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Questions and Answers
What is the primary goal of surgical hernia repair in patients with Gastroesophageal Reflux Disease?
What is the primary goal of surgical hernia repair in patients with Gastroesophageal Reflux Disease?
- To repair the hernia
- To relieve GERD symptoms (correct)
- To prevent esophageal irritation
- To reduce lower esophageal sphincter pressure
What dietary advice should be given to patients with GERD?
What dietary advice should be given to patients with GERD?
- Consume a high-fat diet
- Increase caffeine intake
- Eat a low-fat diet (correct)
- Avoid protein-rich foods
What is the recommended time to avoid eating or drinking before bedtime for patients with GERD?
What is the recommended time to avoid eating or drinking before bedtime for patients with GERD?
- 2 hours (correct)
- 4 hours
- 1 hour
- 3 hours
Why should patients with GERD maintain a normal body weight?
Why should patients with GERD maintain a normal body weight?
What is the recommended approach for postoperative dysphagia in patients with GERD?
What is the recommended approach for postoperative dysphagia in patients with GERD?
Why should patients with GERD avoid tight-fitting clothes?
Why should patients with GERD avoid tight-fitting clothes?
What is the recommended height to elevate the head of the bed for patients with GERD?
What is the recommended height to elevate the head of the bed for patients with GERD?
What should be avoided by patients with GERD to reduce esophageal irritation?
What should be avoided by patients with GERD to reduce esophageal irritation?
Why should patients with GERD be instructed to eat a low-fat diet?
Why should patients with GERD be instructed to eat a low-fat diet?
What is the recommended approach for managing postoperative nausea and vomiting in patients with GERD?
What is the recommended approach for managing postoperative nausea and vomiting in patients with GERD?
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Study Notes
Gastroesophageal Reflux Disease (GERD)
- GERD is a common disorder marked by backflow of gastric or duodenal contents into the esophagus, causing troublesome symptoms and/or mucosal injury to the esophagus.
Symptoms of GERD
- Pyrosis (heartburn, specifically a burning sensation in the esophagus)
- Dyspepsia (indigestion)
- Regurgitation
- Dysphagia or odynophagia (pain on swallowing)
- Hypersalivation
- Esophagitis
Assessment and Diagnostic Findings
- X-ray studies
- Barium swallow
- Esophagogastroduodenoscopy (EGD)
- Esophageal manometry
- Chest CT Scan
- Endoscopy or barium swallow to evaluate damage to the esophageal mucosa
- Ambulatory 12- to 36-hour esophageal pH monitoring to evaluate the degree of acid reflux
Management of GERD
- Frequent, small feedings that can pass easily through the esophagus
- Advise the patient not to recline for 1 hour after eating to prevent reflux or movement of the hernia
- Elevate the head of the bed on 4- to 8-inch blocks to prevent the hernia from sliding upward
- Surgical hernia repair (indicated in symptomatic patients) to relieve GERD symptoms
- Laparoscopic approach is recommended, with an open transabdominal or transthoracic approach reserved for patients with complications
- Medications to manage GERD symptoms:
- Antacids like Calcium Carbonate (Tums) and Aluminum Hydroxide, Magnesium Hydroxide and Simethicone (Maalox)
- H2 receptor antagonists like Famotidine (Pepcid), Ranitidine (Zantac), and Cimetidine (Tagamet)
- Proton pump inhibitors like Lansoprazole (Prevacid), Rabeprazole (AcipHex), Esomeprazole (Nexium), Omeprazole (Prilosec), and Pantoprazole (Protonix)
- Prokinetic agents like Metoclopramide (Reglan) to accelerate gastric emptying
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