Question

rs. Robinson is a 66-year-old female who presented to the emergency department with wheezing, difficulty breathing, right-sided chest pain with deep inspiration, nausea, and vomiting. She stated that she was in her usual state of health until she awoke at 3:00 a.m. with wheezing and was not able to go back to sleep. She was nauseous and vomited a small amount of green, blood-stained emesis. A chest x-ray was done and showed an infiltrate in the right anterior lung base with chronic pleural effusion. Mrs. Robinson’s medical history includes asthma, gastroesophageal reflux disease (GERD) for the past three years, and reoccurring pneumonia. She weighs 170 lbs. with a BMI of 29.2. She was started on albuterol (Ventolin) nebulizer treatments and levofloxacin (Levaquin) intravenously in the emergency department.

Mrs. Robinson was admitted to the medical unit with a diagnosis of pneumonia due to recurrent aspiration related to the GERD. She remained on the levofloxacin (Levaquin) for infection and was prescribed lansoprazole (Prevacid) and ranitidine (Zantac) to prevent reflux.

1. Explain some of the contributing factors to Mrs. Robinson’s GERD.

2. If untreated, what are some of the possible complications of GERD?

3. Discuss the medications that Mrs. Robinson is taking and how they work to reduce the symptoms of reflux. Why are antacids not used to manage GERD?

4. What are some of the foods and medications that may precipitate an episode of reflux esophagitis?

5. How does Mrs. Robinson’s weight affect reflux, and what recommendations should you make?

Answer 1

1. GERD is the regurgitation of the contents of stomach into the oesophagus giving rise to symptoms of acidic taste of the mouth, heartburn, bad breath, chest pain, vomiting, breathing problems.

Risk factors include acidity, smoking, obesity, sdentary lifestyle, unhealthy food habits, certain medications like antihistamines, antidepressants.

2. Complications of GERD includes oesophagitis, oesophageal strictures, Barrets oesophagus.

3. Lansoprazole is a proton pump inhibitor which controls acid secretion by the parietal cells of stomach.

Ranitidine is a class of histamine type 2 receptor antagonist. It acts as competitive reversible inhibitor of the action of histamine on parietal cells in the stomach, thereby inhibiting the normal and meal-stimulated secretion of stomach acid.

Antacids only neutralize the acids and does not reduce the inflammation of oesophagus caused by GERD.

4. Food that precipitate GERD include caffeine, alcohol, chocolate, fatty foods, acidic foods, spicy foods and smoking.

5. Studies have shown that obesity increases the acid reflux and GERD.

Lifestyle changes are recommended for the treatment of GERD. Weight loss to maintain a BMI of 25 is recommended. Dietary modifications include high fibre intake. Light exercises are beneficial.