• Subject Name : Nursing

Gastro-Oesophageal Reflux Disease

1) Gastro-oesophageal reflux disease (GORD) can be defined as the clinical disorder in which the gastric acidic content enter into the oesophagus and provokes complications and associated symptoms that impair the life quality. The pathogenesis of GORD is multifactorial. The mechanism involved in the GORD pathogenesis are as follow:

a) Motor abnormality, which includes impairments of the resting tone of the lower oesophageal sphincter (LES). Further, there can be transient relaxation of LES and delayed gastric content emptying. Compromised oesophageal acidic content clearance is another factor responsible for GORD development. Factors that are responsible for decreasing LES tone are endogenous hormones including progesterone and cholecystokinin), some medications, for instance, calcium channel blockers and nitrate and specific food items including chocolate and high-fat diet. Further, voluntary factory, for example, alcohol intake, caffeine intake and smoking can lead to impaired LES tone.

b) Anatomical factor, which includes hiatal hernia. Hiatus can cause dislocation of the stomach into the chest region and diaphragm get detached from the LES. Additionally, lead to disruption of the gastro-oesophageal sphincter's integrity and increases oesophageal acid exposure.

c) Visceral hypersensitivity.

d) Compromised mucosal resistance (Menezes & Herbella, 2017).

2) The four common clinical manifestations of GORD are- heartburn (pyrosis), odynophagia, vomiting and regurgitation, and haemorrhage. Heartburn is one of the commonest symptoms associated with GORD condition and is occur

due to mucosal irritation caused by the refluxed acidic juice. Further, odynophagia is the transitory discomfort that is characterised by burning sensation at the back of the sternum region due to intake of spicy, hot food items, acidic food items and alcohol intake. Overt bleeding can occur due to reflux esophagitis (Rogers et al., 2020).

3) In the present case, Sarah must be sent to the dentist and dietician. The dentist will treat the decayed tooth and can evaluate the other oral structures. Moreover, gastric reflux can lead to tooth erosion and hypersensitivity due to removal of the enamel layer. Therefore, the dentist will make the proper treatment plan as per the condition of the patient's teeth and oral cavity (Wilder-Smith et al., 2017; Pitts et al., 2017). Further, a dietician will aids in lifestyle modification and assist Sarah for achieving a healthy diet. A healthy diet can be an effective way to reduce acidity (Mukerjee, 2019).

4) Omeprazole is categorised under the proton pump inhibitor drugs that aid in the reduction of acid production in the stomach. Further, this drug can be indicated in reducing the symptoms and signs of GORD. Additionally, omeprazole can be beneficial in promoting the healing of the damaged oesophagus. Over- the – counter, this drug is beneficial in treating heartburn. The drug is contraindicated in liver disease, diarrhoea, anaemic patient, interstitial nephritis, autoimmune disease and osteoporosis etcetera (Richter et al., 2016).

5) In the present case scenario, Sarah could be referred to the gastroenterologists and dietician. A gastroenterologist has specialization in treating the ailments and/or disease associated with the digestive system. Sarah needs a specialist who can treat her GORD condition and symptoms; for instance, nausea, upper abdominal uneasiness and regurgitation of food (Hoffman, 2020). Additionally, a dietician would render effective guidance and support to assist her in achieving viable weight loss, which can eliminate or reduce GORD (Mukerjee, 2019).

References for Sarah Digestive System Case Study

Menezes, M. A., & Herbella, F. A. (2017). Pathophysiology of gastroesophageal reflux disease. World journal of surgery, 41(7), 1666-1671.

Mukerjee, A. (2019). Management of GERD, Obesity and PCOS Leading to Successful Conception Using the ‘Integrated Approach’. Int. J. Sci. Res. in Biological Sciences Vol, 6, 1.

Pitts, N. B., Zero, D. T., Marsh, P. D., Ekstrand, K., Weintraub, J. A., Ramos-Gomez, F., ... & Ismail, A. (2017). Dental caries. Nature reviews Disease primers, 3(1), 1-16.

Richter, J., Jimenez, J., Nagatomo, T., Toelen, J., Brady, P., Salaets, T., ... & Deprest, J. (2016). Proton-pump inhibitor omeprazole attenuates hyperoxia induced lung injury. Journal of translational medicine, 14(1), 247.

Rogers, B. D., Valdovinos, L. R., Crowell, M. D., Bell, R., Vela, M. F., & Gyawali, C. P. (2020). Number of reflux episodes on pH-impedance monitoring associates with improved symptom outcome and treatment satisfaction in gastro-oesophageal reflux disease (GERD) patients with regurgitation. Gut.

Wilder-Smith, C. H., Materna, A., Martig, L., & Lussi, A. (2017). Longitudinal study of gastroesophageal reflux and erosive tooth wear. BMC gastroenterology, 17(1), 1-6.

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