QUESTION
PUD: What would you tell your patient to avoid taking for pain?
Answer:
Make sure to tell your patients not to take NSAIDS for pain relief- use Tylenol instead
QUESTION
EGD
Answer:
major diagnostic test for PUD
QUESTION
Duodenal ulcers – S\/S
Answer:
Duodenal ulcer pain is usually located to the right of or below the epigastrium. The pain
associated with a duodenal ulcer occurs 90 minutes to 3 hours after eating and often awakens the
patient at night. Pain may also be exacerbated (made worse) by certain foods (e.g., tomatoes, hot
spices, fried foods, onions, alcohol, caffeine drinks) and certain drugs (e.g., NSAIDs,
corticosteroids). Perform a comprehensive pain assessment.
QUESTION
Gastritis: Pathophysiology
Answer:
o Prostaglandins provide a protective mucosal barrier that prevents the stomach from digesting
itself (acid autodigestion); break in protective barrier = mucosal injury occurs
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<\/a><\/figure>\n\n\n\nOral cavity disorders can severely affect TISSUE INTEGRITY, NUTRITION, and GAS EXCHANGE; cause intense discomfort; and affect speech, body image, and self-esteem.
These disorders commonly affect people who …..<\/a><\/p>\n\n\n\n\u2022 Have developmental delays or mental health disorders
\u2022 Are homeless or have less (decreased) access to care
\u2022 Reside in institutions
\u2022 Use tobacco and\/or alcohol
\u2022 Consume an unhealthy diet
\u2022 Have an oral cancer
\u2022 Consume dietary excess<\/a><\/p>\n\n\n\nHow to maintain a Healthy Oral Cavity<\/a><\/p>\n\n\n\n
\u2022Eat well-balanced diet and stay hydrated
\u2022Manage stress
\u2022Perform weekly self-examination of mouth
\u2022Report changing conditions
\u2022Dentures should be in good repair and fit
\u2022Brush and floss twice daily
\u2022Avoid alcohol-based mouthwash
\u2022Avoid drugs that increase inflammation
\u2022See dentist regularly<\/a><\/p>\n\n\n\nStomatitis<\/a><\/p>\n\n\n\n
\u2022Any inflammation in the oral cavity
\u2022Painful, inflamed ulcerations
\u2022Classified according to cause of inflammation
Proper oral hygiene helps prevent<\/a><\/p>\n\n\n\nPrimary stomatitis<\/a><\/p>\n\n\n\n
occurs most often, and the most common types are aphthous stomatitis (or canker sores) that present as painful, small oral ulcers that are focal or diffuse
Herpes simplex stomatitis and traumatic ulcers are also considered primary.<\/a><\/p>\n\n\n\nSecondary stomatitis<\/a><\/p>\n\n\n\n
caused by
– cancer
– HIV
– viruses
– bacteria
– chemo
– long term antibiotic use
– yeast<\/a><\/p>\n\n\n\nA common type of secondary stomatitis is caused by Candida albicans. Candida is sometimes present in small amounts in the mouth, especially in older adults.<\/a><\/p>\n\n\n\n
Long-term antibiotic therapy destroys other normal flora and allows the Candida to overgrow. The result can be candidiasis, also called moniliasis, a fungal infection that is very painful.
Candidiasis is also common in those undergoing immunosuppressive therapy, such as chemotherapy, radiation, and steroids.<\/p>\n\n\n\nStomatitis can result from<\/a><\/p>\n\n\n\n
INFECTION, allergy, certain foods, vitamin deficiency, systemic disease, & irritants, such as tobacco & alcohol.<\/a><\/p>\n\n\n\n
The most common type of stomatitis, ____, affects more than 20% of the population of North America; incidence is higher in females than males<\/a><\/p>\n\n\n\n
recurrent aphthous ulcers (RAUs)<\/a><\/p>\n\n\n\n
Stomatitis: Assessment History<\/a><\/p>\n\n\n\n
\u2022Recent infections
\u2022Nutrition changes
\u2022Oral hygiene habits
\u2022Trauma
\u2022Stress
\u2022Physical Assessment\/Signs & Symptoms
\u2022Psychosocial Assessment
\u2022Impaired tissue integrity
\u2022Pain<\/a><\/p>\n\n\n\nStomatitis: Planning and Implementation: Generate Solutions & Take Action<\/a><\/p>\n\n\n\n
\u2022Preserving tissue integrity
\u2022Minimizing pain
\u2022Have healthy oral mucosa without inflammation or infection
\u2022Experience minimized or absence of pain<\/a><\/p>\n\n\n\nWhile examining the mouth….<\/a><\/p>\n\n\n\n
Wear gloves, use a penlight to ensure adequate lighting, and use a tongue blade to aid examining the oral cavity. Assess the mouth for lesions, coating, and cracking. Document characteristics of the lesions, including their location, size, shape, odor, color, and drainage.
