet or liquid forms
  • fast pain relief
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16
Q

H2-Receptor Blockers

A
  • Zantac/ranitidine
  • Pepcid/famotidine
  • Tagment/cimetidine
  • Axid/nizatidine
  • OTC or by Rx
  • Blocks histamine
  • reduces acid and pain
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17
Q

Proton Pump Inhibitors

A
  • Prevacid (lansoprazole)
  • Aciphex (rabeprazole)
  • Prilocec (omeprazole)
  • Protonix (pantoprazole)
  • Nexium (esomeprazole)
  • blocks the enzyme in the stomach that produces acid
  • promotes healing of the stomach and esophagus
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18
Q

Prokinetic Agents

A

-Reglan/metoclopramide

  • Assists the stomach to empty more rapidly
  • May help tighten the LES
  • Rx
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19
Q

Antispasmotics

A
  • Bentyl, Dibent/dicyclomine
  • Levsin, Cystospaz/ hyoscyamine
  • relaxes smooth muscles of intestine
  • works to decrease digestion
  • Rx
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20
Q

Cytoprotective Agents

A
  • Prescription only: Carafate/sucralfate, cytotex/misoprostol
  • OTC (Pepto)
  • Protects lining of stomach and intestine
  • Does not decrease the amount of acid
  • Used to prevent ulcer formation
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21
Q

GERD Complications

A
  • Esophagitis
  • Esophageal stricture
  • Barrett’s Esophagus (considered precancerous)
  • Hiatal Hernia
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22
Q

GERD Patient Teaching

A
  • foods
  • smoking cessation
  • stress avoidance
  • medications and S/E
  • Importance of following medical regime
  • S/S to report to physician
  • Possible pre and post op care
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23
Q

Sliding Hiatal Hernia

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A

stomach moves back and forth through hiatus of the diaphragm

24
Q

Paraesophageal Hiatal hernia

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A

AKA Rolling

-greater curvature of the stomach move above diaphragm forming a pocket

25
Primary Prevention of Hiatal Hernia
-unknown
26
Hiatal Hernia
A condition in which part of the stomach pushes up through the diaphragm muscle.
27
Hiatal Hernia Risk Factors
- weakening of diaphragm muscles - increased intra-abdominal pressure - increased age - trauma - poor nutrition - forced recumbent positioning - congenital - obesity - large meals - alcohol - smoking
28
Hiatal Hernia Degree of Rxn
- may be asymptomatic - heartburn - nocturnal heartburn - dysphagia - mimics gallbladder dz
29
Complications of Hiatal Hernia
- GERD - Hemorrhage - Esophageal stenosis - Ulceration - Strangulation - Regurgitation with aspiration
30
How to Diagnose Hiatal Hernia
- EGD | - Barium Swallowing
31
Hiatal Hernia Secondary Prevention
-conservative therapy: lifestyle modifications and meds surgical therapy: Nissen fundoplication
32
Nissen Fundoplication
sometimes known as laparoscopic fundoplication when performed via laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia.
33
PUD
Peptic Ulcer Dz - erosion of the GI mucosa from the action of HCL and pepsin - Includes gastric and duodenal ulcers
34
Phases of PUD
- Erosion - Acute Ulcer - Perforated Ulcer
35
Helicobacter Pylori
- 80 to 90 percent of all ulcers - bacterium infection - weakens the stomach's protective mucus
36
PUD Manifestations
- heartburn - gnawing/burning pain - acid, bitter, slimy taste in mouth - belching/indigestion - N/V - Weight loss and poor appetite - Feeling tired and weak
37
PUD Complications
-all are emergencies -hemorrhage most common -Perforation most lethal Gastric outlet obstruction
38
Hemorrhage from PUD
- most common - black, tarry stools (MELENA) - Occult blood - Emesis (coffee ground or fresh)
39
Perforation from PUD
- most lethal complication - requires sx - causes peritonitis - S/S onset sudden and dramatic (abdomen pain, muscles contract and board-like, RR shallow and rapid, absent bowel sounds)
40
Gastric Outlet Obstruction from PUD
-narrowing of pylorus: scar tissue, pylorospasm, edema/inflammation - vomiting projectile - contains food particles - offensive odor
41
PUD Secondary Prevention
- endoscopy: direct visualization - H. pylori testing: sputum, urine, blood, tissue, breath, urea breath shows active infection - occult blood
42
Lifestyle Modifications for PUD
- bland diet and 6 small meals per day - protein neutralizes but stimulates gastric secretions - adequate physical/emotional rest - stop ASA and NSAIDs - Strict adherence to prescribed meds - Antibiotic therapy for H. Pylori (maybe two or more ABs)
43
Carafate
Sucralfate - slurry - give on empty stomach 1 hour before meals and bedtime
44
Pepto-Bismol
- promotes healing - partially effective against H. Pylori - may blacken stools
45
Cytotec
Misoprostol - for pts taking ASA or NSAIDs - prevents gastric ulcers induced by the above
46
Surgical therapy
- 20% of ulcer patients - indications: obstruction, perforation, hemorrhage, ulcers unresponsive to tx, multiple ulcer sites, possible malignancy
47
Gastrojejunostomy
- for gastric outlet obstruction | - food bypasses the obstruction
48
Vagotomy
- truncal (total) - selective - reduces acid - reduces gastric motility - often combined with Billroth 1 and 2
49
Pyloroplasty
- surgical enlargement - aids gastric emptying - can do balloon angioplasty
50
Dumping syndrome
- post op complication | - result of large portion of stomach and pyloric sphincter removal
51
Postprandial Hypoglycemia
- form of dumping syndrome | - large bolus of carbs dumps into small intestine resulting in decreased BS
52
Bile Reflux Gastritis
related to sx on pyloric sphincter
53
Pre-op Teaching
- NPO - procedure teaching - C and DB, IS, incisional splinting - IV therapy - NG tube - pain relief - answer all questions
54
Post-op Patient Care
- promote comfort - promote effective airway management and gas exchange - monitor I and Os
55
Monitoring I and O's
- NG drainage: amount, color, odor - bright red in beginning, then coffee-ground - becomes yellow-green after 36-48 hrs - do not irrigate or reposition - abdominal dressing - always at risk for ulcer redevelopment - adequate rest, nutrition with avoidance of stressors - emphasize avoidance of meds not prescribed MD, alcohol and smoking

MS2 Exam 3 (13 decks)

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