GERD, Hiatal Hernia, Peptic Ulcers, and Hepatitis (aoa week 6)

What is Gastroesophageal Reflux Disease (GERD)?

Reflux of gastric contents into the lower esophagus due to an incompetent Lower Esophageal Sphincter (LES).

What is the underlying cause of Gastroesophageal Reflux Disease (GERD)?

An incompetent lower esophageal sphincter (LES) that allows gastric contents to reflux into the esophagus.

What causes GERD?

Incompetent LES, esophageal clearance problems, hiatal hernia, decreased gastric emptying, increased abdominal pressure, and smoking.

Which factors can decrease LES pressure and contribute to GERD?

Caffeine, chocolate, anticholinergic drugs, and smoking.

What is the effect of increased abdominal pressure on GERD?

It can push stomach contents back up into the esophagus.

A patient with GERD reports worsening symptoms during pregnancy. What is the most likely cause?

Increased abdominal pressure pushing gastric contents into the esophagus.

Why does delayed gastric emptying increase the risk for GERD?

It prolongs the presence of acid in the stomach, increasing the likelihood of reflux.

How can smoking affect GERD?

It relaxes the LES and increases acid production in the stomach.

What are common clinical manifestations of GERD?

Heartburn, hypersalivation, bitter/sour taste, post-meal bloating, nausea, vomiting, nocturnal wheezing, hoarseness, and chest pain.

A patient reports nighttime coughing and wheezing with GERD. What is the cause?

Aspiration of gastric contents leading to respiratory irritation.

Which GERD symptom can mimic angina and requires further evaluation?

Chest pain that radiates to the neck, jaw, back, or arms.

What is the most common symptom of GERD?

Heartburn (pyrosis), described as a burning sensation in the lower sternum that may radiate upward.

What diagnostic methods are used for GERD?

History and physical, upper GI endoscopy, barium swallow, biopsies, manometric studies, and ambulatory esophageal pH monitoring.

What diagnostic test directly visualizes the esophagus and stomach in GERD?

Upper GI endoscopy.

Which diagnostic test evaluates esophageal motility in GERD patients?

Manometric studies.

What is the purpose of ambulatory esophageal pH monitoring?

To measure acid levels in the esophagus over time and confirm GERD.

What lifestyle modifications can help manage GERD?

Avoid triggers, maintain normal weight, manage stress, quit smoking, eat smaller meals, remain upright after eating, and elevate the head of the bed.

Which lifestyle modification is most appropriate for a patient with GERD?

Elevating the head of the bed and remaining upright after meals.

What dietary changes are recommended for GERD management?

Avoiding whole milk at night, late-night snacks, caffeine, alcohol, citrus fruits, spicy food, chocolate, and high-fat food.

When should patients with GERD avoid eating before bedtime?

At least 3 hours before going to bed.

What are potential complications of GERD?

Barrett's Esophagus, ulcers, strictures, respiratory involvement, and dental erosion.

What is Barrett's esophagus?

A precancerous condition where chronic acid exposure causes cellular changes in the esophagus.

What complication of GERD involves narrowing of the esophagus?

Esophageal strictures.

Why can GERD lead to dental erosion?

Refluxed acid damages tooth enamel.

What are the symptoms of respiratory involvement due to GERD?

Bronchospasm, laryngospasm, cough, asthma, bronchitis, and aspiration pneumonia.

What types of drug therapy are used for GERD?

Antacids, H2 receptor blockers, and proton pump inhibitors (PPIs).

A patient experiences relief of chest burning after taking antacids. What does this suggest?

The pain is likely related to GERD rather than a cardiac cause.

What teaching should the nurse provide regarding meal patterns for GERD?

Eat small, frequent meals and avoid large meals, especially before lying down.

What is a hiatal hernia?

Protrusion of a portion of the stomach into the esophagus through a weakened diaphragm.

What are other names for a hiatal hernia?

Which population is most commonly affected by hiatal hernias?

Older adults and women.

What are the two types of hiatal hernias?

Sliding hiatal hernia and paraesophageal (rolling) hiatal hernia.

How does a sliding hiatal hernia present?

The stomach slides up into the chest when supine and returns when upright.

How does a paraesophageal (rolling) hernia differ from a sliding hernia?

The stomach (fundus) rolls up beside the esophagus and can become trapped.

What is the emergency situation related to paraesophageal hernia?

Strangulation of the hernia, which can compromise blood supply.

What is a key priority when a patient has an acute paraesophageal hernia?

Immediate medical/surgical intervention due to risk of strangulation.

What are the risk factors for developing a hiatal hernia?

Increasing age, trauma, forced recumbent position, congenital weakness, structural changes with aging, and increased abdominal pressure.

How does increased abdominal pressure contribute to hiatal hernia?

It pushes the stomach upward through the weakened diaphragm.

What are common clinical manifestations of a hiatal hernia?

Similar to GERD: heartburn, pain, regurgitation, and dysphagia.

What percentage of patients with hiatal hernia may be asymptomatic?

About 50%.

What diagnostic methods are used for hiatal hernia?

History and physical, upper GI X-ray, esophagogram, and endoscopy.

What diagnostic test most commonly identifies a hiatal hernia incidentally?

Upper GI X-ray.

What is the purpose of a barium swallow (esophagogram)?

To visualize the esophagus and stomach using contrast to detect herniation.

What does fluoroscopy assess during a barium swallow?

Movement (motility) of barium, identifying blockages or strictures.

What is the role of endoscopy in hiatal hernia diagnosis?

To visualize the esophagus and assess inflammation or damage.

What lifestyle modifications are recommended for hiatal hernia management?

Elevate head of bed, eat small frequent meals, avoid alcohol and smoking.