If lesions are seen along the pharynx and the patient reports dysphagia (difficulty on swallowing) or throat pain, the lesions might extend down the esophagus<\/p>\n\n\n\nBecause you are accountable for the delegated task, remind the UAP to<\/a><\/p>\n\n\n\n
Use a soft-bristled toothbrush or disposable foam swabs to stimulate gums and clean the oral cavity.
Use toothpaste that is free of sodium lauryl sulfate (SLS), if possible, because this ingredient has been associated with stomatitis.
Follow up by inspecting the patient’s oral cavity after the UAP completes the task.
Teach the patient to rinse the mouth every 2 to 3 hours with a sodium bicarbonate solution or warm saline solution (may be mixed with hydrogen peroxide).
He or she should avoid most commercial mouthwashes because they have high alcohol content, causing a burning sensation in irritated or ulcerated areas<\/p>\n\n\n\nCare of the Patient With Problems of the Oral Cavity<\/a><\/p>\n\n\n\n
\u2022Remove dentures if the patient has severe stomatitis or oral pain.
\u2022Encourage the patient to perform oral hygiene or provide it after each meal and as often as needed.
\u2022 Increase mouth care to every 2 hours or more frequently if stomatitis is not controlled.
\u2022 Use a soft toothbrush or gauze for oral care.
\u2022 Encourage frequent rinsing of the mouth with warm saline, sodium bicarbonate (baking soda) solution, or a combination of these solutions.
\u2022Teach the patient to avoid commercial mouthwashes, particularly those with high alcohol content, and lemon-glycerin swabs.
\u2022Help the patient select soft, bland, and nonacidic foods.
\u2022Apply topical analgesics or anesthetics as prescribed by the health care provider and monitor their effectiveness.<\/p>\n\n\n\nDrug therapy for stomatitis<\/a><\/p>\n\n\n\n
antimicrobials, immune modulators, and symptomatic topical agents
A regimen of IV acyclovir (Zovirax, Xerese ) is prescribed for immunocompromised patients who contract herpes simplex stomatitis.
For fungal infections such as yeast, nystatin (Mycostatin, Nadostine , PMS-Nystatin ) oral suspension swish\/swallow is most commonly prescribed.
Ice-pop troches (lozenges) of the antifungal preparation allow the drug to slowly dissolve, and the cold provides an analgesic effect.<\/p>\n\n\n\nOral Tumors: Premalignant Lesions<\/a><\/p>\n\n\n\n
leukoplakia and erythroplakia<\/a><\/p>\n\n\n\n
Leukoplakia<\/a><\/p>\n\n\n\n
thickened, white, leathery-looking spots on the inside of the mouth that can develop into oral cancer
Leukoplakia is the most common oral lesion among adults
Most of these lesions are benign. However, a small percentage of them become cancerous. Although leukoplakia can be found anywhere on the oral mucosa, lesions on the lips or tongue are more likely to progress to cancer.
Leukoplakia results from mechanical factors that cause long-term oral mucous membrane irritation, such as poorly fitting dentures, chronic cheek nibbling, or broken or poorly repaired teeth.<\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/ziKmdwNk9H5mSgnoANRcpQ.png\")
<\/figure>\n\n\n\nLeukoplakia not associated with HIV infection is more often seen in people older than 40 years.<\/a><\/p>\n\n\n\n
The incidence of leukoplakia is two times higher in men than in women; however, this ratio is changing because increasing numbers of women are smoking.<\/a><\/p>\n\n\n\n
Hairy Leukoplakia<\/a><\/p>\n\n\n\n
Lateral border, white, corrugated lesions, associated with HIV, Epstein Barr virus.<\/a><\/p>\n\n\n\n
![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/JUxysRCHey-X-9DvptKTiQ.jpg\")
<\/figure>\n\n\n\nErythroplakia<\/a><\/p>\n\n\n\n
A clinical term used to describe an oral mucosal lesion that appears as a smooth red patch or granular red and velvety patch.
any red patch of tissue in the oral cavity that cannot be associated with inflammation
There are more malignant changes in erythroplakia than in leukoplakia; therefore erythroplakia is often considered “precancerous” in presentation. As such, these lesions should be regarded with suspicion and analyzed by biopsy.
