GRCC AD 155 Upper GI
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| GERD | Backward flow of gastric contents into the esophogus.
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| Physiogical factor is an __________________ Lower Esophageal sphincter (LES) | Incompetent
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| Incompentent LES | Physiological factor that leads to GERD
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| Transient relaxation | Physiological factor that affect fxn of LES & leads to GERD r/t substances such as ETOH, tomato sauce, spicy food and chocolate.
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| Transient relaxation of LES is caused by what substances? | Chocolate, ETOH, tomato sauce, spicy food.
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| Increased pressure in the stomach leads to what? | Leads to GERD,
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| What causes increased pressure in the stomach? | r/t overeating, delayed emptying
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| Which drug delays stomach emptying? | Acarbose (diabetic drug)
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| How does chocolate, ETOH, spicy foods, tomatoes effet the LES? | They can prevent the LES from restricting properly.
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| Fxn of lower esophageal sphincter | Is to keep gastric juices and food from backing up to the esophogus.
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| A complication of GERD that leads to scarring in esophagus caused by exposure to acid. | erosive esophagitis
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| Erosive esophagitis | Which complication of GERD leads to difficulty and painful swallowing?
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| How does scarrs develop withErosive esophagitis? | back up of acids into esophagus, leads to ulcerations, tissue tearing and bleeding
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| What is the horrible pain from erosive esophagitis caused from? | Stricture (restriction caused by scarring in the esophagus from acid back up)
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| This GERD complication is the step before cancer d/t epithelium changes | Barretts esophagus
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| What disease causes stomach lining (epithelium) to become resistant to acid? | Barretts esophagus is caused by stomach acid backing up to esophagus, causing changes to the epithelium.
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| This complication of GERD occurs when there is scarring which causes narrowing of the esophagus? | Esophageal stricture
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| What do you need done if you've been diagnosed with esophageal stricture? | You will need your esophagus dilated.
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| what causes increased gastric pressure? | tight clothing and obesity.
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| Which position do you avoid to prevent gastric contents from moving upward? | Lying down or bending.
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| Increased gastric volume and hiatal hernia could lead to which condition? | Gastroesophageal reflux Disease (GERD)
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| Which factors lead to relux? a) incr gas volume B) sitting up at a 45 degree angle. C} tight clothing d) A condition where part of the stomach sticks up towards chest thru opening of diaphragm? | The correct answers A, C, D.
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| Heartburn | dyspepsia
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| A manifestation of GERD that occurs after eating a high fat meal, bending over or reclining flat? | Heartburn
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| A manifestation of GERD when the movement of stomach contents from the stomach back up through the esophagus. | regurgitation
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| Dysphagia | Difficulty swallowing is a manifestation of GERD
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| atypical chest pain | A manifestation of GERD that doesn't follow MI symptoms.
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| Why is a sore throat a manifestation of GERD? | r/t pharynx damage, difficulty speaking.
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| Why is hoarseness a manifestation of GERD? | Irritation may lead to chronic cough.
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| hypersalivation is a manifestation of GERD? | A condition referred to as water bash.
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| A manifestation of GERD that causes painful swallowing? | odynophagia.
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| Diagnostic tests for GERD | Barium swallow, EGD, and 24 hour ambulatory pH monitoring.
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| Barium Swallow | Records flow of barium through esophagus.
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| EGD | A gastra scope is used that goes down mouth to esophagus into stomach, and can also look at hepatatic duct.
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| This test measures the duration and frequency of acid levels (pH) within 24 hour | 24 hour ambulatory pH monitoring
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| Bravo capsule | A wireless system that is attached to an area of the esophagus that monitors frequency and duration of reflux episodes.
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| This diagnostic test for GERD eventually falls out after 48 hours | bravo capsule.
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| Another way to measure duration and frequency of reflux episodes over a 24 hour period. | A cath is inserted through the nose and into esophagus.
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| medications for GERD | Antacids, H2 receptor blockers (histamine blockers) PPI's, and Prokinetic drugs.
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| Antacids | Neutralizes stomach acids and relieves heartburn pain.
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| This is available in liquid suspensioin and chewable tablets | Antacids
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| Anatacids that contain magnesia compounds | MOM and riopan
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| which of the following antacids contain aluminum compounds? a) Maalox, MOM, amphogel, rolaids b) Maalox, Mylanta, amphogel, riopan c) Maalox, mylanta, amphogel, rolaids d) Maalox, Tums, amphogel and rolaids | C
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| Antacids that contain calcium compounds | TUMS
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| Which antacids contain sodium Bicarbonate? a) Baking Soda & MOM b) Baking Soda, rolaids c) Baking soda, TUMS d) Baking soda, Alka Seltzer | D
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| This GERD med does NOT neutralize the acid | Histamine blockers (H2 receptors)
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| How doed H2 receptors work? | They block histamine, which in turn stop stimulation of hydrochloride acid
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| What do H2 receptor drugs end in? | tidine
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| what do PPI's end in? | prazole
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| Blocking what immune response decreases stimulation that decreases Hcl acid resuling in less GERD? | Histamine is blocked by the H2 receptors that stops the action to produce acid in stomach.
