Flashcards in exam 2 chapter 22 Deck (70)
more vulnerable to complications
decrease ability to handle large volumes
increased risk of aspiration
what is the primary factor in GERD
what is the results of incompetent LES
results in decrease pressure in distal portion of esophagus.
what happens when there is a decrease pressue in the distal portion of the esophagus
gastric contents move from stomach to esophagus.
it can be due to certain foods (caffeine, chocolate) and drugs (anticholinergics.
meal size and number for a patient with GERD
6-8 small males a day
symptoms of GERD
most common clinical manifestation of GERD
tight sensation felt beneath the lower sternum and spreads upward to throat or jaw
relieved by milk, alkaline substances, or water
what are some complications with GERD
1. Barrett's esophagus; replacement of normal squamous epithelium with columner epithelium.
s&s none, to bleeding, to perforation
monitor every2 to 3 years by endoscopy.
due to irritation of upper airway by secretions
3. Dental erosion
Drug there for GERD
1. step up
start with antacids and OTC H2R blockers and progress to prescription H2R blockers and finally PPIs
2. Step down
start with PPIs and titrate down to prescription H2R blockers and finally OTC H2R blockers and antacids
Histamine (H2) receptor blockers for GERD
Suppress secretion of gastric acid (HCl)
when is the best time for the patient to take H2 for GERD
HS (hours of sleep)
to decrease vagally induced histamine release in the stomach
caution with cimetidine
increases bioavailability of many drugs ( beta blockers, morphine, theophyllin, warfarin, dilantin.
passes the blood brain barrier (causes CNS effects)
reacts with antacids
Proton pump inhibitors (PPI) for GERD
REMEMBER (THE PRAZOLES)
suppress gastric acid secretion
promotes esophageal healing
may be beneficial in decreasing esophageal strictures
Tx of active ulcer
take 30 minutes before 1st meals of the day
Side Effects: headache, diarrhea, abd pain, nausea
Drug therapy for GERD; Antacids
quick but short lived relief
Neutralize HCl acid
take 1 to 3 hours after meal before bedtime
Allow 1-2 hour between administration of other medications
Aluminum hydroxide preparations (Maalox, alu-cap)
contain lots of NA (caution: renal, CHF, hypertentsion)
may cause constipation
Calcium carbonate (Mylanta, Tums)
may cause constipation
SE: belching and flatulence (the release of carbon dioxide in the stomach)
Magnesium hydroxide (Milk of magnesia)
may cause diarrhea
caution in renal (toxicity)
often given in combo with aluminum prep
what is vitamin B12 important for
health of peripheral and central nervous system
True or false
evidence that C.difficile is higher risk if patient is on PPIs
acid zaps food born pathogens
what happens when acid production is blocked
decreases intrinsic factor
Treatment of B12 deficiency
diet ( citrus fruits, dried beans, green leafy veggies, liver, buts, organ meats.
B12 injection weekly at first and monthly for lifelong.
which surgical intervention may be necessary if medical management of GERD is unsuccessful
Nissen fundoplication : wrapping of a portion the gastric fundus around the sphincter area of the esophagus.
herniation of portion of the stomach into esophagus through an opening or hiatus in diaphragm
AKA: diaphragmatic and esophageal hernia
most common type of hiatal hernia
stomach slides into thoracic cavity when supine, goes back into abdominal cavity when standing upright
Sliding or type 1 hiatal hernia
Paraesophageal Hiatal hernia
Esophageal junction remains in place, but fundus and greater curvature of stomach roll up through diaphragm.
pt usually feels a sense of fullness after eating or chest pain
causes of hiatal hernia
structural changes: weakening of muscles in diaphragm.
Increased intraabdominal pressure
what are some risk factors for esophageal cancer
excessive alcohol intake
diets low in fruits and veggies
what is noted in the latter stages of esophagus cancer
obstruction of the esophagus
possible perforation into the mediastinum and erosion into the great vessels.
what will be the Dx for an EGD that reveals an esophageal lining that is red rather than pink?