Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition    Esophageal Reflux   Cas

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Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition 

Esophageal Reflux

Case Studies 

A 45-year-old woman complained of heartburn and frequent regurgitation of sour material into her mouth. Often while sleeping, she would be awakened by a severe cough. The results of her physical examination were negative. 

Studies                                                                                               Results

 Routine laboratory studies                                                              Negative

 Barium swallow (BS), p. 941                                                             Hiatal hernia

 Esophageal function studies (EFS), p. 624         

 Lower esophageal sphincter (LES) pressure                                4 mm Hg (normal: 10-20 mm Hg) 

Acid reflux                                                                                            Positive in all positions (normal: negative) 

Acid clearing                                                        Cleared to pH 5 after 20 swallows (normal: <10 swallows) Swallowing waves                                                                            Normal amplitude and normal progression Bernstein test                                                                                     Positive for pain (normal: negative) Esophagogastroduodenoscopy (EGD), p. 547                                Reddened, hyperemic, esophageal mucosa Gastric scan, p. 743                                                                               Reflux of gastric contents to the lungs Swallowing function, p. 1014                                                                 No aspiration during swallowing    Diagnostic Analysis    The barium swallow indicated a hiatal hernia. Although many patients with a hiatal hernia have no reflux, this patient's symptoms of reflux necessitated esophageal function studies. She was found to have a hypotensive LES pressure along with severe acid reflux into her esophagus. The abnormal acid clearing and the positive Bernstein test result indicated esophagitis caused by severe reflux. The esophagitis was directly visualized during esophagoscopy. Her coughing and shortness of breath at night were caused by aspiration of gastric contents while sleeping. This was demonstrated by the gastric nuclear scan. When awake, she did not aspirate, as evident during the swallowing function study. The patient was prescribed esomeprazole (Nexium). She was told to avoid the use of tobacco and caffeine. Her diet was limited to small, frequent, bland feedings. She was instructed to sleep with the head of her bed elevated at night. Because she had only minimal relief of her symptoms after 6 weeks of medical management, she underwent a laparoscopic surgical antireflux procedure. She had no further symptoms.    Critical Thinking Questions  1. Why would the patient be instructed to avoid tobacco and caffeine?  2. Why did the physician recommend 6 weeks of medical management? 3-How do antacid medication work in patients with gastroesophageal reflux?  4. What would you approach the situation, if your patient decided not to take the medication and asked you for an alternative medicine approach? SCIENCE HEALTH SCIENCE NURSING MSN 5600L

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