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GERD (** = NTK)

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cdunbar4's version from 2016-10-16 16:07

Etiology/Manis

Question Answer
#2 cause of esophageal cancers, definition?GERD: chronic symptoms or mucosal damage, secondary to reflux of gastric contents into LE
Acidity of HCl0.9
#1 predisposing factorIncompetent (abnormal relaxation) of LES = gastric contents go up
other predisposing factorshiatal hernia; ↓ esophageal clearance (can't get food to stomach); ↓ gastric emptying; impaired esophageal motility
Acidic gastric secretions reflux and cause __________ & ________________ in esophagus and problems that follow.irritation & inflammation
Clinical Mani that can occur >2x a week, becoming more severe or at nightheartburn (pyrosis) → should be evaluated
top 2 complaints (subjective symptoms)Burning (described as heartburn); tight sensation felt beneath the lower sternum and spreads upwards.
Other reports/complaints from patientswheezing, coughing, dyspnea, hoarseness (over time), sore throat, lump in throat, choking
Regurgitation is common, tastes like?hot, bitter or sour liquid
Gastric symptomsearly satiety, post meal bloating, n/v (delayed gastric emptying)
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Diagnostics

Question Answer
Barium swallow (esophragm)metallic compound that shows up on xray (a picture!) to visualize upper stomach and esophagus
endoscopy can look at what 3 areas?look at esophagus, stomach and duodenum
endoscopy can assess the degree of inflammation, ________ & potential _________.scarring, strictures
Biopsy & cytologic specimens can help diagnose between....stomach or esophageal carcinoma from Barrett's esophagus and degree of dysplasia (high or low-grade)
Esophageal manometric studiesmotility study that measures pressure w/in esophagus (measure of motility function)
Radionuclide tests measures...transit time and percentage of emptying of esophagus (rate of esophageal clearance)
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Collaborative Care

Question Answer
Lifestyle modifications #1?STOP SMOKING
lifestyle modselevate HOB 12" or 30 degrees (use blocks/books under bed posts); stay sitting 1-2 hours after eating.
nutritional therapyavoid acid or acid-producing foods; small/frequent meals (none near bedtime); don't lie down right after eating; if it bothers you, DON'T EAT IT
**Drug to ↑ LES pressure (cholinergic)bethanechol (Urecholine)
**Drug to promote motility (prokinetic)metoclopramide (Reglan)
**Drugs (3) to neutralize acid (antacids)Gelusil, Maalox, Mylanta
**Drugs (4) H2 receptor blockers (antisecretory)cimetidine (Tagemet); famotidine (Pepcid); nizatidine (Axid); ranitidine (Zantac)
**Drugs (3) PPI's (antisecretory)lansoprazole (Prevacid); omeprazole (Prilosec); pantoprazole (Protonix)
Prolonged use of PPIs can lead to?C.Diff
Patients with what complications qualify for surgical therapy?esophagitis, intolerance of meds, strictures, Barrett's metaplasia and persistence of severe symptoms
Objective of surgical intervention↓ reflux by enhancing integrity of LES
Nissan fundolication (usually for hiatel hernia)fundus of stomach is wrapped around lower portion of esophagus to reinforce and repair the defective barrier
Endoscopic therapymucosal resection; photodynamic therapy; cryotherapy; radiofrequency ablation
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Gerontological Considerations

Question Answer
Aging effectsdiaphragm weaker, ↑obesity, surgical interventions are riskier, hard to change lifestyle
REMEMBER with post-op and ppl with ↓gag reflex →**↑ RF ASPIRATION PNEUMONIA
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