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Gastro-Esophageal Reflux

definition return of gastric contents into the esophagus as a result of relaxation of the lower esophageal sphincter
etiology common in PREMATURE infants due to the immaturity of the sphincter, and in NEUROLOGICALLY IMPAIRED infants dur to abnormal neuromuscular control of the sphincter
Does condition get better? yes, with out any intervention by 12-18 months of age
Findings may occur at anytime, not necessarily related to full stomach, eat but fail to gain wt, hungary and irritable, hx of vomiting, and frequent resp. infection or reactive airway disease
patho 1 if gastric contents are returned into and out of ORAL cavity resulting in loss of feeding in sufficient amount to DROP CALORIC INTAKE below required amt child will fail to gain wt. many children who are FTT are diagnosed as having G.E.R.
patho 2 infant who return gastric contents into the ESOPHAGUS(but not necessarily vomit) are at risk of ASPIRATION and the development of resp. comp = infection, reactive airway, apnea
patho 3 chronic subtle reflus may lead to irritation of the esphagesl lining by gastric acid and the development of esophagitis, ulceration of mucus membranes and bld loss; infant being evaluated for Hgb may be found to have G.E.R.
Diagnostics confirmed by thorough feeding hx: pattern, wt gain, hx of vomiting
Diagnostic tests barium swallow. UGI, radionuclide scan, or pH probe monitoring and pneumogram (later is the best)
tx for mild thickened formula with rice cereal, avoid fatty foods and citrus juices, and position with upper body elevated 30degrees after feeding
tx = severe histamine blocker=ZANTAC, CIMETIDINE- TAGMENT= To decrease the prod of gastric acid, Dopamine blocker= REGALAN-metaclopramide= increases esophageal motility and tone and SPEEDS gastric emptying, Acetamenophen - contola pain, Antacids = to neutralize, gast
tx= severe, severe surgery=NISSEN FUNOPLICATION- to tighten the distal esphageal sphincter , and Gastrostomy tube - allow for feeding during healing of the Nissen ( 6weeks)
Created by: meinmethoo