this powerpoint gives concrete idea of gastrointestinal esophageal reflux disease - pathophysiology, signs & symptoms , treatment & nursing management.This ppt may be enough informative & helpful for bsc. & msc. nursing students.

2. PYROSIS
DYSPEPSIA

3. GASTRO-OESOPHAGEAL
REFLUX DISEASE
PRESENTED BY,
KOYEL BASAK
1ST YEAR
M.SC NURSING

4. DEFINITION:
Gastro esophageal reflux disease is a
chronic and relapsing condition in which
prolonged reflux of hydrochloric acid,
pepsin and bile salts in esophagus, oral
cavity and respiratory system occurs that
leads to esophagitis

5. INCIDENCE:
 In India, 18.7% of the older adult population
suffers from GERD. Among pregnant
women, 9.5% women suffer in first trimester,
43.1% women suffer in second trimester
and 54.1% women suffer in third trimester
[according to Indian J Gastroentrol (May-
June 2011) 30(3):105-107]. Approximately
14% to 20% population in USA experience
GERD symptoms at least once a week.

6. RELATED ANATOMY AND
PHYSIOLOGY:

8. ETIOLOGY
Dietary factors:

9. ETIOLOGY

10. LIFE-STYLES

12. Anticholinergics
beta-blocker
bronchodialator
Dopamine active drugs
estrogen
Narcotics containing
codein
nitrates
Benzodiazepines
•
progesterone,
calcium channel blockers

13. ETIOLOGY
Pregnancy
Endocrine disorder
Autoimmune disorder
Neuromuscular disorder
Anatomical disorder

15. ETIOPATHOLOGY OF GERD FROM HIATAL
HERNIA
Hiatal hernia
Small portion of
the stomach lies
with the
esophagus
Esophageal
sphincter above
diaphragm
Pressure on the LES
due to diaphragm is
reduced
Relaxation of LES
occurs
Acid of the
stomach reflux
into the stomach,
thus GERD

16. Relaxation of LES, Decreased esophageal,
Decreased gastric emptying, hypersecretion of
acid in the stomach, Impaired esophageal
motility, Increased abdominal pressure
The acidic gastric
secretion reflux up
into the esophagus
Gastric enzymes
pepsin, intestinal
enzyme trypsin and
bile salts also enter
the esophagus
Esophageal irritation and erosion of esophageal
mucosal lining
Inflammation of esophagus i.e esophagitis
Chronic GERD

17. CLINICAL MANIFESTATION:

18. CLINICAL MANIFESTATION:

19. CLINICAL MANIFESTATION:
Globus
sensation
Hypersaliva
-tion
Regurgita
tion
Respiratory
symptoms
Otolaryngeal
symptom

20. The Los Angeles Classification System
for the endoscopic assessment of reflux
oesophagitis

21. The Los Angeles Classification System for the
endoscopic assessment of reflux oesophagitis

22. The Los Angeles Classification System for the
endoscopic assessment of reflux oesophagitis

23. The Los Angeles Classification System for the
endoscopic assessment of reflux oesophagitis

24. Diagnostic
study
History
taking
Manometric
study
24 hrs pH
monitoring
Radionuclio
tide test
Endoscopic
studies
Barrium
swallow
study
Physical
examination

25. COLLABORATIVE
MANAGEMENT

26. Nutritional
therapy
Lifestyle
modification

27. PHARMACOLOGICAL THERAPY
Antacids
H2 receptor
antagonist
Proton pump
inhibitor
Cytoprotective
drug
Cholinergic
drug
Prokinetic
drug

28. ENDOSCOPIC THERAPY

29. ENDOSCOPIC INTRALUMINAL
VALVULOPLASTY
Gastric tissue is utilised to
increase the integrity of LES
By creating a valve like
structure.

30. Endoscopic radiofrequency
therapy

31. Endoluminal Gastroplication

32. Surgical therapy

33. Nissen fundoplication

34. Roux-en-Y Gastric Bypass

35. Surgically
Implanted
Rings

36. HEALTH
EDUCATION

37. Nursing
management

38. ACUTE PAIN AT EPIGASTRIC REGION RELATED
TO REFLUX OF THE GASTRIC CONTENTS INTO
THE ESOPHAGUS
Plan of Intervention:
 A comprehensive assessment of pain including
location, characteristic, onset, duration, frequency,
quality is to be done to determine the appropriate
intervention.
 Comfortable position is to be provided (head end
elevated).
 Diet therapy is to be provided that is providing
water or any alkaline agent.
 Non-pharmacological techniques e.g guided
imagery, music therapy, diversional therapy is to be
given.
 Analgesics are to be given as per prescription.

39. NAUSEA RELATED TO GLOBUS SENSATION,
REGURGITATION, DELAYED ESOPHAGEAL
EMPTYING.
Plan of intervention:
 A complete assessment of nausea including
severity, duration, frequency, precipitating factors.
 Head end is to be elevated.
 Personal factors are to be eliminated that increase
nausea such as anxiety, fatigue, fear.
 Oral hygiene is to be maintained.
 Small and frequent diet is to be given to prevent
overdistention of the stomach.
 Adequate rest and avoiding of bending after meal is
to be promoted.
 Non-pharmacological techniques are to be taught
i.e relaxation, distraction etc.
 Anti-emetic drugs are to be administered.

40. IMBALANCED NUTRITION: LESS THAN BODY
REQUIREMENT RELATED TO NAUSEA,
INABILITY TO INTAKE FOOD ADEQUATELY
SECONDARY TO GLOBUS SENSATION IN
THROAT, PYROSIS.
Plan of intervention:
 A complete assessment of the nutritional is to be
done.
 Foods that decreases LES pressure is to be
avoided.
 Small amount of meal is to be encouraged.
 Intake output chart is to be monitored.
 Weight is to be checked at frequent interval.
 Preference is to be given to patient’s desire during
preparing food.
 Food is to be served in attractive way.

41. HEMORRHAGE RELATED TO ERODED
MUCOSAL TISSUE OF ESOPHAGUS.
Plan of intervention:
 Assess the evidence of hematemesis, brigh red blood in
stool or malena, abdominal pain or discomfort,
symptoms of shock (cool and calmy skin, tachycardia,
tachyonea etc)
 If ulcer is actively bleeding, NG tube is to be inserted
gently and NG aspiration is to be monitored for amount,
color and degree of bleeding.
 Vital signs are to be checked every 15mins.
 IV infusion is to be started and fluid replacement is to be
done.
 Hematocrit and hemoglobin level is to be checked.
 Intake output is to be monitored and fluid balance is to
be maintained.
 Infusion of proton pump inhibitor is started continuously.
 Antiplatelet drugs may be administered.

42. INEFFECTIVE THERAPEUTIC REGIMEN RELATED
TO LACK OF KNOWLEDGE OF LONG-TERM
MANAGEMENT OF GERD, LIFESTYLE
MODIFICATION, APPROAPRIATE DIET THERAPY.
Plan of intervention:
 Patient’s knowledge about the disease and its
therapy is to be assessed.
 Pathophysiology and treatment modalities of the
disease are to explained.
 Health teaching is to be given to the patient.
 Patient is to be instructed on which sign and
symptoms to report to health care provider to
ensure early initiation of treatment.
 Psychological support is given.
 All the questions of the patient about the disease
and its treatment is to answered with rationale.

43. COMPLICATION
Chronic erosive Oesophagitis: It is
responsible for 40-60% of GERD
symptoms.
Esophageal stricture: It is the result of
healing of erosive esophagitis.
Barrett’s esophagus: It accounts for 8-15%
of all GERD cases.