Erythroplakia is most commonly found on the floor of the mouth, tongue, palate, and mandibular mucosa. I<\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/mX0gyON0Hp8663wTEjIVzw.png\")
<\/figure>\n\n\n\nPeople should visit a dentist at least ____ a year for professional dental hygiene and oral cancer screening, which includes inspecting and palpating the mouth for lesions.<\/a><\/p>\n\n\n\n
twice<\/a><\/p>\n\n\n\n
Prevention strategies for oral cancer include<\/a><\/p>\n\n\n\n
minimizing sun and tanning-bed exposure, tobacco cessation, and decreasing alcohol intake<\/a><\/p>\n\n\n\n
Oral Cancer<\/a><\/p>\n\n\n\n
\u2022Visit dentist twice a year for professional dental hygiene; oral cancer screening
\u2022Occupational exposure can increase risk
\u2022Most are squamous cell carcinomas (lips, tongue, buccal mucosa, oropharynx)
\u2022Basal cell carcinoma (lips)
\u2022Kaposi’s sarcoma (hard palate, gums, tongue, tonsils)<\/a><\/p>\n\n\n\nMore than 90% of oral cancers are<\/a><\/p>\n\n\n\n
squamous cell carcinomas that begin on the surface of the epithelium
Squamous cell cancer can be found on the lips, tongue, buccal mucosa, and oropharynx<\/a><\/p>\n\n\n\nAn increased rate of squamous cell cancer is found in people with occupations such as<\/a><\/p>\n\n\n\n
textile workers, plumbers, and coal and metal workers, mainly as a result of prolonged exposure to polycyclic aromatic hydrocarbons (PAHs).<\/a><\/p>\n\n\n\n
Mucosal erythroplasia is the earliest sign of oral carcinoma. Oral lesions that appear as red, raised, eroded areas are suspicious for cancer.<\/a><\/p>\n\n\n\n
A lesion that does not heal within 2 weeks or a lump or thickening in the cheek is a symptom that warrants further assessment<\/a><\/p>\n\n\n\n
Basal cell carcinoma of the mouth occurs primarily on the<\/a><\/p>\n\n\n\n
lips<\/a><\/p>\n\n\n\n
Kaposi’s sarcoma is a malignant lesion in blood vessels, appearing as a raised, purple nodule or plaque, which is usually painless.<\/a><\/p>\n\n\n\n
In the mouth, the hard palate is the most common site of Kaposi’s sarcoma, but it can be found also on the gums, tongue, or tonsils. It is most often associated with AIDS.<\/a><\/p>\n\n\n\n
OralCDx BrushTest<\/a><\/p>\n\n\n\n
a diagnostic procedure usually performed by a dentist during a routine dental examination. The procedure involves brushing of a lesion and is helpful in determining whether the lesion is precancerous (OralCDx, 2017).
However, biopsy is the definitive method for diagnosis of oral cancer.<\/a><\/p>\n\n\n\nBoth the presence of tumors of the oral cavity and the effects of their treatment threaten the integrity of the oral mucosa and the patient’s airway<\/a><\/p>\n\n\n\n
If the patient has extensive tumor involvement and copious, tenacious (thick and “stringy”) secretions, maintaining an open airway is your priority for care to promote
Implement interventions to manage the patient’s airway by increasing air exchange, removing secretions, and preventing aspiration as needed.
Assess for dyspnea resulting from the tumor obstruction or from excessive secretions.
Assess the quality, rate, and depth of respirations. Auscultate the lungs for adventitious sounds, such as wheezes caused by aspiration.
Listen for stridor caused by partial airway obstruction. Promote deep breathing to help produce an effective cough to mobilize the patient’s secretions.<\/p>\n\n\n\nIt is important to work with the patient to establish an oral hygiene routine. Perform oral hygiene every 2 hours for ulcerated lesions or infection or in the immediate postoperative period.<\/a><\/p>\n\n\n\n
Modifications might be needed because of oral discomfort, bleeding, or edema.
