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Pathophysiology of gastroesophageal reflux disease according to Brunner and Suddarth
Pathophysiology of gastroesophageal reflux disease according to Brunner and Suddarth
Review of gastroesophageal reflux disease
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Description
Gastro-esophageal reflux disease (GERD) can related to the relaxation or incompetence of the lower esophageal sphincter (McCance & Huether, 2010, p. 1523). It was also described by Brunner, Suddarth, & Smeltzer (2008, p. 1165), as the back flow of gastric or duodenal content into the esophagus. It can be a normal physiological process that happens in a healthy child for several times in a day, it becomes a concern when it results to worrisome symptoms or complications.
Pathophysiology
Inappropriate esophageal sphincter relaxation that occurs in GERD can be as a result of delay in the maturation of the lower esophageal sphincter, and alteration in neurotransmitter or hormonal response mechanism (McCance & Huether, 2010, p. 1523). Lower esophageal sphincter integrity in children are maintained by mucosal gathering within the sphincter, esophageal junction location in a high pressure zone within the abdomen and angle at which the esophagus is inserted into the stomach. If any of the pressure maintaining factors that preserves the integrity of the lower esophageal sphincter discussed above is altered, the reflux persists. Acidic gastric content provokes the sphincter leading to deterioration of the esophageal epithelium and stimulation of the vomiting reflex (McCance & Huether, 2010, p. 1523).
Epidemiology
As a result of lack of well-developed neuromuscular control, hormones and increased intra-abdominal pressure, children are unable to control gastric acid reflux to the esophagus. Young infants have increased intra-abdominal pressure because they can’t stand upright, they regurgitate when they cough, cry, or strain. A study by Burns et al (2010, p. 748), elaborates that 73% of healthy young infants regurgitates during ...
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... be educated to keep their child in upright position during feeding and for about 30 minutes after feeding, elevate the head of the crib mattress or bed 30 degrees and not to use pillow, to keep infants in prone position postprandially when awake but not asleep, not to thicken formulas with rice cereal, to void smoking in the house hold, to give a milk free and soy free diet, avoid too large meal at a time and give small frequent meals instead ("UpToDate," 2013, p. 1). Education for children and their parents should include elevating the head of bed, to maintain body weight according to guideline or lose weight if indicated, parent and adolescent who smoke should stop smoking, avoid eating within 1-3 hours of going to bed and to avoid substances that can cause lower esophageal relaxation including caffeine, chocolate, peppermint, garlic, citrus tomatoes and alcohol.
The case study that I chose to focus my literature review on is concerning premature babies who developed Necrotising Enterocolitis (NEC) from a milk thickener that was given to them while while was on the Neonatal Intensive Care Unit (NICU), and which some babies were discharge home on. In one example of this occurrence, which I will use to guide my search for literature, the staff on the NICU had noticed that the baby’s heart rate slightly slowed down when he ate, so they thought that he was having difficulty feeding. To combat this difficulty the staff added a thickener, SimplyThick, to his feedings. When he was discharged home they gave the thickener to the parents to take home with them. Thickening foods makes them easier to swallow because it allows them to move more slowly in the mouth giving more time for a patient to close their airway, which can prevent aspiration (Queensland Health Dietitians, 2007). SimplyThick is a thickener made of Xanthan Gum, which is a substance commonly added to thicken foods for adults. There is a lack of information on how safe Xanthan Gum is for babies. SimplyThick was marketed to speech language pathologists as being easy to dissolve in breast milk as well as maintaining its consistency when mixed. These pathologists recommended SimplyThick as an additive to milk for babies with problems swallowing.
q Heartburn: occurs when acid content from the stomach backs up into the esophagus. If a person has hiatal hernia they may experience heartburn.
Esophagus: Esophagus is a long straight tube which connects the pharynx to the stomach. Once the food has been reduced to a soft mush, the tongue pushes it to the throat which leads to a long straight tube called esophagus. The esophagus squeezes the mass of food with rhythmic muscle contraction called peristalsis which then forces the food to the stomach.
