Alterations in the Gastrointestinal System
Which of the following symptoms are considered atypical for GERD?
Belching
Chest pain
Bloating
Nausea - (correct Answer) - Chest pain
Chest pain is atypical for classic GERD.
A 50-year-old is diagnosed with gastroesophageal reflux disease. This condition is caused by:
Reverse peristalsis of the stomach.
Sympathetic nerve stimulation.
Fibrosis of the lower third of the esophagus.
Loss of muscle tone at the lower esophageal sphincter. - (correct Answer) - Loss of muscle tone at the
lower esophageal sphincter.
The disease is due to the loss of muscle tone at the lower esophageal sphincter.
Which of the following symptoms are typical GERD symptoms?
Heart burn and regurgitation
Cough and hoarseness
Chest pain and globus (lump in the throat)
Epigastric pain and belching - (correct Answer) - Heart burn and regurgitation
___________ is a risk factor for the development of GERD.
Obesity
,Taking beta blockers
Inguinal hernia
Asthma - (correct Answer) - Obesity
Obesity is the only choice listed that is a risk factor to developing GERD. Obesity exerts pressure on the
lower esophageal sphincter which causes the up-flow of acid from the stomach into the esophagus.
The bacteria that is associated with GERD is:
Pseudomonas
Staph aureus
H. pylori
E. Coli - (correct Answer) - H. pylori
Typical associated GERD symptoms: - (correct Answer) - Heart burn
Regurgitation (reflux)
Atypical associated GERD symptoms: - (correct Answer) - Chest pain
Hoarseness
Cough
Asthma
Globus (lump in throat)
Associated GERD symptoms: - (correct Answer) - Dyspepsia
Epigastric pain
Bloating
Belching
Nausea
Complications of H. pylori include: - (correct Answer) - dyspepsia and adenocarcinoma.
With GERD the patient will report: - (correct Answer) - burning or reflux that occurs 30-90 minutes
following a meal; the symptoms are worse in a reclining position, but symptoms improve with sitting or
standing or when an antacid is taken. Sour taste, lump in the throat, cough, hoarseness, worsening
asthma episodes, epigastric pain and chest pain may also be reported.
, Warning signs for GERD: - (correct Answer) - Symptoms over the age of 50
Dysphagia
Odynophagia (pain on swallowing)
N/V
Weight loss
Melena
Early satiety
During collection of the social, diet and medication history, the NP should explore if: - (correct Answer) -
the patient smokes or drinks alcohol, ingests foods that triggers reflux (i.e. peppermint and chocolate) or
takes medications which may be predispose the patient to GERD by relaxing the LES allowing for the
reflux of acid.
These tests require a referral to a gastroenterologist and may be used to establish the diagnosis: -
(correct Answer) - Upper GI series
Endoscopy
Esophageal manometry
Esophageal pH
GERD Treatment Goals: - (correct Answer) - Eliminating symptoms
Healing esophagitis
Preventing the relapse or development of complications
Decreasing the amount of acid that refluxes from the stomach back to the esophagus
Management of GERD: - (correct Answer) - lifestyle modifications, over the counter antacids or
prescription medication. Proton-pump inhibitors (PPI) are the gold standard for treating GERD when it's
required. All PPIs are considered effective for treating reflux. The NP must be mindful of the dosage and
length of therapy recommendations when prescribing a PPI as well as each patient's severity of
symptoms. For example, in mild, intermittent GERD (<2 episodes/week) with no evidence of erosive
esophagitis, the patient may be started on 10 mg once daily. The dose can be increased to 20 mg daily
after 4-8 weeks. Once the patient is asymptomatic for 8 weeks, the medication should be discontinued
to avoid any associated side effects.
Non-pharmacologic management of GERD includes: - (correct Answer) - Weight loss, especially if body
mass index (BMI) is 25 or >
Elevating the head of bed
Avoiding food 2-3 hours prior to bedtime
Which of the following symptoms are considered atypical for GERD?