Oral care with a soft-bristled toothbrush is preferred.
If the platelet count falls below 40,000\/mm3 , switch the patient to an ultrasoft “chemobrush.” The use of “Toothettes” or a disposable foam brush is discouraged because these products may not adequately control bacteremia-promoting plaque and may further dry the oral mucosa.
Lubricant can be applied to moisten the lips and oral mucosa as needed.<\/p>\n\n\n\nRadiation therapy for oral cancers can be given by external beam or interstitial implantation to reduce the size of the tumor before surgery.<\/a><\/p>\n\n\n\n
External-beam radiation passes through the skin or mucous membrane to the tumor site. Typically, treatments are given as five daily treatments per week, with a 2-day break each week, over a 6- to 9-week period.<\/a><\/p>\n\n\n\n
Another option is the implantation of radioactive substances (interstitial radiation therapy or brachytherapy) to either boost the dosage or deliver a radiation dose close to the tumor bed.<\/a><\/p>\n\n\n\n
This form of implant therapy can be curative in early-stage lesions in the floor of the mouth or anterior tongue. It may also add a boost of radiation to a tumor that received external-beam radiation.<\/a><\/p>\n\n\n\n
Place patients on radiation transmission precautions while the materials are active or in place. Patients need to be placed in a private room with lead-lined walls or movable panels.<\/a><\/p>\n\n\n\n
When permitted, visitors may stay only 30 minutes or less each day and must sit or stand away from the patient in designated areas. Pregnant women and children younger than 18 years should not be permitted to visit<\/a><\/p>\n\n\n\n
Acute Sialadenitis<\/a><\/p>\n\n\n\n
\u2022Salivary gland inflammation that is usually bacterial in origin and presents with pain, swelling, erythema, fever, and trismus; parotid gland most common site
\u2022Untreated infections of the salivary glands can evolve into abscesses, which can rupture and spread infection into the tissues of the neck and the mediastinum
\u2022Often occurs with ionizing radiation to head or neck
\u2022Treatment includes hydration, moist heat, massage, NSAIDs, antibiotics<\/p>\n\n\n\nInstructions for the patient undergoing large surgical resections may include but are not limited to these expectations after surgery:<\/a><\/p>\n\n\n\n
\u2022 Placement of a temporary tracheostomy, oxygen therapy, and suctioning
\u2022 Temporary loss of speech because of the tracheostomy
\u2022 Frequent monitoring of postoperative vital signs
\u2022 NPO status until intraoral suture lines are healed
\u2022 Need to have IV lines in place for drug delivery and hydration
\u2022 Postoperative drug therapy and activity (out of bed on the day or surgery or first postoperative day)
\u2022 Possibility of surgical drains<\/p>\n\n\n\nThree factors influence the extent of surgery performed for oral cancers:<\/a><\/p>\n\n\n\n
the size and location of the tumor, tumor invasion into the bone, and whether there has been metastasis (cancer spread) to neck lymph node<\/a><\/p>\n\n\n\n
The most extensive oral operations are composite resections, which combine partial or total glossectomy (tongue removal) and partial mandibulectomy (jaw removal).<\/a><\/p>\n\n\n\n
In the commando (co-mandible) procedure (COMbined neck dissection, MANDibulectomy, and Oropharyngeal resection), the surgeon removes a segment of the mandible with the oral lesion and performs a radical neck dissection (see Chapter 29).<\/a><\/p>\n\n\n\n
If radiation therapy is part of the oral cancer patient’s treatment plan, home care considerations include health teaching and management strategies.<\/a><\/p>\n\n\n\n
Complications from radiation to the head or neck can be acute or delayed.
Acute effects include treatment-related mucositis, stomatitis, and alterations in taste. Long-term effects such as xerostomia (excessive mouth dryness) and dental decay require ongoing oral care, the use of saliva substitutes, and follow-up dental visits<\/p>\n\n\n\nCare of the Patient With Oral Cancer at Home<\/a><\/p>\n\n\n\n
\u2022 Follow the treatment plan for cancer therapies.
\u2022 Remember that taste sensation may be decreased; add nonspicy seasonings to food to better enjoy it.
\u2022 Use a thickening agent for liquids if dysphagia is present. \u2022 Eat soft foods if stomatitis occurs.
