GASTROINTESTINAL
SYSTEM
Amish
Nursing Lecturer
RLNC
1
Objectives
At the end of the session, the learner will be able to:
 Define GERD and hiatal hernia.
 Explain the causes and risk factors of GERD and hiatal
hernia.
 Describe the clinical manifestations of GERD and
hiatal hernia.
 Discuss diagnostic evaluation and management of
GERD and hiatal hernia.
 Explain complications associated with GERD and
hiatal hernia.
 Describe nursing management and patient education for
GERD and hiatal hernia.
2
Gastroesophageal Reflux
Disease
Gastroesophageal reflux disease (GERD) occurs when
stomach acid frequently flows back into the tube
connecting your mouth and stomach (esophagus). This
backwash (acid reflux) can irritate the lining of your
esophagus. (Robinson & Dimango, 2014)
Many people experience acid reflux from time to time.
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Clinical Manifestations
• Pyrosis (burning sensation in the
esophagus)
• Dyspepsia (indigestion)
• Regurgitation of food or sour liquid
• Dysphagia
• Odynophagia (pain on
swallowing)
• Hypersalivation
• Esophagitis
If you have night time acid reflux, you
might also experience:
•Chronic cough
•Laryngitis
•Disrupted sleep (Hart, 2013)
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Causes
GERD is caused by frequent acid reflux.
If the sphincter relaxes abnormally or weakens,
stomach acid can flow back up into your esophagus.
This constant backwash of acid irritates the lining of
your esophagus, often causing it to become inflamed.
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Risk Factors
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Conti……
•Obesity
•Bulging of the top of the stomach up into the diaphragm
(hiatal hernia)
•Pregnancy
•Delayed stomach emptying
•Factors that can aggravate acid reflux include:
•Smoking
•Eating large meals or eating late at night
•Eating certain foods (triggers) such as fatty or fried foods
•Drinking certain beverages, such as alcohol or coffee
•Taking certain medications, such as aspirin
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Complications
Over time, chronic inflammation in esophagus can cause:
•Narrowing
of
the
esophagus
(esophageal
stricture). Damage to the lower esophagus from stomach
acid causes scar tissue to form. The scar tissue narrows the
food pathway, leading to problems with swallowing.
•An open sore in the esophagus (esophageal
ulcer). Stomach acid can wear away tissue in the
esophagus, causing an open sore to form. An esophageal
ulcer can bleed, cause pain and make swallowing difficult.
•Precancerous changes to the esophagus (Barrett's
esophagus). Damage from acid can cause changes in the
tissue lining the lower esophagus. These changes are
associated with an increased risk of esophageal cancer.
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Assessment and Diagnostic Findings
•
•
•
History
Physical examination
Endoscopy or barium
swallow to evaluate
damage to the
esophageal mucosa
• Ambulatory 12–36-hour
esophageal pH
monitoring (Hart, 2013)
• Bilirubin monitoring
• Bilitec is used to measure
bile reflux patterns
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10
9 ways to relieve acid reflux
without medication
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Conti……..
1. Eat sparingly and slowly
2. Avoid certain foods
3. Don't drink carbonated beverages
4. Stay up after eating
5. Don't move too fast
6. Sleep on an incline
7. Lose weight if it's advised
8. If you smoke, quit
9. Check your medications
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Medical Management
• Antacids or H2 receptor antagonists
famotidine (Pepcid), nizatidine (Axid),
or ranitidine (Zantac),
• Proton pump inhibitors
(medications that decrease the release of gastric
acid, such as lansoprazole [Prevacid], rabeprazole
[AcipHex], esomeprazole [Nexium], omeprazole
[Prilosec], and pantoprazole [Protonix])
• Prokinetic agents, which accelerate gastric
emptying include bethanechol (Urecholine),
domperidone (Motilium), and metoclopramide
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Conti……
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Medical Management
• Avoid situations that decrease lower esophageal sphincter
pressure or cause esophageal irritation.
