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327-GI-studyguide2.docx - Disease Issue Risk Factors Signs...

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GERD Teaching: Disease/ Issue Risk Factors Signs and Symptoms Diagnostic Tests Interventions /treatments Complications Gastroeso phageal Reflux Disease (GERD) Reflux (backward flow) of GI contents into the esophagus, irritating the mucosa and causing inflammati on . Chronic inflammati on causes hyperemia and erosion resulting in the body replacing the tissue with Barrett’s epithelium (pre- malignant) instead of squamous. Fibrosis and scarring can produce Excessive LES relaxation (MOST COMMON cause) o Smoking o Alcohol NG tube placement keeps sphincter open so acid can back up into the throat H. pylori Sleep apnea Factors that increase abdominal and intragastric pressure: o Obesity o Pregnan cy o Wearing tight belts or girdles o Bending over o Ascites Gastric distention from eating large meals or foods that lower LES Dyspepsia (“heartburn”) o Pyrosis (retrostern al burning) may also occur Regurgitation (lead to aspiration or bronchitis) o “Sour” or “bitter” taste after warm fluid travels up the throat Epigastric pain substernal wave- like “burning” pain that occurs after each meal and lasts for 20 minutes to 2 hours o WORSENS when patient: Ben ds ove r Stra ins Lies dow n o RELIEVED by: 24-hour ambulatory esophageal pH monitoring MOST ACCURATE method Place small catheter through nose into the esophagus and patient asked to keep diary of activities and symptoms while pH is being continuous ly monitored. Esophagogast rodueodenos ocopy (EGD) Diagnosing or evaluating reflux esophagitis OR monitoring Barrett’s esophagus EVERY 1-3 NUTRITIONAL THERAPY: Limit or eliminate foods that decrease LES pressure o F atty o A lcohol o C affeine o C hocolate o C itrus o T omatoes o S picy Restrict spicy and acidic food such as OJ and tomatoes To promote HEALING Have patient eat four to six small meals per day Large meals increase pressure and delay emptying Teach patient to eat a high protein , low fat diet. Eat SLOWLY and CHEW thoroughly to prevent belching Remain UPRIGHT for at least 1-2 hours after eating NO FOOD 3 HOURS BEFORE BED!!! Reflux is the MOST damaging at night LIFESTYLE CHANGES: Sleep in right side lying position and MOUTH : Dental erosion (decay) ESOPHAGUS : Barrett’s esophagus Squamous epithelium is replaced with columnar epithelium (PRE- MALIGNENT!) o NO s/sx o Endoscopy every 1-3 years Esophagitis Irritation + inflammation causes erosion, ulceration, and fibrous tissue leading to: o Dysphagia o Bleeding Esophageal strictures RESPIRATORY : Aspiration pneumonia Adult-onset asthma Bronchospasms Laryngospasms Chronic bronchitis
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NUTRITION: 1. Limit or eliminate foods that decrease LES pressure AVOID the FACCCTS !
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