Belching
Chest pain
Bloating
Nausea - (correct Answer) - Chest pain
Chest pain is atypical for classic GERD.
A 50-year-old is diagnosed with gastroesophageal reflux disease. This condition is caused by:
Reverse peristalsis of the stomach.
Sympathetic nerve stimulation.
Fibrosis of the lower third of the esophagus.
Loss of muscle tone at the lower esophageal sphincter. - (correct Answer) - Loss of muscle tone at the
lower esophageal sphincter.
The disease is due to the loss of muscle tone at the lower esophageal sphincter.
Which of the following symptoms are typical GERD symptoms?
Heart burn and regurgitation
Cough and hoarseness
Chest pain and globus (lump in the throat)
Epigastric pain and belching - (correct Answer) - Heart burn and regurgitation
___________ is a risk factor for the development of GERD.
Obesity
,Taking beta blockers
Inguinal hernia
Asthma - (correct Answer) - Obesity
Obesity is the only choice listed that is a risk factor to developing GERD. Obesity exerts pressure on the
lower esophageal sphincter which causes the up-flow of acid from the stomach into the esophagus.
The bacteria that is associated with GERD is:
Pseudomonas
Staph aureus
H. pylori
E. Coli - (correct Answer) - H. pylori
Typical associated GERD symptoms: - (correct Answer) - Heart burn
Regurgitation (reflux)
Atypical associated GERD symptoms: - (correct Answer) - Chest pain
Hoarseness
Cough
Asthma
Globus (lump in throat)
Associated GERD symptoms: - (correct Answer) - Dyspepsia
Epigastric pain
Bloating
Belching
Nausea
Complications of H. pylori include: - (correct Answer) - dyspepsia and adenocarcinoma.
With GERD the patient will report: - (correct Answer) - burning or reflux that occurs 30-90 minutes
following a meal; the symptoms are worse in a reclining position, but symptoms improve with sitting or
standing or when an antacid is taken. Sour taste, lump in the throat, cough, hoarseness, worsening
asthma episodes, epigastric pain and chest pain may also be reported.
, Warning signs for GERD: - (correct Answer) - Symptoms over the age of 50
Dysphagia
Odynophagia (pain on swallowing)
N/V
Weight loss
Melena
Early satiety
During collection of the social, diet and medication history, the NP should explore if: - (correct Answer) -
the patient smokes or drinks alcohol, ingests foods that triggers reflux (i.e. peppermint and chocolate) or
takes medications which may be predispose the patient to GERD by relaxing the LES allowing for the
reflux of acid.
These tests require a referral to a gastroenterologist and may be used to establish the diagnosis: -
(correct Answer) - Upper GI series
Endoscopy
Esophageal manometry
Esophageal pH
GERD Treatment Goals: - (correct Answer) - Eliminating symptoms
Healing esophagitis
Preventing the relapse or development of complications
Decreasing the amount of acid that refluxes from the stomach back to the esophagus
Management of GERD: - (correct Answer) - lifestyle modifications, over the counter antacids or
prescription medication. Proton-pump inhibitors (PPI) are the gold standard for treating GERD when it's
required. All PPIs are considered effective for treating reflux. The NP must be mindful of the dosage and
length of therapy recommendations when prescribing a PPI as well as each patient's severity of
symptoms. For example, in mild, intermittent GERD (<2 episodes/week) with no evidence of erosive
esophagitis, the patient may be started on 10 mg once daily. The dose can be increased to 20 mg daily
after 4-8 weeks. Once the patient is asymptomatic for 8 weeks, the medication should be discontinued
to avoid any associated side effects.
Non-pharmacologic management of GERD includes: - (correct Answer) - Weight loss, especially if body
mass index (BMI) is 25 or >
Elevating the head of bed
Avoiding food 2-3 hours prior to bedtime
