Abdelrahman Alkilani, RN, BSN

Gastro-Esophageal Reflux Disease

Overview

Anatomy and physiology Definition of GERD Phathophysiology Clinical manifistations Diagnostic tests Medical management Nursing management

Anatomy and physiology

Esophagus Mucus-lined, muscular tube that carries food from the

mouth to stomach. Begins at the base of the pharynx and ends about

4cm below the diaphragm. Its ability to transport food and fluid is facilitated by

the upper esophageal sphincter (hypophrengeal) and the lower esophageal sphincter (gastroesophageal).

There is no serosal layer of the esophagus.

GERD

Some degree of esophageal reflux (back-flow of gastric and dudenal contents into the esophagus) is normal in both adults and children.

GERD is the excessive reflux.

Pathophysiology

Normally, Lower Esophageal Sphincter (LES) creates enough pressure around the lower end of the esophagus to close it. So, gastric content don’t back up into the esophagus.

Reflux occurs when LES pressure is deficient or the pressure of the stomach exceed LES pressure

When this happens, the LSE relaxes.

Pathophysiology

Common causes Incompetent lower esophageal sphincterPyloric stenosisMotility disorder

Pathophysiology

The acidity of gastric content and amount of time in contact with esophageal mucosa are related to the degree of mucosal damage.

Esophageal ulcer and esophagitis may result

Clinical Manifestations

Pyrosis (Burning sensation in the esophagus). Dyspepsia (indigestion). Regurgitation. Dysphagia or odynophagia (pain on swallowing) Hypersalivation. Esophagitis.

Assessment and Diagnostic findings Endoscopy

Assessment and Diagnostic findings Barium swallow

To evaluate the damageto the esophgeal mucosa.

Assessment and Diagnostic findings Ambulatory 12- to 36-hour

esophageal pH monitoring to evaluate the degree of acid reflux

Assessment and Diagnostic findings Bilirubin monitoring (bilitec)

To measure bile reflux patterns

Medical Management

Health EducationDiet

Low fat diet Avoid caffeine, tobacco, beer, milk, foods

containing peppermint or spearmint, and carbonated beverage.

Avoid eating or drinking 2 hours before bed time.

Medical Management

Health EducationMaintain body weight.Avoid tight-fitting clothes.Elevate the head of the bed on 15-20cm

blocks.Elevate the upper body on pillow.

Medical Management

MedicationsAntacids or H2 receptor antagonist.

famotidine, nizatidine, or rantidineProton pump inhibitors

Lanzoprazole, esomeprazole, or rabeprazole.Prokinetic agents

Bethanecol, dompridone, and meetoclopramide.

Medical Management

Surgical interventionNissen fundoplication(wrapping of a portion of the gastric fundus around the

sphincter area of esophagus)

Nursing managementAssessment Nursing

diagnosisObjective Intervention evaluation

Pt complains of pyrosis

Impaired tissue integrity R/T esophageal exposure to gastric acid

- Pt not to have pyrosis for after 8 hrs.- Pt is able to verbalize knowledge of necessity lifestyle changes with 24 hours of discharge from the hospital

Teach patient to avoid foods that cause pain and or can increase acid secretion.

-Pt has no more pyrosis-Pt knows the necessity lifestyle changes

Nursing managementAssessment Nursing

diagnosisObjective Intervention evaluation

- Pt complains of recurrent regurgitation

- Pt shows signs of uncomforting.

Risk of aspiration R/T recurrent regurgitation

Pt won’t show signs of aspiration within 8 hours

Teach the pt to:-Elevate the HOB while in bed -Eat small frequent meals.-Not to eat or drink 2 hours before bed time

-No more regurgitations, according to the pt

Nursing managementAssessment Nursing

diagnosisObjective Intervention evaluation

- Pt complains of pain 8 on scale

-Pt shows signs of uncomfort

Acute pain R/T tissue exposed to gastric content

Pain will be relieved within 8 hours

-Assure that pt is taking his medication on timeTeach patient to avoid foods that cause pain and or can increase acid secretion

- Pain score became 2 out of 10

Nursing managementAssessment Nursing

diagnosisObjective Intervention evaluation

-Pt has weight loss-Pt state that he is not eating so he’ll not feel pyrosis.

Imbalance nutrition R/T decrease intake

Pt will achieve adequate caloric and nutritional intake

-Explain the importance of adequate nutrition -Teach the pt about the diet which doesn’t cause esophagus irritation

-No more weigh loss during the daily weighting-Pt receiving and adequate caloric diet as followed by Dietitian

Summary GERD is an excessive reflux may occur because

of a incompetent lower esophageal sphincter, pyloric stenosis, or a motility disorder.

symptoms may include pyrosis, dyspepsia, regurgitation.

Management starts with health education, then medications, and the last option will be the surgical interventions

Nurses play a significant role in providing care for patients with GERD.

Assignment

Write about a diet plan for patient with GERD. What are the recommended food for them and which types of food should be avoided.Date of submission, Monday 12th Oct, 2015.

Reference

Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 2013.

Thanks