\u2022 Inspect the mouth every day for changes, such as redness or lesions.
\u2022 Continue meticulous oral hygiene at home using a chemobrush and frequent rinsing; clean brush after every use.
\u2022 Use saliva substitute as prescribed. \u2022 Avoid sun or tanning-bed exposure if radiation is part of therapy.
\u2022 Clean with a gentle, nondeodorant soap, such as Ivory.<\/p>\n\n\n\nabscess<\/a><\/p>\n\n\n\n
Collection of pus underneath the skin<\/a><\/p>\n\n\n\n
The health care provider can often remove small, noninvasive lesions of the oral cavity in an ambulatory surgical center with local anesthesia.<\/a><\/p>\n\n\n\n
The surgical opening is usually small enough to be closed by sutures. These smaller lesions may also be responsive to carbon dioxide laser therapy or cryotherapy (extreme cold application), as well as photodynamic therapy.
These procedures can be performed as an ambulatory care procedure in a surgical center but may require general anesthesia.<\/p>\n\n\n\nSalivary gland inflammation can have a bacterial or viral cause, such as infection with cytomegalovirus (CMV).<\/a><\/p>\n\n\n\n
The most common bacterial organisms are Staphylococcus aureus, Staphylococcus pyogenes, Streptococcus pneumoniae, and Escherichia coli.<\/a><\/p>\n\n\n\n
A decrease in the production of saliva (as in dehydrated or debilitated patients or in those who are on NPO status after surgery for an extended time) can lead to<\/a><\/p>\n\n\n\n
acute sialadenitis.<\/a><\/p>\n\n\n\n
Patients who receive radiation for the treatment of cancers of the head and neck or thyroid may develop decreased salivary flow, predisposing them to<\/a><\/p>\n\n\n\n
acute or persistent sialadenitis.<\/a><\/p>\n\n\n\n
With acute sialadenitis, be sure to<\/a><\/p>\n\n\n\n
Assess facial function because the branches of cranial nerve VII (the facial nerve) lie close to the salivary glands.<\/a><\/p>\n\n\n\n
Collaborative care for acute salivaitis includes the administration of IV fluids and measures such as these to treat the underlying cause and increase the flow of saliva:<\/a><\/p>\n\n\n\n
\u2022 Hydration
\u2022 Application of warm compresses
\u2022 Massage of the gland
\u2022 Use of a saliva substitute
\u2022 Use of sialagogues (substances that stimulate the flow of saliva such as lemon slices or citrus and other flavored fruit candy)<\/a><\/p>\n\n\n\nPost irradiation Sialadenitis<\/a><\/p>\n\n\n\n
The salivary glands are sensitive to ionizing radiation, such as from radiation therapy or radioactive iodine treatment of thyroid cancers.
Exposure of the glands to radiation produces a type of sialadenitis known as xerostomia (very dry mouth caused by a severe reduction in the flow of saliva) within 24 hour
Xerostomia may be temporary or permanent, depending on the dose of radiation and the percentage of total salivary gland tissue irradiated. Little can be done to relieve the patient’s dry mouth during the course of radiation therapy. Frequent sips of water and frequent mouth care, especially before meals, are the most effective interventions<\/p>\n\n\n\nSalivary gland tumors<\/a><\/p>\n\n\n\n
rare, generally benign, and occur in parotid gland<\/a><\/p>\n\n\n\n
With salivary gland tumors, pay particular attention to assessment of the facial nerve because of its proximity to the salivary glands. Assess the patient’s ability to:<\/a><\/p>\n\n\n\n
\u2022 Wrinkle the brow
\u2022 Raise the eyebrows
\u2022 Squeeze and hold the eyes shut while you gently pull upward on the eyebrows and cheeks beneath the orbit to check for symmetry
\u2022 Wrinkle the nose
\u2022 Pucker the lips
\u2022 Puff out the cheeks
\u2022 Grimace or smile<\/a><\/p>\n\n\n\nPatients who have undergone parotidectomy (surgical removal of the parotid glands) or submandibular gland surgery are at risk for weakness or loss of function of the facial nerve because the nerve courses directly through the gland.<\/a><\/p>\n\n\n\n
Facial nerve repair with grafting can be done at the time of surgery<\/a><\/p>\n\n\n\n
gastroesophageal reflux disease (GERD)<\/a><\/p>\n\n\n\n
backflow of contents of the stomach into the esophagus, often resulting from abnormal function of the lower esophageal sphincter, causing burning pain in the esophagus
\u2022Most common upper GI disorder in the U.S.
