Gastro-Esophageal Reflux Disease (GERD) Case
I know it has been a while since I last posted an ICU case but today I have an exciting one about GERD. I am sure most of you already know what Gastro Esophageal Reflux Disease is or at least have heard the word FERD. Gastro-Esophageal Reflux Disease is a very common disease that affects people of all ages and commonly known as heart burn. When you talk about heartburn though, you should be aware that it is not all heartburns can be called GERD.
As usual, I never give any personal identifying information to keep privacy in observance of HIPPA laws. This case about Gastro-Esophageal Reflux Disease is about a young male in 40’s who was admitted in ICU in critical condition.
The patient went to seek medical help after he couldn’t swallow anything including his own saliva due to pain. On arrival to ER, he had very low hematocrit and appeared malnourished.
His heart rate was in130’s and 140’s and his blood pressure was very low with systolic blood pressure of 70’s and 80’s. These are critical findings on admission that made the patient to be automatically admitted to ICU. Immediately he arrived in the ICU, the GI-Team came and did an endoscopy on him only to find that his esophagus had eroded so much to a point of having perforations. There was no way to repair such a damaged tissue other than to remove it.
In Gastro-Esophageal Reflux Disease, the acid produced in the stomach regurgitates through the esophagus and can be felt as a burning sensation with belching. Sometimes it may be happening when a patient is lying down especially at night sleeping and so may not be noticed immediately until some significant changes have occurred.
This patient had to be taken to operating room for a long urgent surgery to repair his torn esophagus. Can you imagine acid so potent that it can erode your esophagus to a point of getting perforations? In surgery, the surgeons took out his esophagus all the way down to the stomach. Then, they cut a part of his small intestine called Jejunum and improvised it to become his new esophagus. This was a long procedure that took hours by a team of 3 surgeons.
So I took care of this patient for 2 days and it has been in a while since I saw someone in so much pain that even on dilaudid epidural pump, the guy was still in pain.
You will notice that I am changing the style of my nursing stories. I am changing it such that anyone reading this blog post can benefit from it whether you are a nurse like me or you are a consumer, someone who might be a looking for information about the topic am blogging about.
So what causes Gastro-Esophageal Reflux Disease?
GERD is mostly caused by foods we eat and lifestyle and we have a lot in our hands that we can control to avoid GERD.
Certain foods and lifestyle are considered to promote gastroesophageal reflux:
1. Coffee alcohol, and excessive amounts of Vitamin C supplements stimulate gastric acid secretion. Be careful the way you take your vitamins. Taking these before bedtime especially can cause evening reflux.
2. Antacids based on calcium carbonate (but not aluminum hydroxide) were found to actually increase the acidity of the stomach. However, all antacids reduced acidity in the lower esophagus, so the net effect on GERD symptoms may still be positive.
3. Foods high in fats and smoking reduce lower esophageal sphincter competence, so avoiding these tends to help. Fat also delays stomach emptying.
4. Eating within 2-3 hours before bedtime.
5. Large meals. Having more but smaller meals reduces GERD risk, as it means there is less food in the stomach at any one time.
6. Carbonated soft drinks with or without sugar.
7. Chocolate and peppermint.
8. Acidic foods, such as oranges and tomatoes.
9. Cruciferous vegetables: onions, cabbage, cauliflower, broccoli, spinach, brussels sprouts.
10. Milk and milk-based products containing calcium and fat, within 2 hours of bedtime. Now this sounds tricky as you may have heard that milk actually help curb GERD. NO, Milk only makes you feel relieved as you swallow it down soothing your esophagus. Milk also causes a lot of thick mucous secretion (take warm glass of milk and try to spit. You will see how much thick mucous you gotJ)
Now that you know what may cause GERD, what are you going to do about it? Do you think you might be doing something that might put you at a risk of having GERD? Or do you actually have GERD but not aware of it?
¨ If you sometimes feel like there is something in your throat that you can’t swallow, you may be having Gastro-Esophageal Reflux Disease.
¨ If you sometimes get horse in your voice especially in the mornings, you may have Gastro-Esophageal Reflux Disease
¨ If your baby/children are having tooth decay that is linear or has a pattern, they may be having Gastro-Esophageal Reflux Disease.
¨ If you sometimes feel hot sour tasting regurgitation in your mouth, you may be having Gastro-Esophageal Reflux Disease.
¨ You need to see your doctor.
health is wealth alwas take care of ur self every one
In eroded esophagus….Chronic hiccups…can be a signal. In my personal experience, this was the only symptom….for 10 days. It was finally diagnosed after four days in the hospital. I have never experienced “heartburn”.