Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease (GERD)

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Gastroesophageal reflux disease (GERD)

NUR -1040-LD08 Gastroesophageal reflux disease (GERD)

Introduction Gastroesophageal reflux disease or GERD, is a chronic condition where stomach contents flows back up into the esophagus which is mainly due to a damaged/weak lower esophageal sphincter (LES). Pathophysiology • Digestion starts in the mouth when food is chewed. Then it is swallowed. The food is then squeezed down into the esophagus and the lower esophageal sphincter relaxes to let the food into the stomach and then it CLOSES again to prevent the food from back flowing. • Acid reflux occurs when the sphincter muscle at the lower end of your esophagus relaxes at the wrong time, allowing stomach acid to back up into your esophagus. This can cause heartburn and other signs and symptoms. • Frequent or constant reflux can lead to gastroesophageal reflux disease (GERD) Risk Factors • Obesity • Sleep apnea • Delayed gastric emptying • Nasogastric tube • Pregnancy Signs and Symptoms Common signs and symptoms of GERD include: • A burning sensation in your chest (heartburn), usually after eating, which might be worse at night • Chest pain • Difficulty swallowing • Regurgitation of food or sour liquid • Sensation of a lump in your throat • Bitter taste in mouth • Dry cough Laboratory Tests • A barium Swallow (Esophagram): can check for ulcers or a narrowing of the esophagus. You firs swallow a solution to help structures show up on an X-ray. • PH monitoring : can check for acid in your esophagus. The doctor inserts a device into your esophagus and leaves it in place for 1 to 2 days to measure the amount of acid in your esophagus. • Endoscopy : can check for problems in your esophagus or stomach. This test involves inserting a flexible, lighted tube with a camera down your throat. First, the doctor will spray the back of your throat with anesthetic and give you a sedative to make you more comfortable. • A biopsy : may be taken during endoscopy to check samples of tissue under a microscope for infe or abnormalities. • Esophageal manometry: Esophageal manometry is a test to assess motor function of the upper esophageal sphincter, esophageal body and lower esophageal sphincter Diagnosis Procedures • Upper endoscopy. Your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat, to examine the inside of your esophagus and stomach. Test results can often be normal when reflux is present, but an endoscopy may detect inflammation of the esophagus (esophagitis) or other complications. Laparoscopy is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera.

Gastroesophageal reflux disease (GERD) – Nurses Homework | Nurses Homework

The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen. . Diagnosis Procedures • Laryngoscopy is endoscopy of the larynx, a part of the throat. It is a medical procedure that is used to obtain a view, for example, of the vocal folds and the glottis. • X-ray of your upper digestive system. X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. The coating allows your doctor to see a silhouette of your esophagus, stomach and upper intestine Treatment • The primary treatment of GERD is diet and lifestyle changes, advancing to medication use (antacids, H2 receptor antagonists, proton pump inhibitors) and surgery. • Untreated GERD leads to inflammation, breakdown, and long-term complications, such as Barrett’s esophagus or adenocarcinoma of the esophagus Medications • Proton pump inhibitors (PPIs) Pantoprazole, omeprazole, esomeprazole, rabeprazole and lansoprazole reduce gastric acid by inhibiting the cellular pump of the gastric parietal cells necessary for gastric acid secretion Nursing Consideration •Monitor for electrolyte imbalances and hypoglycemia in clients who have diabetes mellitus •Long term us of PPI increases the risk for fractures and has been related to the development of community acquired pneumonia and C. diff. incfections Medications • Antacids Aluminum hydroxide, magnesium hydroxide, calcium carbonate and sodium bicarbonate neutralize excess acid and increase lower esophageal sphincter (LES) pressure Nursing Consideration • Ensure there are no contraindications with other prescribed medications (levothyroxine), • Evaluate kidney function in clients taking magnesium hydroxide • Take antacids when acid secretion is the highest (1 to 3 hr after eating and at bed time), separate from other medications by at least 1 hour Medications • Prokinetics Metoclopramide increases the motility of the esophagus and stomach Nursing Consideration • Monitor clients taking metoclopramide for extrapyramidal side effects • Report abnormal, involuntary movements Medications • Histamine2 receptor antagonists Ranitidine, famotidine, and nizatidine reduce the secretion of acid. The onset is longer than antacid, but the effect has a longer duration Nursing Consideration • Use cautiously in clients who have kidney disease • Take with meals and at bed time • Separate dosages from antacids (1 hour before or after taking antacids) Therapeutic Procedure (Stretta) Stretta procedure uses radiofrequency energy, applied by an endoscope, to decrease vagus nerve activity.