1. Gastroesophageal Reflux Disease PRESONTATION BY MELISSA VANDYKE

2. What is GERD????? A BACKWARD FLOW OF THE STOMACH ACID UP INTO THE ESOPHAGUS THE LOWER ESOPHAGEAL SPHINCTER (LES) DOESN’T CLOSE PROPERLY A BACKWARD FLOW OF THE STOMACH ACID UP INTO THE ESOPHAGUS THE LOWER ESOPHAGEAL SPHINCTER (LES) DOESN’T CLOSE PROPERLY COMMON IN THE POSTPRANDIAL STATE (AFTER MEALS) MORE THAN 60% OF REFLUX SUFFERS HAVE DELAYED STOMACH EMPTYING COMMON IN THE POSTPRANDIAL STATE (AFTER MEALS) MORE THAN 60% OF REFLUX SUFFERS HAVE DELAYED STOMACH EMPTYING

3. SIGNS AND SYMPTOMS SYMPTOMS OF GERD DEVELOP WHEN THE LES IS WEAK OR EXPERIANCES PROLONGED OR FREQUENT TRANSIENT RELAXATION WHICH THEN CAUSES THE BACKFLOW OF GASTRIC CONTENTS. SYMPTOMS OF GERD DEVELOP WHEN THE LES IS WEAK OR EXPERIANCES PROLONGED OR FREQUENT TRANSIENT RELAXATION WHICH THEN CAUSES THE BACKFLOW OF GASTRIC CONTENTS. TYPICAL SYMPTOM IS BURNING AND PRESSURE BEHEIND THE STERNUM TYPICAL SYMPTOM IS BURNING AND PRESSURE BEHEIND THE STERNUM BURNING SENSATION TENDS TO RAIDIATE UPWARD AND MAY INVOLVE THE NECK, JAW, OR BACK BURNING SENSATION TENDS TO RAIDIATE UPWARD AND MAY INVOLVE THE NECK, JAW, OR BACK

4. SYMPTOMS CONTINUED PAIN TYPICALLY OCCURS 20 MINUTES TO 2 HOURS AFTER EATING PAIN TYPICALLY OCCURS 20 MINUTES TO 2 HOURS AFTER EATING REGURGITATION FEELING OF WARM FLUIDS MOVING UP THE THROAT. REGURGITATION FEELING OF WARM FLUIDS MOVING UP THE THROAT. SEVER CASES NOCTURNAL COUGHING, WHEEZING, OR HOARSNESS SEVER CASES NOCTURNAL COUGHING, WHEEZING, OR HOARSNESS

5. DIAGNOSTIC TESTS 24 HOUR pH MONITORING (RECORDS NUMBER, DURATION, AND SERVERITY OF REFULX EPISODES) 24 HOUR pH MONITORING (RECORDS NUMBER, DURATION, AND SERVERITY OF REFULX EPISODES) EVALUATE LES COMPETENCE AND THE RESPONSE OF ESPHAGUS TO ACID INFUSION EVALUATE LES COMPETENCE AND THE RESPONSE OF ESPHAGUS TO ACID INFUSION

6. MEDICATIONS  ANTIACIDS, ACID BLOCKING MEDS (TAGAMENT,ZANTAC, PEPCID, AXID)  PROTON PUMP INHIBITORS (PRILOSEC, NEXIUM, PROTONIX, PREVACID)  REGLAN A PROMOTILITY AGENT IS USED IN SEVERE CASES TO HELP INCREASE PERISTALSIS WITHOUT STIMULATING SECRETIONS  LAST RESORT? FUNDOPLICATION IS PREFORMED TO STRENGTHEN THE LES

7. WHAT HAPPENS IF LEFT UNTREATED???? SERIOUSE PATHOLOGICAL CHANGES IN THE ESPHAGEAL LINING MAY DEVELOP (BARRETT’S ESOPHAGUS) SERIOUSE PATHOLOGICAL CHANGES IN THE ESPHAGEAL LINING MAY DEVELOP (BARRETT’S ESOPHAGUS) BARRETT’S ESOPHAGUS THERE IS REPLACEMENT OF THE NORMAL SQUAMOS EPITHELIUM OF ESOPHAGUS WITH COLUMNAR EPITHELIUM BARRETT’S ESOPHAGUS THERE IS REPLACEMENT OF THE NORMAL SQUAMOS EPITHELIUM OF ESOPHAGUS WITH COLUMNAR EPITHELIUM PATIENTS WITH BARRETT’S ESOPHAGUS ARE AT HIGH RISK FOR ADENOCARCINOMA PATIENTS WITH BARRETT’S ESOPHAGUS ARE AT HIGH RISK FOR ADENOCARCINOMA

8. NURSING INTERVENTIONS AND PATIENT TEACHING  DIET : EAT 4-6 SMALL MEALS A DAY; LOW FAT HIGH PROTEIN; REDUCE CAFFIENE INTAKE; AVOID FOODS THAT PRODUCE HEARTBURN AVOID EATING 2-3 HOURS BEFORE BEDTIME AND ELEVATE THE HEAD OF THE BED 6-8 INCHES NEVER SLEEP FLAT

9. PATIENT TEACHING CONTINUED ELIMINATE OR DRASTICALLY REDUCE SMOKING ELIMINATE OR DRASTICALLY REDUCE SMOKING  AVOID CONSTRICTIVE CLOTHING

10. AND THE OUTCOME IS…………. IF GERD IS NOT SUCCESSFULLY CONTROLLED CAN PROGRESS TO SERIOUS EVEN LIFE THREATENING PROBLEMS. IF GERD IS NOT SUCCESSFULLY CONTROLLED CAN PROGRESS TO SERIOUS EVEN LIFE THREATENING PROBLEMS. ESOPHAGEAL ULCERATION AND HEMORRAGE MAY RESULT ESOPHAGEAL ULCERATION AND HEMORRAGE MAY RESULT CHRONIC NIGHTTIME REFLUX IS ACCOMPANIED BY SERIOUSE RISK FOR ASPIRATION CHRONIC NIGHTTIME REFLUX IS ACCOMPANIED BY SERIOUSE RISK FOR ASPIRATION ADENOCARCINOMA CAN DEVELOP FROM THE PREMALIGNANT TISSUE (BARRETT’S EPITHELIUM) ADENOCARCINOMA CAN DEVELOP FROM THE PREMALIGNANT TISSUE (BARRETT’S EPITHELIUM) GRADUAL OR REPEATED SCARRING CAN PERMANENTLY DAMAGE ESOPHAGEAL AND PRODUCE STRICTURE. GRADUAL OR REPEATED SCARRING CAN PERMANENTLY DAMAGE ESOPHAGEAL AND PRODUCE STRICTURE.