GERD and Peptic Ulcers Quiz
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Questions and Answers

What is a common symptom of gastroesophageal reflux disease (GERD)?

  • Diarrhea
  • Nausea and vomiting
  • Heartburn (Pyrosis) (correct)
  • Constipation
  • What physiological mechanism is primarily responsible for gastroesophageal reflux?

  • Decreased esophageal motility
  • Increased stomach acidity
  • Transient relaxation or incompetence of the lower esophageal sphincter (correct)
  • Overproduction of saliva
  • Which factor does NOT contribute to gastroesophageal reflux disease?

  • Low dietary fiber intake (correct)
  • Hiatal hernia
  • Positioning such as bending or lying down
  • Increased gastric volume post meals
  • Which of the following is a potential complication of regurgitation in GERD?

    <p>Respiratory complications (C)</p> Signup and view all the answers

    What lifestyle factor is associated with an increased risk for developing GERD?

    <p>Wearing tight clothing (C)</p> Signup and view all the answers

    What is the primary purpose of performing an esophagogastroduodenoscopy (EGD) in patients suspected of having peptic ulcers?

    <p>To visualize the ulcer crater and take tissue biopsies (C)</p> Signup and view all the answers

    Which symptom is considered an 'alarming symptom' that necessitates endoscopy in the evaluation of potential peptic ulcers?

    <p>Weight loss and anorexia (B)</p> Signup and view all the answers

    Which of the following is an expected outcome after a patient undergoes a barium study?

    <p>The patient's stool may appear white for several days (C)</p> Signup and view all the answers

    What is the primary indication for urea breath testing in the context of peptic ulcers?

    <p>To diagnose the presence of H. pylori infection (B)</p> Signup and view all the answers

    What complication can occur when a peptic ulcer erodes into blood vessels?

    <p>Hemorrhage (D)</p> Signup and view all the answers

    What is considered the gold standard for diagnosing GERD?

    <p>Esophageal Endoscopy (B)</p> Signup and view all the answers

    Which of the following lifestyle modifications can help manage GERD symptoms?

    <p>Elevating the head of the bed (A)</p> Signup and view all the answers

    Which medication class is specifically known to reduce gastric secretions in GERD treatment?

    <p>Proton-pump inhibitors (B)</p> Signup and view all the answers

    Which complication is associated with chronic GERD and increased risk for esophageal cancer?

    <p>Barrett's esophagus (B)</p> Signup and view all the answers

    Which of the following is not a recommended dietary modification for managing GERD?

    <p>Consuming peppermint (D)</p> Signup and view all the answers

    Which surgical procedure is indicated for individuals with persistent GERD symptoms despite lifestyle changes?

    <p>Nissen fundoplication (D)</p> Signup and view all the answers

    What is a common symptom of GERD that can be confused with cardiac issues?

    <p>Chest pain (B)</p> Signup and view all the answers

    Which of the following is an example of a maintenance therapy for mild to moderate GERD symptoms?

    <p>Antacids (A)</p> Signup and view all the answers

    What is a primary symptom indicative of perforation in a patient with a peptic ulcer?

    <p>Sudden, sharp, severe epigastric pain spreading throughout the abdomen (D)</p> Signup and view all the answers

    Which management technique is crucial during hemorrhage from a duodenal ulcer?

    <p>NGT placement for saline lavage (C)</p> Signup and view all the answers

    What condition can result from the obstruction of the pyloric area due to ulcers?

    <p>Hypokalemia and metabolic alkalosis (C)</p> Signup and view all the answers

    Which type of surgical procedure creates a passage from the stomach to the small intestine?

    <p>Gastroenterostomy (C)</p> Signup and view all the answers

    What is the most significant reason for surgical treatment of peptic ulcers?

    <p>Failure of medical treatment or complications (A)</p> Signup and view all the answers

    What lifestyle modification is crucial for conservative management of ulcers?

    <p>Smoking cessation (C)</p> Signup and view all the answers

    Which class of medication is initially recommended for treating ulcers?

    <p>H2 receptor antagonists (D)</p> Signup and view all the answers

    What laboratory findings are associated with significant hemorrhage due to ulcers?

    <p>Decreased hemoglobin and hematocrit levels (C)</p> Signup and view all the answers

    Which nursing diagnosis is primarily related to symptoms of nausea and vomiting in patients with peptic ulcer disease?

