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DISORDERS IN THE ESOPHAGUS GASTROESOPHAGEAL REFLUX DISEASE (GERD) Is a condition in which gastric secretions reflux into the esophagus.

Caused primarily by conditions that affect the ability of the lower esophageal sphincter to close tightly. Clinical Manifestations Vomiting of formula or breast milk Regurgitation may be described as bitter or sour tasting. Dyspepsia (Heartburn ) Dysphagia Pain Upper abdominal discomfort Diagnostic Tests Barium swallow Esophagoscopy Esophageal pH: acidic (normal pH of esophagus: alkaline)

THERAPEUTIC INTERVENTIONS AIM: To decrease the reflux of gastric secretions into the esophagus. Lifestyle changes, eating small frequent meals A low-fat, high-protein diet is recommended Caffeine, milk products and spicy foods are avoided Losing weight if obese Avoid meals within 3 hours of going to bed. Medications & Surgery Antacids (Mylanta, Tums, Gaviscon) H2 receptor blockers (Cimetidine, Famotidine, Ranitidine HCl) Proton pump inhibitors (Esomeprazole (Nexium), pantoprazole) block all gastric acid secretion by binding and deactivating the ATPase enzyme pumps. Surgery: FUNDOPLICATION - endoscopic wrapping of the gastric fundus COMPLICATIONS Esophagitis due to acid reflux Barretts esophagus precancerous lesion Respiratory Complications such as bronchospasm, laryngospasm and aspiration pneumonia Nursing Interventions Position with head elevated 30-45 degrees Give small, frequent feedings with adequate burping Avoid lying down for 2 hours after eating. Avoid smoking and alcohol

If surgery is completed, provide pain medications on routine schedule. MALLORY-WEISS TEAR (MWT) Is a longitudinal tear in the mucous membrane of the esophagus at the stomach junction (gastric cardia) These tears occur from a sudden powerful or prolonged force due to: a. coughing b. vomiting c. prolapsed of stomach to esophagus d. CPR SIGNS AND SYMPTOMS Bleeding bright red bloody emesis bloody or tarry stools DIAGNOSTIC TESTS Esophagogastroduodenoscopy (EGD) Hemoglobin and hemactocrit determination THERAPEUTIC INTERVENTIONS Medications: Antiemetic , epinehprine injection Blood transfusion if there is an excessive bleeding that results to shock

Nursing Management 1. Monitor the patient for signs of bleeding and report 2. Teach about the medications and avoidance of alcohol ESOPHAGEAL VARICES These are dilated blood vessels in the esophagus. If they rupture, it can be a life-threatening event Develop from portal hypertension

GASTRITIS Is the inflammation of the stomach mucosa and can be acute or chronic. Results when the protective mucosal barrier is broken down and allows autodigestion from HCl and pepsin. Severe gastritis becomes gangrenous and perforated- may lead to peritonitis and scarring may result to pyloric obstruction. Causes of Gastritis DIET Alcohol Spicy foods MICROORGANISMS Helicobacter pylori Salmonella MEDICATIONS:

Aspirin NSAID Corticosteroids Digitalis Chemotherapeutic drugs Causes of Gastritis STRESS Physiological Psychological ENDOSCOPIC PROCEDURES TRAUMA Accidental or intentional ingestion of corrosive substances OTHER FACTORS: Reflux of bile Smoking Radiation Nasogastric suctioning SIGNS AND SYMPTOMS Abdominal pain Nausea and vomiting Abdominal tenderness Feeling of fullness Reflux Hematemesis or melena DIAGNOSTIC TESTS EGD Blood tests to check for anemia and detect H. pylori Urea breath test to check for H. pylori Stool tests to check for blood and H. pylori in the digestive tract THERAPEUTIC INTERVENTIONS Removal of the irritating substance Provide bland diet of liquids and soft foods Lifestyle changes. Medications: Antacids and H2 antagonist Proton-pump inhibitors Mucosal barrier fortifiers Sucralfate to protect the mucosal barrier THERAPEUTIC INTERVENTIONS

Infection with H. pylori requires 2-week course with 3 drugs: bismuth subsalicylate (Pepto-Bismol)or a proton-pump inhibitor and metronidazole (Flagyl) and tetracycline or clarithromycin and amoxicillin. HIATAL HERNIA Occurs when part of the stomach protrudes through the esophageal hiatus (opening in the diaphragm through which the esophagus passes through) HIATAL HERNIA CAUSES: Malformation Muscle weakness of the esophageal hiatus Esophageal shortening Obesity HIATAL HERNIA Signs & symptoms: Feeling of fullness, suffocation after meals Anemia - bleeding of the lining of the hernia may occur HIATAL HERNIA DIAGNOSTIC TESTS: Fluoroscopy X-ray studies TREATMENT: Dietary and medical management similar to GERD Remind the client to sit up after eating to keep the stomach down.