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• Gastroesophageal reflux disease (GERD) results from relaxation of the lower esophageal sphincter, causing stomach contents to back up into the esophagus.

Symptoms and Management of GERD

• Acid erosion and ulceration of the esophagus are caused by frequent vomiting.
• The cardinal symptom of GERD is a physical sensation known as heartburn, caused by acidic stomach contents touching the inside of the esophagus.
• To manage GERD symptoms, individuals should eat small, frequent meals and remain in an upright position for at least 30 minutes after eating.
• Lying recumbent following meals is contraindicated.
• Relief can be achieved with small, bland meals, H2 receptor antagonists, antacids, and elevating the thorax after meals and during sleep.
• Substances that decrease lower esophageal sphincter pressure, such as fatty foods, chocolate, caffeinated beverages, peppermint, and alcohol should be avoided.

Ulcerative Colitis and Its Types

• Left-sided colitis (distal colitis) starts in the rectum and extends to the sigmoid and descending colon.
• Ulcerative proctitis affects the rectum only, while proctosigmoiditis affects the rectum and sigmoid colon.
• Right-sided colitis is not a recognized type of ulcerative colitis.

Initial Treatment for Mild Ulcerative Colitis

• 5-Aminosalicylates (Sulfasalazine) are typically prescribed as a first-line treatment.
• Corticosteroids are prescribed if aminosalicylates are ineffective or if the patient has a sulfa allergy.
• Immunosuppressors and immunomodulators are used in severe cases when other medications have not worked.

Pancolitis and Toxic Megacolon

• Pancolitis affects the entire colon and is a severe form of ulcerative colitis, leading to a risk of toxic megacolon.
• Toxic megacolon involves dilation of the large intestine due to overwhelming inflammation, causing paralysis and improper function.
• Signs and symptoms of toxic megacolon include abdominal distention, fever, diarrhea, abdominal pain, dehydration, and tachycardia.

Peptic Ulcer Disease (PUD)

• Bleeding related to peptic ulcer disease (PUD) requires starting a large-bore intravenous (IV) line as the highest priority nursing intervention, enabling blood product administration.
• Clients with PUD may find licorice and slippery elm helpful, however, they should consult with their physician before adding them to their treatment regimen.
• Those with gastric ulcers typically experience pain 30-60 minutes after eating, not usually at night, whereas those with duodenal ulcers have pain during the night that is often relieved by eating.
• Clients with gastric ulcers usually pain occurs 30-60 minutes after eating.
• In contrast, a client with a duodenal ulcer has pain during the night that is often relieved by eating food, with pain recurring 1-3 hours after meals.
• A client with PUD should avoid E-mycin, an antibiotic
• The nurse should teach the client that Nizatidine (Axid) is most effective when administered twice daily rather than three times a day.
• Dietray modifications include reduced fat intake. * Fats are associated with decreased esophageal sphincter time

Role of Vagotomy in Ulcer Treatment

• A vagotomy is performed to eliminate the acid-secreting stimulus to gastric cells.

Crohn's Disease

• Common signs and symptoms include episodes of diarrhea and constipation.
• The nurse would most likely find stool cultures negative for microorganisms or parasites.
• Malabsorption is expected due to the transmural nature of the lesions.

Difference Between Crohn's and Ulcerative Colitis

• One major difference is that Crohn's disease often recurs after surgery, while ulcerative colitis can be cured with a colectomy.

Dietary and Treatment Considerations for Crohn's Disease

• A high-protein diet, supplemented with canned protein products, is recommended for clients.
• In planning care, medications are the preferred treatment due to the high likelihood of recurrence after surgical treatment.

Acute Exacerbation of Ulcerative Colitis

• The nurse should implement intravenous fluids during acute exacerbation.

Colon Cancer Risk and Ulcerative Colitis

• Chronic ulcerative colitis, granulomas, and familial polyposis increase a person's chance of developing colon cancer.

Diagnostic Procedures and Findings

• An esophagogastroduodenoscopy confirms PUD.
• Upper GI series requires a laxative following the procedure.
• It is important to auscultate the client's abdomen first. Palpation may give false information.
• Rebound tenderness could indicate peritonitis.

Symptoms of an Upper GI Bleed

• Low blood pressure. A decrease in blood pressure is the most indicative sign.
• Coffee ground-type emesis indicates upper GI bleeding.

Assessment findings

• Bowel sounds auscultated 15 times in 1 minute requires further intervention.
• A systolic BP decrease of 20 mm Hg from lying to sitting. This might be indicate the clients is bleeding

Important Nursing Interventions

• Tube feeding solutions and tubing should be changed at least every 24 hours. Also maintain the head of the bed at a 30-45 degree.

Hiatal Hernia and its Management

• Laying recumbent/flat following meals or at night will cause reflux and pain.

Nursing Education

• Client should avoid air swallowing with meals.
• Client should use Acetaminophen. Acetaminophen is recommended doe irritation of the mucosa.
• Teach the client to not lie down for 2 hours after eating
• Take a laxative after an upper GI series
• Always follow a low-residue diet

Common Adverse drug effects

• For Bethanechol (Urecholine) look for urinary urgency

Assessment and intervention for peptic ulcer

• Asses bowel sounds. This should be done first