Upper GI Disorders
Esophageal cancer patients must be assessed for what periodically
new lesions, swallow evaluations, signs of anemia from bleeding, losing too much weight, coughing up blood
what is a paraesophageal hernia (rolling)
part of the fundus of the stomach rolls up
Medical treatment of hiatal hernias
antacids, maalox, tums
if GERD is severe, PPI or H2 antagonist may be prescribed
surgical manipulation of stomach
Key points for hiatal hernias:
weight control:
obesity is going to increase that intra-abdominal pressure
diagnostic tests and lab studies to determine GERD
H&P, probe inserted into the distal esophagus that measures the pH for 24 hours (during which patient keeps diary of symptoms and activities and food), biopsies, barium swallows, endoscopy,
gold standard test: esophageal manometry or motility testing for monitoring activity *** is not a diagnostic tool but gives good information**
what consults might you want to order for these patients
mental, chaplain, home health, dietary
causes of hiatal hernia
simply acquired, trauma, hereditary weakness in the muscle, increase intra-abdominal pressure
Key points for hiatal hernias:
assessments:
respiratory assessment (after meals especially, they will feel fullness or suffocating)
swallowing evaluations
assess for symptoms of GERD, N/V, bleeding (labs to detect anemia, etc)
Key points for hiatal hernias:
educate
if surgery was performed, post-op teachings, s/sx of infection, how and when to perform vital signs
Treatment for GERD
medications
short acting to lower gastric pH: antacids, histamine receptor antagonist
prokinetic medication to increase gastric emptying
long acting to lower gastric pH: PPIs
what is a hiatal hernia
a portion of the stomach protrudes upwards through the diaphragm where the esophagus passes through
s/sx of hiatal hernia
heartburn, regurgitation, chest pain, dysphagia, belching, feeling of fullness after eating (breathless), feeling of suffocating, angina like pain
all s/sx increased when lying flat
Key points for hiatal hernias:
medications:
give meds as prescribed: acid histamine receptor antagonist, PPIs, anti-emetics
Define GERD
stomach acid backs up into the esophagus due to weakened or relaxed sphincter between the stomach and esophagus
treatment for GERD
surgical
sutures to the lower esophageal sphincter to tighten and lessen back flow
Nissen fundoplication is the GOLD STANDARD for patients who did not respond well to medication or had complications
what are the two types of hiatal hernias
sliding hernia
paraesophageal hernia or rolling hernia
complications of hiatal hernias
gastroesophageal reflux disease (GERD), strictures, ulcers, barrett's esophagus (precancerous condition), hernia may develop into an obstruction becomiong strangulated
Key points for hiatal hernias:
lifestyle changes
lying as upright as possible, can lie supine but on RIGHT side only (help with gastric emptying), diet modification, exercise, weight control
Risk factors for GERD
hiatal hernias, loss of esophageal motility, increased gastric secretions, eating large meals, obesity
complications of GERD
barrett's esophagus, scarring and strictures due to acid
what is a sliding hernia
the stomach slides up past the diapragm (most common)
diagnostic and lab studies for hiatal hernias
xray, endoscopy, barium swallow, fluroscopy (most specific), EGD (give a view of esophagus and stomach lining)
Key points for hiatal hernias:
diet:
limit spicy food, caffiene, chocolate, carbonated beverages, peppermint, and alcohol
S/sx of GERD
heartburn, chest pain, excess saliva production, regurgitation, gas, bloating, trouble sleeping, persistent cough, chronic sore throat, difficulty swallowing, gum disease, dental erosions
prevention of GERD
limit spicy and fatty foods, caffiene, chocolate, carbonated drinks, acidic foods, peppermint, alcohol, smoking cessation, avoid the use of NSAIDS and aspirin, avoid tight clothing and maintain a healthy weight