Nursing Field Notes / GI · Pathophysiology Course
GERD 🔥
Gastresophageal Reflux Disease
NG-036
GI
ADHD-friendly visual edition
Fancy words for heartburn or acid reflux where stomach acids burn the esophagus, leading to pain, inflammation, & even CANCER called Barrett's esophagus — if the chronic acid reflux is not treated.
📄 Simple Nursing original — opens in Drive →
🚪 It's all about the LESAnything that weakens or damages the Lower Esophageal Sphincter → reflux.
🛏️ Worse pain = lying downDyspepsia “heartBURN” that fires up when flat.
⏱️ 3 hours + HOB upNo eating 3 hours before lying down; elevate HOB at night.
🚨 Board-like abdomenPeritonitis after a procedure = PRIORITY, report to HCP.
🧨
CAUSE
STEP 1 · THE LOOSE DOOROne muscle explains the whole disease — when the door won't stay shut, acid climbs.
🚪 The LES is a door between the stomach & the esophagus
EXAM TIP Anything that can weaken or damage the LES — the Lower Esophageal Sphincter, the muscle that closes the opening between the stomach & esophagus.
🧠 “Loose lid = burning kid.” The LES is the lid on a jar of acid — tighten the lid (meds, small meals, gravity) and the burn stops. Everything in this whole topic is either loosening the lid or tightening it.
🔤 Say the word — it tells you the disease
- Gastro = Stomach 🫙
- Esophageal = Esophagus 🚪
- Reflux = flowing back ⬆️
Gastro · Esophageal · Reflux · Disease = stomach contents flowing back into the esophagus.
🧠 Dyspepsia = “heartBURN” — the burn isn't the heart at all, it's the esophagus sitting right behind it.
⚠️ Risk factors — what loosens the lid
- 😖 Stress
- ⚖️ Obese — BMI over 30 (BMI >30)
- 🫁 Hiatal hernia — at the diaphragm
🧠 “SOH” — Stress · Obese · Hiatal hernia. Say it like a sigh — “sohhh…” — the sound of a lid going slack.
🔎
CLUES
STEP 2 · SPOT ITA burn that gets worse when they lie flat — plus the scope that looks, and the emergency that follows it.
🔥 Dyspepsia “heartBURN” — Worse pain = Lying down
🧠 “Flat = fire, upright = alright.” If the question puts the client flat after a meal, the answer is heartburn getting worse.
📈 Untreated reflux → the cancer ending
🔥 Chronic acid reflux, not treated
▼
😣 Pain & inflammation of the esophagus
▼
🎗️ CANCER — Barrett's esophagus
🧠 Barrett's = the “burnt” esophagus. Barrett and burn-it rhyme — years of burn-it turns into cancer.
🔬 Diagnostics: the scope that looks
Upper gastrointestinal endoscopy = EGD — Esophagogastroduodenoscopy.
- E = Esophagus 🚪
- G = Gastro (stomach) 🫙
- D = Duodenal (duodenum) 🌀
🧠 EGD = “Every Gut Door.” The camera passes three doors in a row: Esophagus → Gastro → Duodenum.
🚨 Complication of procedures: Peritonitis PRIORITY — Report to HCP!
- 🌡️ Fever — over 100.3°F
- 🤲 Rebound tenderness
- 🪵 “Rigid” or “board-like abdomen”
- 📈 Increasing pain, tenderness
- 😰 Restless
- 💓 Fast HR & RR (tachycardia / tachypnea)
🧠 “BOARD” — Board-like rigid abdomen · Over 100.3°F · Agitated & restless · Rebound tenderness + Rising pain · Dashing HR & RR. A board belly after a scope = call the provider.
🩺
CARE
STEP 3 · CALM THE ACIDThree levers: drop the acid 💊, drop the trigger foods ❌, and use gravity ⬇️ — surgery only tightens what's left.
💊 Pharmacology: acid reducers
| Class | Drug from the source | Name clue |
|---|---|---|
| Antacids 🧴 | — | “ANT-acid” = against acid |
| Histamine receptor blockers 🚫 | Ranitidine | -tidine |
| PPIs: Proton pump inhibitors ⛽ | Omeprazole | -prazole |
🧠 “TIDY the acid, PRAZOLE the pump.” Ranitidine = histamine receptor blocker · Omeprazole = Proton Pump Inhibitor. Three tiers, one job: reduce acid.
❌ AVOID Eating — and the big three NOs
☕NO Caffeinecoffee
🚬NO Cigarettestobacco
🍺NO Alcohol
🍟Fried Foodsfries, fried chicken
🥓Fatty Foodsgo low fat
🍋Citrusacidic
🥛Dairymilk, cheese
🍫Chocolate
🌿Peppermint/ Spearmint
low fat diet = BEST
Why this exact list? Every item on it can weaken or damage the LES — no lid, no protection. 🚪
🧠 Picture the worst midnight snack in nursing school: a chocolate-dipped peppermint patty, fried in fat, washed down with citrus juice, milk, coffee and booze — with a cigarette after. Every single item on that tray loosens or burns the LES.
✅ Causes & Education: let gravity work
1
🍽️ Eat small meals
2
🪑 Sit up after meals
3
⏱️ AVOID eating before lying down — 3 hours after meals
4
🛏️ Elevate HOB at night
🧠 “SEE-3” — Sit up after meals · Elevate HOB · Eat small meals · 3 hours before lying down. You have to SEE-3 to sleep.
🔪 Surgery: two ways to tighten the same sphincter
| ⚡ Stretta procedure | 🎀 Fundoplication |
|---|---|
| Delivers radiofrequency energy waves through electrodes | Wrap the upper curve of the stomach — called the fundus — around the esophagus & sew it shut |
| 🎯 Tighten the LES | 🎯 Helping to tighten this esophageal sphincter |
🧠 Stretta = Zap it tight ⚡ · Fundoplication = Fold the Fundus 🎀. Both answers to the same question: how do we tighten the LES?
⚡
QUICK RECALL
SAY IT OUT LOUD🚪 Weak LES= acid climbs = GERD
🛏️ Lying down= worst heartburn pain
🍟 Low fat diet= BEST · no caffeine, cigarettes, alcohol
🪵 Board-like belly= peritonitis → report to HCP
🎯 Cover & check — 4 rapid-fire questions
Q1: When is GERD pain the worst?
Lying down — flat = fire. Sit up after meals and elevate the HOB at night.
Q2: One muscle explains GERD — which one, and why?
The LES (Lower Esophageal Sphincter) — the muscle that closes the opening between the stomach & esophagus. Anything that weakens or damages it causes reflux.
Q3: How long after a meal before the client may lie down?
3 hours — plus small meals, sit up after eating, elevate HOB at night.
Q4: After an EGD the client has a fever of 101°F, rebound tenderness and a rigid, board-like abdomen. Now what?
Peritonitis — PRIORITY. Report to the HCP. Also watch for increasing pain/tenderness, restlessness, tachycardia & tachypnea.
📌
STUDY SHEETS
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