    <p>Imbalanced nutrition related to acute exacerbation of disease process (D)</p> Signup and view all the answers

    When considering dietary modifications for a patient with peptic ulcer disease, which behavior should be specifically discouraged?

    <p>Ingesting spicy or acidic foods (B)</p> Signup and view all the answers

    What is the primary focus of nursing interventions for a patient diagnosed with anxiety related to the fear of an unknown prognosis?

    <p>Reducing anxiety through emotional support and counseling (A)</p> Signup and view all the answers

    In managing peptic ulcer disease, which of the following interventions is aimed at achieving optimal nutritional status?

    <p>Planning frequent, balanced meals (D)</p> Signup and view all the answers

    Which medication type is primarily used to reduce acid secretion in the treatment of peptic ulcers?

    <p>Proton pump inhibitors (PPIs) (D)</p> Signup and view all the answers

    What is the primary effect of a vagotomy in gastric surgery?

    <p>It eliminates the stimulus for acid secretion. (A)</p> Signup and view all the answers

    Which of the following symptoms are typically associated with early dumping syndrome?

    <p>Nausea and diarrhea (D)</p> Signup and view all the answers

    How can dumping syndrome potentially be prevented after gastric surgery?

    <p>By eating smaller meals and limiting sugary foods. (C)</p> Signup and view all the answers

    What is a common late symptom of dumping syndrome?

    <p>Weakness and dizziness several hours post-meal (A)</p> Signup and view all the answers

    What surgical procedure aims to widen the pylorus for enhanced stomach emptying?

    <p>Pyloroplasty (C)</p> Signup and view all the answers

    Which factor is least likely to be assessed in nursing management of peptic ulcers?

    <p>Sleep patterns (D)</p> Signup and view all the answers

    What is the main consequence of gastric contents moving into the small intestine too quickly?

    <p>Development of dumping syndrome (A)</p> Signup and view all the answers

    What change is recommended in dietary habits to manage post-surgical complications?

    <p>Limiting water intake during meals (D)</p> Signup and view all the answers

    Flashcards

    What is gastroesophageal reflux?

    The backward flow of stomach content into the esophagus.

    What is the most common cause of GERD?

    A weak or malfunctioning lower esophageal sphincter (LES) can't properly keep stomach contents from flowing back into the esophagus.

    What is heartburn or pyrosis?

    The most common symptom, often described as a burning sensation behind the breastbone, usually occurring after a meal or when lying down.

    What is regurgitation?

    The effortless return of stomach and/or esophagus contents into the throat. It can be a more serious symptom of GERD leading to respiratory issues.

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    How do factors like obesity and tight clothing contribute to GERD?

    Conditions like obesity, tight clothing, or eating large meals can increase pressure on the stomach, making it more likely for stomach acid to back up into the esophagus.

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    Barrett's Esophagus

    Abnormalities in the lining of the esophagus that can increase the risk of esophageal cancer. It happens when the cells lining the esophagus change due to prolonged GERD.

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    Esophageal Stricture

    A narrowing or constriction of the esophagus, which can make swallowing difficult.

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    H2-receptor Blockers

    A group of medications designed to decrease acid production in the stomach. Examples: Cimetidine, Ranitidine (Zantac), Famotidine.

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    Proton Pump Inhibitors (PPIs)

    A type of medication that reduces the amount of acid your stomach makes. Examples: Omeprazole.

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    Antacids

    Drugs that act quickly to neutralize stomach acid for temporary relief of heartburn. Examples: Maalox, Gaviscon.

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    Peptic Ulcer

    An open sore or ulceration in the lining of the stomach, duodenum, or esophagus.

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    Esophageal Endoscopy

    The gold standard test for confirming GERD, where a scope is passed down the esophagus.

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    Nissen Fundoplication

    A procedure where the lower esophageal sphincter is tightened using a laparoscopic approach. This procedure is indicated when lifestyle changes and medications are not effective.

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    What is esophagogastroduodenoscopy (EGD) used for?

    A procedure using a fiberoptic endoscope to visualize the ulcer crater, allowing for tissue biopsy to rule out cancer and diagnose H. pylori infection.

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    What is a barium study used for?

    A thick, milkshake-like liquid ingested by the patient, followed by multiple X-rays. This test can detect structural disorders. The patient should drink plenty of liquids afterward due to the barium's effect.

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    What is Urea Breath Testing used for?

    A diagnostic test used to identify Helicobacter pylori infection. The client drinks a carbon-enriched urea solution, and exhaled carbon dioxide is measured to detect the bacteria.