Why should patients avoid reclining after meals?

It increases reflux and worsens symptoms.

What activity should patients avoid to prevent worsening of hiatal hernia?

Heavy lifting and straining.

What medications are commonly used for hiatal hernia?

Antacids and proton pump inhibitors (PPIs).

What is the purpose of PPIs in hiatal hernia management?

To reduce gastric acid and minimize reflux symptoms.

What surgical procedure is used for severe hiatal hernia cases?

Nissen fundoplication.

What is Nissen Fundoplication?

A laparoscopic procedure where the stomach is wrapped around the lower esophagus to reinforce the sphincter.

What is the importance of monitoring after Nissen Fundoplication surgery?

To check for bleeding and other complications post-operation.

When is surgery indicated for hiatal hernia?

Severe symptoms, complications, or paraesophageal hernia with risk of strangulation.

What is a key nursing priority after hiatal hernia surgery?

Monitoring for bleeding.

What lab values indicate possible post-op bleeding?

Low hemoglobin and hematocrit.

What vital sign changes suggest post-op bleeding?

Hypotension, tachycardia, dizziness.

What stool characteristic may indicate GI bleeding post-op?

Black, tarry stools (melena).

A patient with a paraesophageal hernia reports sudden severe chest pain and vomiting. What is the nurse's priority action?

Notify the provider immediately—possible strangulation (medical emergency).

Which patient statement indicates a need for further teaching about hiatal hernia management?

"I will lie down right after meals."

Which intervention is most effective to reduce nighttime reflux symptoms?

Elevating the head of the bed.

A nurse is caring for a post-op hiatal hernia patient. Which finding requires immediate attention?

Decreasing blood pressure with increasing heart rate.

What is Peptic Ulcer Disease (PUD)?

Erosion of the GI mucous membrane of the stomach and/or duodenum.

Where do peptic ulcers most commonly occur?

Lower esophagus, stomach, and duodenum.

What is the primary pathophysiology behind PUD?

Breakdown of the mucosal barrier in an acidic environment, allowing hydrochloric acid (HCl) to damage tissue.

What role does hydrochloric acid (HCl) play in PUD?

It irritates and erodes the mucosa, causing inflammation and tissue destruction.

What are the two types of peptic ulcers?

Acute ulcers and chronic ulcers.

What is the difference between acute and chronic peptic ulcers?

Acute: Sudden onset, superficial, may cause severe bleeding; Chronic: Deeper erosion into muscle, scarring, long-term condition.

Which age group is most commonly affected by chronic PUD?

Adults aged 35-45 years.

What is the primary cause of peptic ulcers?

Helicobacter pylori (H. pylori) infection.

What percentage of duodenal ulcers are caused by H. pylori?

About 90%.

How is H. pylori transmitted?

Person-to-person or through contaminated food and water.

What are common causes of peptic ulcers?

H. pylori, NSAID use, steroids, chemotherapy, smoking, alcohol, and decreased blood flow to the stomach lining.

How do NSAIDs contribute to PUD?

They irritate and erode the gastric mucosa, especially when taken without food.

How does decreased blood flow contribute to PUD?

Reduced perfusion weakens mucosal defenses, making it more vulnerable to acid.

What are common causes of decreased blood flow to the stomach lining?

Hypotension, shock, severe injury, extensive burns, complicated surgeries.

What chronic diseases are associated with PUD?

COPD, cirrhosis, chronic pancreatitis, renal failure, hyperparathyroidism.

What are the clinical manifestations of peptic ulcers?

Epigastric pain and tenderness, which can be dull, gnawing, intermittent, burning, cramp-like, or gaseous.

What GI symptoms are associated with PUD?

Nausea, vomiting, and dyspepsia.

What lifestyle changes can help prevent peptic ulcers?

Avoiding NSAIDs, managing stress, and reducing alcohol and smoking.

What is the role of psychological stress in peptic ulcers?

It contributes to ulcer formation but does not directly cause it.

What is a common clinical manifestation of gastric ulcers?

Epigastric pain and tenderness, often occurring 1-2 hours after eating.

What are black tarry stools indicative of?

Melena, which is caused by digested blood in the GI system.

What is hematemesis?

Vomiting bright red blood.

What is the difference between gastric and duodenal ulcers in terms of pain timing?

Gastric ulcer pain occurs 1-2 hours after eating; duodenal ulcer pain occurs 2-5 hours after eating.

When does pain occur in gastric ulcers?

1-2 hours after eating.

When does pain occur in duodenal ulcers?

2-5 hours after eating, often at night.

Which type of ulcer is associated with higher cancer risk?

Gastric ulcers.

Which ulcer type often awakens patients at night?

Duodenal ulcers.

What is the gold standard test for H. pylori infection?

Urea breath test.

What is the purpose of an endoscopy in PUD?

Visualize ulcers and obtain biopsy.

What does a fecal occult blood test (FOBT) detect?

Hidden blood in stool.

What is a bleeding scan used for?

To locate active bleeding sites in the GI tract.

What are the main treatment strategies for managing gastric ulcers?

Reduce gastric acid, eliminate causative drugs, smoking cessation, dietary modifications.

How long does it typically take for ulcer healing?

3-9 weeks.

What lifestyle changes are recommended for PUD?

Smoking cessation, stress reduction, dietary modifications.

What foods should patients with PUD avoid?

Caffeine, alcohol, spicy foods, high-fat foods.

What type of diet is recommended for PUD?

Bland diet with small frequent meals.

Why should high-fat milk products be avoided in PUD?

They may initially neutralize acid but later increase acid production.

What medications are used to treat PUD?

Antacids, H2 blockers, PPIs, antibiotics, anticholinergics, cytoprotective agents.