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Michaela Burke Case Study

Symptoms/signs Dull pain behind sternum Pain after meals Associated with belching Worse when lying down or extortion after heavy meal Radiated to back, jaw, shoulders and inner aspects of arm Angina pectoris Portion of stomach above diaphragm Mucosal inflammation Decreased LES pressure Reflux of gastric contents = gastroesophageal reflux Treatment recommended Elevate head of bed by 6inches Use cholinergic agonists like bethanechol Use histamine (H2) antagonists like cimetidine These reduce LES competence Avoid stimulants of gastric acid secretion like coffee and alcohol Avoid drugs like anticholinergics Avoid foods like fat, chocolate, whole milk, orange juice Avoid smoking Answers to questions Gastroesophageal reflux disease (GERD). The lower esophagus sphincter (LES) fails and doesn't prevent the flow of food, bile, enzymes and stomach acid back into the esophagus. This causes burning and inflammation of the esophagus tissue which is highly sensitive.It may damage the esophagus. The risk factors for reflux are possibly alcohol, hiatal hernia(condition where part of stomach moves above the diaphragm). As a portion of the business executive's stomach is above their diaphragm, shown by X-rays, the disorder they have is a hiatal hernia....... The lower esophageal sphincter, the muscular ring at the lower end of the esophagus, normally prevents gastric reflux when lying down or bending over. Since a portion of the stomach is above the diaphragm the muscle fibers in the LES are prevented from closing. Lower esophageal pressure at the LES normally prevents reflux into esophagus em lying down or bending over. Anticholinergic agents block acetylcholine in the parasympathetic nerve fibres. They are avoided as they cause a decrease in LES pressure. Anticholinergics are used to prevent nausea so are prescribed to reduce the effects of seasickness. Cholinergic agents increase LES contraction as they stimulate the acetylcholine receptors in the parasympathetic nerves in the LES smooth muscle. Elevation of the head of the bed reduces the flow of stomach contents into the esophagus as a result of gravity. The stomach and esophagus are not normally level but if the lower esophageal sphincter doesn't work the two just become one big connected tube. By elevating the head the esophagus is elevated higher than the stomach so acidic contents doesn't flow into it. Head elevation encourages flow of gastric contents by gravity to the pyloric sphincter end of the stomach. The esophageal pH is normally close to 7. The stomach has a pH of between 1-3, about pH2 normally when empty. When the stomach contains food the pH can be between 4-5. Definition of gastroesophageal reflux is during pH monitoring a sudden decrease below pH4 in the esophagus. The stomach pH for this individual would not change. References

Michaela Burke,13763