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    What is Hemorrhage, a complication of peptic ulcers?

    Damage to blood vessels as the ulcer erodes into the stomach or duodenal wall, causing bleeding. Symptoms include coffee ground vomitus, tarry stools, and potentially bright red blood in vomit.

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    What is Perforation, a complication of peptic ulcers?

    A hole in the stomach or duodenum that can occur due to the ulcer eroding through the wall. It's a serious complication requiring immediate medical attention.

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    Vagotomy

    A surgical procedure that involves cutting the vagus nerve to reduce the amount of acid produced in the stomach.

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    Pyloroplasty

    A surgical procedure that widens the pyloric sphincter, allowing for more efficient emptying of the stomach even without vagus nerve stimulation.

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    Dumping Syndrome

    A condition that occurs after gastric surgery, where food moves too quickly from the stomach to the small intestine, causing digestive discomfort.

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    Early Dumping Syndrome

    A symptom of early dumping syndrome characterized by nausea, vomiting, abdominal cramps, and diarrhea.

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    Late Dumping Syndrome

    A symptom of late dumping syndrome characterized by sweating, hunger, fatigue, dizziness, weakness, and rapid heart rate, occurring 1-3 hours after eating.

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    Gastroenterostomy

    A surgical procedure that reroutes the digestive system to bypass the ulcerated area, reducing acid exposure to the ulcer.

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    Gastroesophageal Reflux Disease (GERD)

    A condition that occurs when the stomach contents flow backward into the esophagus, causing heartburn and other discomfort.

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    Perforated Ulcer

    A type of ulcer complication where the ulcer erodes through the entire stomach/duodenal wall, allowing bacteria and partially digested food to leak into the abdominal cavity.

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    Ulcer Obstruction (Pyloric)

    A condition where the stomach or duodenum narrows, obstructing food passage. This can cause repeated vomiting, abdominal bloating, and a buildup of pressure in the stomach.

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    Melena

    Dark, tar-like stool, often a sign of bleeding in the upper digestive tract, particularly in the duodenum.

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    Ulcer Hemorrhage

    A common complication of ulcers where the weakened blood vessels in the ulcer rupture, causing bleeding into the digestive tract.

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    Peritonitis

    A severe and potentially life-threatening abdominal inflammation caused by the leakage of bacteria and digestive contents into the peritoneal cavity.

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    Lifestyle Modification for Ulcers

    A type of conservative treatment for ulcers that involves reducing stress, abstaining from alcohol and smoking, and avoiding NSAIDs.

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    Pharmaceutical Treatment for Ulcers

    A type of treatment for ulcers that involve medications such as antibiotics, antiacids, H2 receptor antagonists, and anticholinergics.

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    Surgical Treatment for Ulcers

    A type of surgical intervention used to treat ulcers when medical management fails or complications arise. It may involve bypassing the damaged portion of the stomach or duodenum.

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    What kind of peptic ulcer causes pain relieved by food and worsens at night?

    A peptic ulcer that typically causes pain that is relieved by eating and worsens at night.

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    How do medications like ranitidine (Zantac) work for peptic ulcer disease?

    A medication like ranitidine (Zantac) primarily reduces acid production in the stomach.

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    What habits are forbidden for people with gastroesophageal reflux?

    A person with gastroesophageal reflux disease should strictly avoid alcohol and smoking. There is no time limit on eating before bed, but they should avoid bending and tight clothing.

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    What is a common nursing diagnosis for peptic ulcer disease?

    Acute pain related to increased gastric secretions, decreased mucosal protection, and ingestion of gastric irritants.

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    How can peptic ulcers be prevented?

    Peptic ulcers can be caused by a variety of factors such as bacteria, medications, and lifestyle habits. It is important to follow treatment plans and potentially make lifestyle changes.

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    Study Notes

    Gastroesophageal Reflux Disease (GERD)

    • GERD is the backward flow of gastric contents into the esophagus.
    • GERD and peptic ulcer are common GIT diseases.
    • Unhealthy food, analgesia, and bad lifestyles are risk factors.
    • GERD affects 15-20% of adults.

    Learning Objectives

    • Define gastroesophageal reflux (GERD) and peptic ulcer.
    • Discuss the etiology and pathophysiology of GERD and peptic ulcer.
    • Describe the symptoms of GERD and peptic ulcer.
    • Recognize the diagnostic studies of GERD and peptic ulcer.
    • Discuss collaborative management of GERD and peptic ulcer.
    • Discuss nursing management of GERD and peptic ulcer.
    • Identify complications of GERD and peptic ulcer.

