Sphincter normally opens and shuts to allow food to pass with GERD its an

Sphincter normally opens and shuts to allow food to

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Sphincter normally opens and shuts to allow food to pass, with GERD it’s an inappropriate relaxation with this sphincter which allows food contents to go back up into the esophagus where it is not suppose to go It should stay down below the sphincter o The problem with this is you get esophageal inflammation the degree of inflammation depends on the number of episodes, the duration, the acidity or alkalinity of the acid reflux episode When the esophagus becomes inflamed it loses its ability to clear reflux material efectively this leads to further esophageal damage and progression of the severity of GERD Nighttime swallowing rate and salivation is usually lower Patient being in a recumbent position interferes with clearance of that airway o Chronic reflux causes hyperuremia and inflammation which also causes minor capillary bleeding which is common so this could cause upper GI bleeding in some patients Causes of decreases in Lower Esophageal Sphincter (LES) pressure o Fatty food o Nicotine o Cafeine-containing substances chocolate, cola, cofee, tea o Elevated hormone level estrogen, progesterone o Increased intraabdominal pressure obesity, pregnancy, heavy lifting, tight clothing o Certain meds CCBs, theophylline, NSAIDS Clinical Manifestations o Pyrosis (Heartburn) burning sensation in the esophagus Heart burn may radiate to their neck, back, and jaw May feel like having chest pain or angina Usually occurs within 20 minutes to 2 hours after eating Sometimes if patient comes in with chest pain and want to rule out cardiac, pt given “GI cocktail” liquid, antacid, viscous lidocaine, anticholinergic medications (any medication used to treat dyspepsia)—wide variety o Another mixture may be Maalox, dilatol, xylocaine in equal parts Each hospital’s pharmacy has their recipe for GI cocktail mix it and send it to them in a bottle just like liquid medication administer this to patient to rule our whether it’s GI or cardiac o Dyspepsia indigestion o Regurgitation—warm feeling Fluid moving in the throat Can lead to aspiration! Can have a sour bitter taste that’s preceding the pharynx Biggest concern is ASPIRATION with someone with regurgitation o Water brash reflex hypersecretion of the salivary glands Excessive saliva in their mouth May occur with GERD o Frequent belching and Flatulence o Dysphagia—trouble swallowing – Only occur in severe cases o Odynophagia (pain on swallowing) – Only occur in severe cases o Nocturnal cough when they lay down in bed at night will start coughing o Wheezing and hoarseness o Hypersalivation o Esophagitis o Symptoms may mimic those of a heart attack—patient’s history aids in obtaining accurate diagnosis Complications o Can progress to serious or life threatening problems o Esophageal ulceration & hemorrhage caused from severe erosion o Aspiration at risk for aspiration with night time reflux
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  • Spring '14
  • AmyG.Bufford
  • Gastroesophageal reflux disease, Achalasia

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