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Gastroesophageal Disease (GERD) - Coggle Diagram
Gastroesophageal Disease (GERD)
Complications
Barrett's syndrome (precancerous changes to the esophagus)
Esophageal cancer
Esophageal stricture narrowing of the esophagus)
Asthma
Esophagitis
Tooth enamel erosion, gum disease, or other dental problems
Risk factors
For pregnant women, the hormones that are produced during pregnancy can relax the lower esophageal sphincter, thus causing food and acids to move back into the esophagus
Alcohol consumption
Cigarette smoking
Obesity
Older adults have an increase risk because the esophagus muscles can weaken with age
Scleroderma
Connective tissue disorders
Causes
Pregnancy
Smoking or inhaling secondhand smoke
Being overweight or obesity
Certain medicines such as benzodiazepines, sedatives that makes you calmer
Hiatal hernia
Nonsteroidal anti-inflammatory drugs (NSAIDS)
Poor eating habits, e.g. overeating, eating large meals and eating before bedtime
Definition
GERD is a disease that occurs when stomach contents and stomach acids enter the esophagus. At the bottom of the esophagus, a ring of muscles opens to allow food into the stomach. Normally, the ring closes tightly after the food has entered, but with GERD, the ring does not close tightly, instead, it remains open and allows stomach contents and acids to pass into the esophagus, damaging the lining.
Signs and symptoms
Chronic dry cough
Hoarse voice
Dyspepsia
Regurgitation
Heartburn
Excessive salivation
Sore throat
Breathing problems
References
Van Rensburg K. Gastro-oesophageal reflux disease (GERD). SAPJ. 2010; 77.
Heartburn patient information from BMJ. BMJ Best Practice. 2020.
Diagnostic procedures
Esophageal manometry
X-ray of the upper digestive system
Ambulatory acid (pH) probe test
Upper endoscopy
Health education
Inform them not to take over the counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen
Teach the patient about well balanced diet, and not to eat foods that might bother their stomach, such as fats, chocolate, and caffeine
Teach them to limit alcohol intake to no more than 2 drinks a day
Emphasis should be made about taking medication as directed and at the right time, no doses should be skipped
Health educate the patient to break the smoking habit, and advice him/her to join the stop-smoking program to improve their chances of life
The patient must be encouraged to start an exercise program, and the healthcare provider must help the patient with activities that will be good for the patient, such as walking, and gardening
The patient should be told not to wear tight-fitting clothes, as these puts pressure in the abdomen and may force acid and food in the stomach up into the esophagus
Nursing management
The head of the bed must be elevated by 6 to 9 inches. This in turn helps to elevate the body from the waist up, preventing reflux into the esophagus
The patient must maintain a healthy weight, as excess pounds put pressure on the abdomen, pushing up the stomach and causing acid to reflux into the esophagus
The patient must avoid food or drink 2 hours before bedtime or lying down after eating
The patient must not lie down after a meal, but wait at least 3 hours after eating before lying down or going to bed
They must avoid irritants, such as spics or acidic foods, alcohol, caffeine, and tobacco, because they increase gastric acid secretion
The patient should eat a low-fat, high-fiber diet, and avoid foods and drinks that trigger reflux, which include fried foods, tomato sauce, alcohol, mint, garlic, onion, and caffeine
Nursing care plan
Prevent aspiration- avoid placing the patient in supine position, have the patient sit upright after meals, and elevate head of bed while in bed
Identify amount of weight loss needed for optimal body size and frame, which will provide basis for dietary planning
Carefully assess any signs of pain and its location and discern pain from GERD and angina pectoris
Weigh patient every day, on same scale, same time, if possible, as this provides goal achievement weight loss information, or lack of progress that may require changes or deviation in the plan of care
Assess for heartburn, since this is the most common feature of GERD
Improve nutrition by encouraging small frequent meals of high calories and high protein foods, as they are easier to digest
Pathophysiology
The pathogenesis of GERD is complex and involves changes in reflux exposure, epithelial resistance, and visceral sensitivity. The gastric refluxate is a noxious material that injures the esophagus and elicits symptoms. Esophageal exposure to gastric refluxate is the primary determinant of disease severity.