    Introduction

    • Gastroesophageal reflux disease (GERD) and peptic ulcers are common diseases affecting the gastrointestinal tract.
    • Unhealthy food choices, analgesics, and poor lifestyle choices are risk factors.

    Definition

    • Gastroesophageal reflux is the backward flow of gastric contents into the esophagus.

    Pathophysiology

    • GERD results from transient relaxation or incompetence of the lower esophageal sphincter, or increased pressure within the stomach.
    • Backflow of acid and stomach contents into the esophagus causes heartburn.

    Factors Contributing to GERD

    • Increased gastric volume (post-meals)
    • Position pushing gastric contents close to the gastroesophageal junction (e.g., bending or lying down).
    • Increased gastric pressure (e.g., obesity or tight clothing).
    • Hiatal hernia

    Hiatal Hernia

    • A hiatal hernia occurs when part of the stomach protrudes up into the chest through the diaphragm, weakening the sphincter.

    Risk Factors for GERD

    • Smoking
    • Large meals, eating late at night
    • Fatty/fried foods
    • Alcohol/coffee/soda consumption
    • Medications without doctor's consultation
    • Going to bed shortly after eating.

    Symptoms of GERD

    • Typical Symptoms (Heartburn or Pyrosis):
      • Most common, felt as a burning sensation behind the breastbone.
      • Often occurs after eating or when lying down/bending over.
      • Often relieved by milk or water.
    • Regurgitation:
      • Effortless return of gastric/esophageal contents into the pharynx
      • May cause respiratory complications if contents spill into the airway.
    • Atypical Symptoms:
      • Cough, dyspnea, hoarseness, chest pain

    Diagnosis of GERD

    • Exclude other potential causes (e.g., cardiac, peptic ulcer, esophagitis).
    • Esophageal Endoscopy: Gold standard for definitive diagnosis.
    • Barium swallow: Not as definitive in mild cases.

    Collaborative Management of GERD

    • Dietary and Lifestyle Management
    • Drug Therapy
    • Surgical therapy

    Dietary and Lifestyle Management for GERD

    • Maintain ideal body weight.
    • Elevate the head of the bed 6-8 inches (20-30 cm).
    • Eliminate acid foods (e.g., tomatoes, spicy, citrus foods, coffee).
    • Avoid foods that relax the esophageal sphincter or delay gastric emptying (e.g., fatty foods, chocolate, peppermint, alcohol).
    • Eat small meals and stay upright for 2 hours after eating; no eating 3 hours before bed.
    • Stop smoking
    • Avoid bending and wear loose-fitting clothing

    Drug Therapy for GERD

    • Antacids (mild-moderate symptoms): Maalox, Gaviscon.
    • H2-receptor blockers (decrease acid production): Cimetidine, Ranitidine (Zantac), Famotidine.
    • Proton-pump inhibitors (reduce gastric secretions, promote healing): Omeprazole.

    Surgical Therapy for GERD

    • Indicated for patients with GERD that isn't improved with diet and lifestyle changes.
    • Laparoscopic procedures (e.g., Nissen fundoplication) to tighten the lower esophageal sphincter.

    Nursing Management of GERD

    • Avoid factors that cause reflux (e.g., stop smoking, frequent, small meals, avoid acid-producing foods)
    • Elevate the head of the bed ~30 degrees
    • Don't lie down 2-3 hours after eating
    • Drug therapy: Evaluate effectiveness and monitor for side effects.

    Lifestyle Changes to Treat GERD

    • Quit smoking
    • Exercise regularly
    • Sit up straight
    • Eat small meals throughout the day
    • Chew food slowly
    • Avoid heartburn triggers
    • Wear loose clothing
    • Sleep with head and shoulders propped up
    • Minimize caffeine and alcohol consumption
    • Avoid lying down for at least 3 hours after a meal

    Complications of GERD

    • Esophageal strictures (narrowing leading to difficulty swallowing).
    • Barrett's esophagus (changes in the cells lining the esophagus, increased risk of esophageal cancer).

    Peptic Ulcer

    • A hole or open sore in the lining of the stomach, duodenum (beginning of the small intestine), or esophagus.