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| Which H2 blocker must be taken before eating, increases level of dilantin and coumadin, and shouldn't be used often due to drug interactions? | Tagamet (climetidine)
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| Why should you take tagamet (climetidine) with food? | Cuz food absorbs the drug and decreases it's effectiveness
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| Which h2 blocker decreases libido, causes impotence, confusion and hallucinations? a) Ranitidine (Zantac) b) Famotidine (pepcid) c) climetidine (tagamet) d) Nizatidine (axid) | C
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| C | Which H2 blockers can be taken IV and PO? (choose all that apply)
a) Ranitidine (Zantac)
b) Famotidine (pepcid)
c) climetidine (tagamet)
d) Nizatidine (axid)
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| Which H2 blockers can be taken IV, PO, IM? (choose all that apply) a) Ranitidine (Zantac) b) Famotidine (pepcid) c) climetidine (tagamet) d) Nizatidine (axid) | A
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| Which H2 blockers can be taken IV push or drip and PO? (choose all that apply) a) Ranitidine (Zantac) b) Famotidine (pepcid) c) climetidine (tagamet) d) Nizatidine (axid) | B
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| Which H2 blockers can be taken PO only? (choose all that apply) a) Ranitidine (Zantac) b) Famotidine (pepcid) c) climetidine (tagamet) d) Nizatidine (axid) | D
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| Suppresses gastric acid secretions that blocks final pathway of acid productions | Proton Pump Inhibitors (PPI)
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| How long does proton pump inhibitors (PPI) last? | Affects last long after drug is cleared from the body.
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| which GERD medicine has less side effects or side effects are rare? H2 blockers of PPI's? | PPI's
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| Which GERD medication can you take on an empty stomach? | PPI's
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| Which PPI's can be taken orally and IV? a) Omeprazole (prolosec or zegrid) b) Lansoprazole (Prevacid) c) Rabeprazole (Aciphex) d) Pantoprazole (Protonix) e) Esomeprazole (nexium) | B, D
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| Why does pantoprazole (protonix) require a filter with an IV? | Contains precipitates that can leak out.
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| Which PPI's can Increase digoxin levels by 20%? a) Omeprazole (prolosec or zegrid) b) Lansoprazole (Prevacid) c) Rabeprazole (Aciphex) d) Pantoprazole (Protonix) e) Esomeprazole (nexium) | C
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| Which PPI's is prone to phlebitis complications and is only compatible with Normal Saline, Lactated ringers or D5W? a) Omeprazole (prolosec or zegrid) b) Lansoprazole (Prevacid) c) Rabeprazole (Aciphex) d) Pantoprazole (Protonix) e) Esomeprazole (nex | E
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| This is a prokinetic med for GERD which enhances esophogeal clearance and gastric emptying? | metocloprimide (reglan)
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| Reglan increases what? | Increases gastric mobility in order to speed food through vs food sitting in the stomach.
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| What is the function of Reglan with regards to the effect it has increasing gastric mobility? | Increased pressure in the stomach (leads to GERD) & occurs d/t delayed emptying...the benefit of this med is to increase mobility to help with decrease stomach pressure.
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| Another function of reglan is to tighten what? | the LES, so that food won't back up into esophagus.
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| the decrease in reflux and regurgitation | Reglan tightens the LES resulting in
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| What are some procedures done to combat GERD if meds and other interventions don't work and pt has s/sx of Barretts or ersosive esophagus? | Nissen fundoplication
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| Nissent fundoplication is performed open surgery or laproscopy? | Either one.
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| Nissen fundoplication | known as stomach wrap
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| What is the procedure with nissen fundoplication | No incision is made in the stomach; instead the stomach is wrapped around the Lower esophogus like a taco and sutured together.
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| If someone has a nissen fundoplication what aren't they able to do? | No longer able to belch or vomit.
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| What restrictions following nissen fundoplication | No longer drink soda pop r/t lack of ability to belch.
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| What are things you'd tell the patient before surgery on what to expect following the surgery. | They will have an NG tube for drainage and C&DB d/t shallow respirations.
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| why do nissen post op patients have an NG tube and are NPO? | to prevent Nausea and vomiting- retching can cause ripping of suture.
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| Teaching a post-op nissen the proper way to cough and why its important? | The procedure causes a lot of pain, resulting in shallow breathing, to minimize pain with c&DB they should splint with a pillow.
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| On d/c day post nissen, what teaching do you give people? | Avoid food and fluid at bedtime, frequent small meals, avoid items that cause gas
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| Why avoid food and fluid at bedtime following nissen? | cuz food and fluid acan put pressure on LES.
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| Why small frequent meals following nissen? | so as not to stretch sutured area.
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| Things that cause gas bloating syndrome include: | Carbonated beverages, gum chewing, drinking with a straw, gas producing foods, and lifting and straining.
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| Less invasive procedure compared to laproscopic or open surger? | Incisionless fundoplication (esophyx) same as nissen fundoplication, but without incision.
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| Stretta procedure thru endoscope does what | puts tiny holes in esophogeal lining & as the holes heal, they tighten and contract the LES.
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