GERD

Question 1

backward flow of stomach contents into the esophagus due to incompetent lower esophageal sphincter (LES)

Answer 1

Gastroesophageal reflux (GER)

Question 2

Reflux of gastric content in the esophagus causes _______________ which may be mild or severe

Answer 2

reflux esophagitis

Question 3

Assessment for GERD

Answer 3

• Substernal or retrosternal burning pain
• Pain worsens when lying down, bending, or straining
• Ask about:
  a. chronic cough
  b. Hoarseness (morning)
  c. Dysphagia
  d. Newly diagnosed asthma
  e. Recurrent pneumonia

Question 4

Heartburn + cough + hoarseness = ?

Answer 4

severe reflux

Question 5

Diagnostic Tests

Answer 5

1. Barium swallow
2. Upper Endoscopy
3. 48 hr pH monitoring: gold standard
4. Esophageal manometry

Question 6

Signs & Symptoms for GERD
Primary

Answer 6

• Dyspepsia (indigestion)
• Pyrosis (heartburn)

Question 7

Signs & Symptoms for GERD

GI

Answer 7

“BO GERD”

• Belching
• Odynophagia
• Globus sensation
• Epigastric pain
• Regurgitation
• Dysphagia

Question 8

S/S for GERD

Respiratory / Oral

Answer 8

“CHAD”

• Chronic cough
• Hoarseness
• Aspiration pneumonia
• Dental caries

Question 9

Nursing Priorities (GERD)

Answer 9

1. Positioning
   o Elevate HOB 30–45°
2. Diet Teaching
   o Small, frequent meals
   o Avoid fatty, spicy foods, caffeine, alcohol
3. Safety
   o Watch for aspiration signs
   o Monitor dysphagia

Question 10

Burning pain relieved by?

Answer 10

ANTACIDS

Question 11

✔ Chronic cough + GERD = ?

Answer 11

micro-aspiration

Question 12

GERD INTERVENTIONS
1. DIET MODIFICATIONS – “PROTECT LES”

Answer 12

P – Protein ↑, Fat ↓
R – Reduce acidic & spicy foods
O – Omit alcohol, chocolate, peppermint
T – Take small, frequent meals
E – Eliminate late-night eating (≥3 hrs before bed)
C – Carbonated drinks avoided
T – Tobacco cessation

LES
L – Low-fat diet
E – Eat upright, stay upright 1–2 hrs
S – Small meals

Question 13

GERD INTERVENTIONS
POSITIONING & LIFESTYLE – “UPRIGHT”

Answer 13

U – Upright after meals (1–2 hrs)
P – Pounds reduction if obese
R – Raise HOB 4–6 inches
I – Inhibit smoking & alcohol
G – Garments loose (avoid tight clothes)
H – Hours before bed: no eating (≥3 hrs)
T – Turn to right lateral position during sleep

Question 14

DRUG THERAPY FOR GERD

– “PAH Pro”

Answer 14

P – PPIs (Omeprazole, Pantoprazole) → MAIN TREATMENT
A – Antacids (Maalox, Gaviscon)
H – H2 blockers (Famotidine, Cimetidine)

Pro – Prokinetics
* Metoclopramide
* Domperidone

Question 15

MEDICATIONS THAT WORSEN GERD – “ABCCN”

Answer 15

A – Anticholinergics
B – Beta-agonists
C – Calcium channel blockers
C – Contraceptives (oral)
N – Nitrates

Question 16

GERD INTERVENTIONS
Priority Goal

Answer 16

➡️ Reduce gastric acid exposure
➡️ Increase LES pressure
➡️ Prevent reflux & aspiration

Question 17

NURSING SAFETY PRIORITY

Long-term use of PPI’s

Answer 17

• Long-term use → ↓ calcium absorption
• ↑ risk of hip fractures, especially in older adults

Question 18

H2-Receptor Blockers

Answer 18

• Famotidine, Cimetidine, Ranitidine
• Reduce acid production
• Promote esophageal healing

Question 19

Antacids

Answer 19

• Maalox, Gaviscon, Alka-Seltzer
• Neutralize gastric acid
• Administer 1–3 hrs after meals and at bedtime

Question 20

Prokinetic Agents

Answer 20

• Metoclopramide, Domperidone
• ↑ Gastric emptying
• ↑ LES pressure
• ↑ Esophageal peristalsis

Question 21

Indication for Surgery
Anti-reflux surgery is considered when:

Answer 21

• Medications and lifestyle changes fail
• GERD is severe or chronic
• Complications are present (aspiration, strictures, Barrett’s)

Question 22

Types of Anti-Reflux Surgery – “FLiT

Answer 22

F – Fundoplication
L – LINX device
T – Transoral incisionless fundoplication (TIF)

Question 23

Fundoplication Types – “Ni To”

Answer 23

Ni – Nissen
* Full (360°) wrap
* Used for severe GERD

To – Toupet
* Partial (270°) wrap
* Used for dysphagia risk

Question 24

Which fundoplication lowers dysphagia risk?

Answer 24

Toupet

Question 25

* Ring of **magnetic beads** placed around the LES * Keeps valve closed to prevent reflux * Opens during swallowing to allow food passage

Answer 25

LINX Device

Question 26

* Performed through the mouth * Uses an endoscope * Creates a partial wrap * No external incisions

Answer 26

Transoral Incisionless Fundoplication (TIF) 📌 Exam clue: Minimally invasive, incisionless