Transcript Gastroesophageal Reflux Disease

Gastroesophageal Reflux
Disease
PRESONTATION BY MELISSA VANDYKE
What is GERD?????
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A BACKWARD FLOW OF THE STOMACH ACID UP INTO
THE ESOPHAGUS
THE LOWER ESOPHAGEAL SPHINCTER (LES) DOESN’T
CLOSE PROPERLY
COMMON IN THE POSTPRANDIAL STATE (AFTER
MEALS) MORE THAN 60% OF REFLUX SUFFERS HAVE
DELAYED STOMACH EMPTYING
SIGNS AND SYMPTOMS
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SYMPTOMS OF GERD DEVELOP WHEN THE LES IS WEAK OR
EXPERIANCES PROLONGED OR FREQUENT TRANSIENT
RELAXATION WHICH THEN CAUSES THE BACKFLOW OF GASTRIC
CONTENTS.
TYPICAL SYMPTOM IS BURNING AND PRESSURE BEHEIND THE
STERNUM
BURNING SENSATION TENDS TO RAIDIATE UPWARD AND MAY
INVOLVE THE NECK, JAW, OR BACK
SYMPTOMS CONTINUED
PAIN TYPICALLY OCCURS 20 MINUTES
TO 2 HOURS AFTER EATING
 REGURGITATION FEELING OF WARM
FLUIDS MOVING UP THE THROAT.
 SEVER CASES NOCTURNAL COUGHING,
WHEEZING, OR HOARSNESS
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DIAGNOSTIC TESTS
24 HOUR pH MONITORING (RECORDS
NUMBER, DURATION, AND SERVERITY OF
REFULX EPISODES)
 EVALUATE LES COMPETENCE AND THE
RESPONSE OF ESPHAGUS TO ACID INFUSION
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MEDICATIONS
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ANTIACIDS, ACID BLOCKING MEDS
(TAGAMENT,ZANTAC, PEPCID, AXID)
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PROTON PUMP INHIBITORS
(PRILOSEC, NEXIUM, PROTONIX,
PREVACID)
REGLAN A PROMOTILITY AGENT IS
USED IN SEVERE CASES TO HELP
INCREASE PERISTALSIS WITHOUT
STIMULATING SECRETIONS
LAST RESORT? FUNDOPLICATION IS
PREFORMED TO STRENGTHEN THE
LES
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WHAT HAPPENS IF LEFT
UNTREATED????
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SERIOUSE PATHOLOGICAL
CHANGES IN THE ESPHAGEAL
LINING MAY DEVELOP
(BARRETT’S ESOPHAGUS)
BARRETT’S ESOPHAGUS THERE
IS REPLACEMENT OF THE
NORMAL SQUAMOS EPITHELIUM
OF ESOPHAGUS WITH
COLUMNAR EPITHELIUM
PATIENTS WITH BARRETT’S
ESOPHAGUS ARE AT HIGH RISK
FOR ADENOCARCINOMA
NURSING INTERVENTIONS AND
PATIENT TEACHING
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DIET: EAT 4-6
SMALL MEALS A DAY;
LOW FAT HIGH
PROTEIN; REDUCE
CAFFIENE INTAKE;
AVOID FOODS THAT
PRODUCE
HEARTBURN
AVOID EATING 2-3 HOURS
BEFORE BEDTIME AND
ELEVATE THE HEAD OF
THE BED 6-8 INCHES
NEVER SLEEP FLAT
PATIENT TEACHING CONTINUED
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ELIMINATE OR
DRASTICALLY
REDUCE SMOKING
AVOID
CONSTRICTIVE
CLOTHING
AND THE OUTCOME IS………….
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IF GERD IS NOT SUCCESSFULLY CONTROLLED CAN
PROGRESS TO SERIOUS EVEN LIFE THREATENING
PROBLEMS.
ESOPHAGEAL ULCERATION AND HEMORRAGE MAY
RESULT
CHRONIC NIGHTTIME REFLUX IS ACCOMPANIED BY
SERIOUSE RISK FOR ASPIRATION
ADENOCARCINOMA CAN DEVELOP FROM THE
PREMALIGNANT TISSUE (BARRETT’S EPITHELIUM)
GRADUAL OR REPEATED SCARRING CAN PERMANENTLY
DAMAGE ESOPHAGEAL AND PRODUCE STRICTURE.