Once the child has wound down, but not fallen asleep, you should bring him to his room and put him down. It is very important that the child is awake when being put in his bed. Ferber preaches a routine called progressive waiting. This practice is allowing
When these two muscles layer contracts in an alternate fashion, it propels the food through the pharynx into the esophagus. This mechanism is called peristalsis. (Marieb E. 2006)
Start the night weaning process gradually by nursing your baby for shorter periods or by giving her smaller amounts of bottled milk at night. Prolong intervals between her feedings by comforting the baby with gentle pats until asleep.
The second type of dysphagia is called Esophageal dysphagia. This type dysphagia is characterized by the diminished ability to move food through the esophagus (Eisenstadt, pg. 18). This may cause chest pain or cause the patient to spit up their f...
Recurrent esophageal stricture. Patient with personal history of stage I adenocarcinoma of the esophagus in the setting of Barrett's esophagus, diagnosed elsewhere. He has a history of a distal esophagectomy with a gastroesophageal reanastomosis performed at or near 09/2016. The patient at one point, had a tracheostomy which has been removed. At one point, a feeding jejunostomy tube that has been removed. He has recurrent dysphagia and previous endoscopic dilatation. He presents today for a repeat endoscopy with probable dilatation of the EG junction.
Both Dr. Richard Ferber and Dr. William Sears have impressive credentials. Richard Ferber, M.D is an associate professor of neurology at Harvard Medical School. His other credentials include board certification in pediatrics and sleep disorders medicine and being the director of the Center for Pediatric Sleep Disorders at Children’s Hospital in Boston. Beginning in 1978, he has been doctoring children with sleep problems. Dr. William Sears is an Associate Clinical Professor of Pediatrics at the University of California, Irvine, School of Medicine. Dr. Sears received his pediatric training at Harvard Medical School’s Children’s Hospital in Boston and The Hospital for Sick Children in Toronto, where he served as associate ward chief of the newborn nursery and associate professor of pediatrics. Dr. Sears is a fellow of the American Academy of Pediatrics and a fellow of the Royal College of Pediatricians. In addition to all his professional credentials he is a father of eight children and has written over 30 books associated with ...
Some mothers complain that they do not produce enough milk for their babies. Ironically, others have an oversupply of milk that their babies choke on it. To help your baby deal with this problem, position your baby's head above your nipple's level so that she is doing “uphill” nu...
...ve eaten, to break down the food into a liquid mixture and to slowly empty that liquid mixture into the small intestine. Once the bolus has entered your stomach it begins to be broken down with the help of the strong muscles and gastric juices which are located in the walls of your stomach. The gastric juices are made up of hydrochloric acid, water, and mucus- and the main enzyme inside of your stomach is what is known as pepsin, which needs to be surrounded in an acidic setting in order to do its job, that is to break down protein. Once the bolus has been inside of your stomach for long enough it begins to form into a liquid called chyme, and what keeps the chyme from flowing back into our esophagus are ring shaped muscles known as sphincters located at the beginnings and ends of the stomach and they have the task of controlling the flow of solids and liquids.
If no pulse is present, give five chest compressions. To achieve effective compressions, the child should be supine on a hard, flat surface. Use one hand to maintain the position of the head. With the other hand, use two fingers to trace the lower margin of the rib cage. Find where the ribs and sternum meet, avoid doing compressions in that notch. Place the heel of your hand over the lower half in the sternum, between the nipple line and the notch. Compress the chest approximately one to one and a half inches. Follow the compressions with one slow breath.
Hockenberry, M. J., & Wilson, D. (2013). Wong’s nursing care of infants and children + study guide: Multimedia enhanced version. Philadelphia, PA, United States: Elsevier Mosby.
The esophagus is a stretchy pipe, about 25 centimeters that carries food and liquids from the throat to the stomach for digestion after it has been chewed and chemically softened in the mouth. (InnerBody, 2013) ...
Esophageal ulcers are found on the inside of the stomach lining. They occur within the muscular hollow tube called the esophagus, which carries food from the throat to the stomach. In severe cases, when there is a reflux of gastric juices through the cardiac sphincter, it can ultimately perforate and cause severe inflammation of the tissues that surround it, the heart, and tissue between the lungs.