• Eat a low-fat diet
• Avoid caffeine, tobacco, beer, milk,
• Foods containing peppermint or spearmint, carbonate
beverages;
• Avoid eating or drinking 2 hours before bedtime
• To maintain normal body weight
• To avoid tight-fitting clothes;
• To elevate the head of the bed at least 30 degrees
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Surgical Management
• Nissen fundoplication (wrapping of a portion of
gastric fundus around the sphincter
area
of
esophagus).(Garg & Gurusamy, 2015)
the
the
• can be performed by the open method or by
laparoscopy.
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Nursing Management
•Assess severity of heartburn, regurgitation, dysphagia, and
chest discomfort.
•Administer prescribed medications such as antacids, PPIs,
and H2 receptor blockers.
•Encourage small frequent meals and avoid spicy, fatty, and
acidic foods.
•Advise patient to avoid lying down after meals and elevate
head of bed during sleep.
•Encourage lifestyle modifications including weight
reduction, smoking cessation, and avoiding alcohol.
•Monitor for complications such as aspiration, bleeding, or
Barrett’s esophagus.
•Educate patient regarding medication adherence, dietary
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management, and prevention of recurrence.
Hiatal Hernia
• Opening in the diaphragm
through which the
esophagus passes becomes
enlarged, and part of the
upper stomach tends to
move up into the lower
portion of the thorax.
• occurs more often in
women than in men.
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Classification
Two types

Sliding

Paraesophageal.
Sliding hiatal hernia
• occurs when the upper stomach and the gastroesophageal
junction are displaced upward and slide in and out of the
thorax
• About 95% of patients with esophageal hiatal hernia have
a sliding hernia
Paraesophageal hernia
• occurs when all or part of the stomach pushes through
the diaphragm beside the esophagus Paraesophageal
hernias are further classified as types II, III, or IV,
depending on the extent of herniation, with type IV
having the greatest herniation (Oleynikov &Jolley,
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2015)
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Clinical Manifestations
• 50% of patients are
asymptomatic
• Heartburn
• Regurgitation
• Dysphagia
• Reflux
• Sense of fullness or chest pain
after eating
• Hemorrhage
• Obstruction
• Strangulation (Oleynikov
&Jolley, 2015)
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Risk Factors
•Obesity
•Increasing age
•Pregnancy
•Heavy lifting or straining
•Chronic coughing
•Smoking
•Increased intra-abdominal pressure
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Causes
•Weakening of diaphragmatic muscles with aging
•Congenital enlargement of esophageal hiatus
•Increased abdominal pressure causing stomach protrusion
•Trauma or injury to diaphragm area
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Assessment and Diagnostic
Findings
• History
• Physical Examination
• X-ray studies
• Barium swallow
• Esophagogastroduodenoscopy (Kohn, Price,
Demeester, et al., 2013)
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Medical Management
• Similar to that for gastroesophageal reflux
Instruct for frequent, small feedings that can
pass easily through the esophagus.
• The patient is advised not to recline for 1
hour after eating, to prevent reflux or
movement of the hernia, and to
• Elevate the head of the bed on 4- to 8-inch
(10- to 20-cm) blocks to prevent the hernia
• Surgery is indicated in about 15% of patients.
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Surgical management
• To correct torsion (twisting) of the stomach
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Nursing Management
• Vital signs monitoring
• Administer medications as prescribed
• Client education
• Encouraging Adequate Nutritional Intake
• Decreasing Risk of Aspiration
• Relieving Pain
• Providing Patient Education
• Promoting Home and Community-Based Care
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References
Hinkle, J. L., & Cheever, K. H. (2021). Brunner
& Suddarth’s textbook of medical-surgical
nursing (15th ed.). Wolters Kluwer
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Video Links
GERD
https://youtu.be/k8UqRCPA6Kw?si=9VB5ZHZ
nGt3nHarz
Hiatal Hernia
https://youtu.be/j8CT7K_7rX0?si=5UtVOJpQ6
JX1WpHm
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