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1) What is the Etiology and Pathophysiology of gerd?
2) what is the S&S of gerd
1) Gastric contents enter esophagus causing inflammation; may cause aprecancerous condition (Barrett’s esophagus) Secondary to ↓lower esophageal sphincter (LES) tone, obesity, hiatalhernia, pregnancy
- 2)Heartburn (pyrosis), hoarseness, wheezing, dysphagia
- Esophageal pH shows acidity, endoscopy or barium swallow reveal tissue damage
- 3)Proton pump inhibitors, H2 receptor blockers, antacids, cholinergics
- ■ Surgery to tighten esophageal fundus
1) What is hiatal hernia?
- 1) Part of stomach slides upward into thoracic cavity; may cause reflux,obstruction, hemorrhage
- ■ Secondary to obesity, congenital weakness, pregnancy, female gender
- 2)■ May be asymptomatic, evident in barium swallow
- ■ Sense of fullness, regurgitation, pyrosis, dysphagia, nocturnal dyspnea
- 3)Paraesophageal hernias may require emergency surgery to ↓restricted blood flow
- ■ See GERD
What is barium swallow
The patient is asked to drink a suspension of barium sulfate. Fluoroscopy images are taken as the barium is swallowed. This is typically at a rate of 2 or 3 frames per second. The patient is asked to swallow the barium a number of times, whilst standing in different positions, i.e. AP, oblique and lateral, to assess the 3D structure as best as possible. This technique induces gas production in the esophagus, and can be uncomfortable to the subject.
Nursing Care for Hiatal Hernia and GERD
- Monitor S&S; support weight control
- ■ Teach patient to have small, frequent, low-fat meals; drink fluids between meals; and remain upright 1hr after meals
- ■ Teach patient to ↑HOB to prevent night time distress
- ■ Advise patient to avoid tight belts and waistlines and to avoid chocolate,caffeine, alcohol, and peppermint, which ↓LES tone
plan nursing care of pt with esophageal disorders including: GERD ( gastrointestinal reflux), hiatal hernia, dysphagia, and esophageal varicies
what is peptic ulcer disease
what are S& S
↑Pepsin, ↑HCl acid or ↓tissue resistance to acid →gastric or duodenalulcers May → hemorrhage,perforation,or peritonitis
Gnawing epigastric pain Duodenal ulcer pain occurs 2-3hr pc and is relieved by food Gastric ulcer pain occurs 1hr pc and is relieved by vomiting
- Antibiotics (H. pylori),proton pump inhibitors,H2 receptor blockers
- Surgery: Vagotomy to↓HCl, antrectomy, and reattachment to duodenum (Billroth I)or jejunum (Billroth II)