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Flashcards in GERD Deck (55)
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1

Functions of the Digestive System

-ingestion
-mechanical processing
-digestion
-secretion
-absorption
-excretion

2

Stomach

-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

3

Alteration in Gastric Digestion

-GERD (Gastroesophageal Reflux Dz)

-Hiatal Hernia

-PUD (Peptic Ulcer Dz)

-Gastic Cancer

4

GERD

-caused by gastric acid flowing upward into the esophagus

-incompetent lower esophageal sphincter

-acid becomes an irritant destroying esophageal lining

5

Degree of Reaction

-Heartburn

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

6

Lifestyle Variables

-relaxed lower esophageal sphincter (LES)

-overweight

-overeating

-caffeine/alcohol

-smoking

-gastritis

-ulcer dz

-stress

-NSAIDs

-Certain foods (citrus, peppermint, chocolate, fatty and spicy food)

7

Upper GI Series

-Diagnosis

-Barium swallow

-ingestion of barium followed by xrays

8

EGD

Esophagogastroduodenoscopy

-endoscope used
-direct visualization
-can perform biopsy
-oral anesthetic
-observe for return of gag reflex

9

Esophageal Manometry

-determine the strength of the muscles in the esophagus

-small nasal tube

10

PH monitoring

-small nasal tube
-rest above LES
-last 12-24 hrs

11

Bernstein Test

-mild acid placed in the esophagus

12

GERD Tx determined by:

-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

13

GERD Tx

-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)

14

Stretta Procedure

-done on the LES
-use of radiofrequency
-tiny cuts leading to scar tissue

15

Antacids

-Sodium bicarb
-calcium carbonate
-aluminum hydroxide
-magnesium hydroxide

*neutralize stomach acid
*OTC
*tablet or liquid forms
*fast pain relief

16

H2-Receptor Blockers

-Zantac/ranitidine
-Pepcid/famotidine
-Tagment/cimetidine
-Axid/nizatidine

*OTC or by Rx
*Blocks histamine
*reduces acid and pain

17

Proton Pump Inhibitors

• 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

18

Prokinetic Agents

-Reglan/metoclopramide

-Assists the stomach to empty more rapidly
-May help tighten the LES
-Rx

19

Antispasmotics

-Bentyl, Dibent/dicyclomine
-Levsin, Cystospaz/ hyoscyamine

-relaxes smooth muscles of intestine

-works to decrease digestion

-Rx

20

Cytoprotective Agents

-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

21

GERD Complications

-Esophagitis
-Esophageal stricture
-Barrett's Esophagus (considered precancerous)
-Hiatal Hernia

22

GERD Patient Teaching

-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

23

Sliding Hiatal Hernia

stomach moves back and forth through hiatus of the diaphragm

24

Paraesophageal Hiatal hernia

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