\u2022Occurs as a result of backward flow of stomach contents into esophagus
\u2022Hiatal hernias increase risk for GERD
\u2022During healing, Barrett’s epithelium and esophageal stricture are concerns<\/p>\n\n\n\nGERD: Etiology and Genetic Risk<\/a><\/p>\n\n\n\n
\u2022No single causative agent
\u202231% heritability
\u2022Greatest rise in proportion of people with GERD is in 30-39 year old demographic<\/a><\/p>\n\n\n\nGERD: Assessment: Recognize Cues<\/a><\/p>\n\n\n\n
History
\u2022Morning hoarseness
\u2022Coughing or wheezing at night
Physical Assessment\/Signs and Symptoms
\u2022Dyspepsia
\u2022Auscultate lungs for crackles
Psychosocial Assessment
Diagnostic assessment
\u2022Upper endoscopy (EGD)
\u2022Ambulatory esophageal pH monitoring<\/a><\/p>\n\n\n\nGERD health promotion and maintenance<\/a><\/p>\n\n\n\n
\u2022Patients may be initially asymptomatic
\u2022Healthy eating habits
\u2022Limitation of fried, fatty, spicy foods and caffeine
\u2022Sit upright for one hour after eating<\/a><\/p>\n\n\n\nFactors Contributing to Decreased Lower Esophageal Sphincter Pressure<\/a><\/p>\n\n\n\n
\u2022 Caffeinated beverages, such as coffee, tea, and cola \u2022 Chocolate
\u2022 Citrus fruits
\u2022 Nitrates
\u2022 Peppermint, spearmint
\u2022 Alcohol
\u2022 Tomatoes and tomato products
\u2022 Smoking and use of other tobacco products
\u2022 Calcium channel blockers
\u2022 Anticholinergic drugs
\u2022 High levels of estrogen and progesterone
\u2022 Nasogastric tube placement<\/p>\n\n\n\nGERD: Potential Problems<\/a><\/p>\n\n\n\n
\u2022Potential for compromised nutrition status due to dietary selection
\u2022Acute pain due to reflux of gastric contents
\u2022Adhere to appropriate diet, medication therapy, and lifestyle modifications
\u2022Minimized or absence of pain<\/a><\/p>\n\n\n\nDuring the process of healing, the body may substitute Barrett’s epithelium (columnar epithelium) for the normal squamous cell epithelium of the lower esophagus.<\/a><\/p>\n\n\n\n
Although this new tissue is more resistant to acid and therefore supports esophageal healing, it is considered premalignant and is associated with an increased risk for cancer in patients with prolonged GERD<\/a><\/p>\n\n\n\n
The fibrosis and scarring that accompany the healing process from GERD can produce esophageal stricture (narrowing of the esophageal opening).<\/a><\/p>\n\n\n\n
The stricture leads to progressive difficulty swallowing. Uncontrolled esophageal reflux also increases the risk for other complications such as asthma, laryngitis, dental decay, cardiac disease, as well as serious concerns for hemorrhage and aspiration pneumonia<\/a><\/p>\n\n\n\n
Patients who have a nasogastric tube also have decreased esophageal sphincter function. The tube keeps the cardiac sphincter open and allows acidic contents from the stomach to enter the esophagus.<\/a><\/p>\n\n\n\n
Other factors that increase intra-abdominal and intragastric pressure (e.g., pregnancy, wearing tight belts or girdles, bending over, ascites) overcome the gastroesophageal pressure gradient maintained by the LES and allow reflux to occur.<\/a><\/p>\n\n\n\n
Dyspepsia, also known as indigestion, and regurgitation are the main symptoms of GERD, although symptoms may vary in severity (Chart 54-1).<\/a><\/p>\n\n\n\n
Symptoms associated with “indigestion” may include abdominal discomfort, feeling uncomfortably full, nausea, and burping.