    Pathophysiology of Peptic Ulcer

    • Defensive Mechanisms: Bicarbonate, mucus layer, prostaglandins, Mucosal blood flow, epithelial renewal

    • Aggressive Factors: H. pylori infection, NSAIDs, Bile acids, smoking and alcohol

    • Under normal conditions, there is a balance between gastric acid secretion and gastro-duodenal mucosal defense.

    • Mucosal injury occurs when this balance is disrupted due to aggressive factors, such as NSAIDs, H. pylori infections, alcohol, bile salts, acid, and pepsin, which potentially damage the mucosal defense mechanisms by allowing back diffusion of hydrochloric acid, leading to epithelial cell injury.

    Etiology/Risk Factors of Peptic Ulcer

    • Lifestyle: Smoking, alcohol, acidic drinks, NSAID medications
    • H. Pylori infection (passed from person to person)
    • Age (duodenal - 30-40 years, gastric - over 50).
    • Gender (more common in males).
    • Genetic factors.
    • Stress.

    Types of Peptic Ulcers

    • Gastric
    • Duodenal
    • Stress

    Clinical Presentation of Peptic Ulcers

    • Epigastric pain (dull, gnawing, burning)
    • Pain usually relieved by eating (duodenal).
    • Tenderness
    • Pyrosis (heartburn)
    • Vomiting, constipation or diarrhea, bleeding
    • Burping
    • Bleeding
    • Tarry stool

    Comparing Duodenal and Gastric Ulcers

    • Incidence: Duodenal (30-40 years, male:female = 2:3) is more prevalent; Gastric (50+, male:female = 1:1)
    • Signs/Symptoms: Duodenal pain 2-3 hours after eating, relieved by food; Gastric pain 1-2 hours after eating, possibly relieved by vomiting.
    • Weight: Duodenal may have weight gain, Gastric may have weight loss.
    • Vomiting: Duodenal infrequent; Gastric more common.
    • Hemorrhage (Bleeding): Duodenal more common (melena).
    • Risk Factors: Both involve H. pylori, alcohol, smoking, cirrhosis, NSAID use, and stress.

    Investigations/Diagnostic Tests

    • Stool examination for fecal occult blood.
    • Complete blood count (CBC) for decreased blood cells.
    • Esophagogastroduodenoscopy (EGD)
    • Barium study
    • Urea breath testing

    Complications of Peptic Ulcers

    • Hemorrhage
    • Perforation
    • Pyloric obstruction.

    Management of Ulcers

    • Conservative therapy: Rest, dietary modifications, lifestyle modifications (stop smoking, alcohol, NSAIDs, stress reduction), long-term follow-up.
    • Pharmaceutical therapy: Antibiotics (H. pylori eradication), H2 receptor antagonists, antacids.
    • Surgical therapy: Indicated for failure of medical treatment, complication development, high levels of gastric secretion, or combined duodenal/gastric ulcers.

    Surgical Procedures

    • Gastroenterostomy
    • Vagotomy
    • Pyloroplasty

    Dumping Syndrome

    • A complication of gastric surgery, food (especially sugar) moves too quickly from the stomach to the small intestine.
    • Early symptoms (15-30 minutes after eating high-sugar foods): Nausea, vomiting, abdominal cramps, diarrhea, flushing, dizziness, rapid heart rate.
    • Late symptoms (1-3 hours after eating high-sugar foods): Sweating, hunger, fatigue, dizziness, lightheadedness, weakness, rapid heart rate.
    • Management Strategies: Eating smaller, high-fiber meals, limiting water intake during meals, and reducing high-sugar foods.

    Nursing Assessment and Diagnoses for Peptic Ulcers

    • Assess pain (type, timing, duration).
    • Assess antacid use, vomiting, smoking, alcohol and NSAID use.
    • Assess stress level and family history of ulcers.
    • Assess eating habits, blood in stool, and perform physical examination.
    • Identify nursing diagnoses such as: acute pain, imbalanced nutrition, anxiety, ineffective therapeutic regimen

    Nursing Interventions for Peptic Ulcers

    • Relieving pain
    • Promoting optimal nutritional status
    • Promoting fluid intake
    • reducing anxiety
    • Teaching self-care.

    Learning about Self care for Peptic Ulcers includes

    • Reduce psychological stress
    • Reduce physical stress
    • Cessation of cigarette smoking
    • Avoid spicy foods, caffeine, alcohol.
    • Drink plenty of water
    • Avoid fasting and maintain optimum gap between meals

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