Because indigestion might not be viewed as a serious concern, patients may delay seeking treatment. The symptoms typically worsen when the patient bends over, strains, or lies down. If the indigestion is severe, the pain may radiate to the neck or jaw or may be referred to the back, mimicking cardiac pain.<\/p>\n\n\n\nGastroesophageal Reflux Disease Symptoms<\/a><\/p>\n\n\n\n
\u2022 Dyspepsia (indigestion)
\u2022 Regurgitation (may lead to aspiration or bronchitis)
\u2022 Coughing, hoarseness, or wheezing at night \u2022 Water brash (hypersalivation)
\u2022 Dysphagia
\u2022 Odynophagia (painful swallowing)
\u2022 Epigastric pain
\u2022 Generalized abdominal pain
\u2022 Belching
\u2022 Flatulence
\u2022 Nausea
\u2022 Pyrosis (heartburn)
\u2022 Globus (feeling of something in back of throat)
\u2022 Pharyngitis
\u2022 Dental caries (severe cases)<\/a><\/p>\n\n\n\nUpper endoscopy<\/a><\/p>\n\n\n\n
visual examination of the GI tract, from esophagus to duodenum<\/a><\/p>\n\n\n\n
A pH monitoring examination is the most accurate method of diagnosing GERD. This involves either<\/a><\/p>\n\n\n\n
(1) placing a small catheter through the nose into the distal esophagus or (2) temporarily attaching a small capsule to the wall of the esophagus during an upper endoscopy (the 48-hour Bravo esophageal pH test).
The patient is asked to keep a diary of activities and symptoms over 24 to 48 hours<\/a><\/p>\n\n\n\nHealth Promotion and Lifestyle Changes to Control Reflux<\/a><\/p>\n\n\n\n
\u2022 Eat four to six small meals a day.
\u2022 Limit or eliminate fatty foods, coffee, tea, cola, and chocolate.
\u2022 Reduce or eliminate from your diet any food or spice that increases gastric acid and causes pain.
\u2022 Limit or eliminate alcohol and tobacco and reduce exposure to secondhand smoke.
\u2022 Do not snack in the evening and do not eat for 2 to 3 hours before you go to bed.
\u2022 Eat slowly and chew your food thoroughly to reduce belching.
\u2022 Remain upright for 1 to 2 hours after meals, if possible. \u2022 Elevate the head of your bed 6 to 12 inches using wooden blocks or elevate your head using a foam wedge. Never sleep flat in bed.\u2022 If you are overweight, lose weight.
\u2022 Do not wear constrictive clothing.
\u2022 Avoid heavy lifting, straining, and working in a bent-over position.
\u2022 Chew “chewable” antacids thoroughly and follow with a glass of water.<\/p>\n\n\n\nGERD drug therapy<\/a><\/p>\n\n\n\n
H2 receptor blockers, proton pump inhibitors, antacids<\/a><\/p>\n\n\n\n
Hiatal hernias<\/a><\/p>\n\n\n\n
a portion of the stomach protrudes through the diaphragm into the thoracic cavity
\u2022Also called diaphragmatic hernias
\u2022Protrusion of the stomach through the esophageal hiatus of the diaphragm into the chest
\u2022Types I through IV<\/a><\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/48XdJi62.ZdGMoojITKV-A.png\")
<\/figure>\n\n\n\nSliding Hiatal Hernias vs Rolling<\/a><\/p>\n\n\n\n
Sliding Hiatal Hernias
\u2022 Heartburn
\u2022 Regurgitation
\u2022 Chest pain
\u2022 Dysphagia
\u2022 Belching
Paraoesophageal (rolling) Hernias
\u2022 Feeling of fullness after eating
\u2022 Breathlessness after eating
\u2022 Feeling of suffocation
\u2022 Chest pain that mimics angina
\u2022 Worsening of manifestations in a recumbent position<\/a><\/p>\n\n\n\nHiatal Hernias: Assessment: Recognize Cues<\/a><\/p>\n\n\n\n
\u2022Many people are asymptomatic; others have GERD-like symptoms
\u2022Symptoms often increase after a meal or when lying supine
\u2022Barium swallow study with fluoroscopy
\u2022High resolution manometry with esophageal pressure topography<\/a><\/p>\n\n\n\nHiatal Hernias: Interventions: Take Action<\/a><\/p>\n\n\n\n
Nonsurgical management
\u2022Nutrition modification
\u2022Stool softeners or bulk laxatives
\u2022Daily incisional inspection
\u2022Signs to report to the health care provider
\u2022Avoidance of those who are ill
Surgical management
\u2022Performed transabdominally or transthoracically<\/a><\/p>\n\n\n\n