GERD in Women’s Health: Connecting Pathophysiology to Clinical Practice

CONNECTING PATHOPHYSIOLOGY TO CLINICAL PRACTICE: 25 points

Instructions: Read the assigned textbook chapters. Choose ONE diagnosis from the readings for the current body system. Fill out the assignment below by connecting essential knowledge of pathophysiology of the primary diagnosis / problem a patient would have coming to the APRN’s clinical practice. Include a well-developed physical examination, relevant diagnostic tests, pharmacotherapy, and treatment plan – ALL based on the pathophysiology of the disease. Show the connection between the pathophysiologic process of the disease and the clinical manifestations and the pharmacotherapeutic treatment and plan.

It is required that at least 2 citations / 2 references (Ex. Rogers’ Textbook and Clinical Practice Guidelines) are used for this assignment. Points are included into the points listed for each section. A citation is required for the following sections: “Pathophysiology,” “Signs and Symptoms” (Body Systems; Subjective / HPI; Objective); “Labs and Diagnostics,” “Diagnosis” (Pathophysiology of differential diagnoses), and “Pharmacotherapy” (Plan, Guidelines, and SDoH).

DIAGNOSIS CHOSEN FROM THE READINGS IN ROGERS’ TEXTBOOK ON THIS BODY SYSTEM :
(It is required that a different population must be chosen for each of the next assignments. For example, if you choose an adult disease for cardiovascular system, then you should choose a pediatric disease for pulmonary assignment and then choose women’s health for GI assignment Gastroesophageal reflux (GERD) Women’s Health – CONNECTING PATHOPHYSIOLOGY TO CLINICAL PRACTICE

Diagnosis: Gastroesophageal reflux (GERD)(Women’s Health)

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY OF PRIMARY MEDICAL CONCERN (Disease chosen – specific to the population) (2 points)

GERD happens when the lower esophageal sphincter (LES) does not close well. This muscle is supposed to stop food and acid from coming back up from the stomach. In women, hormones like estrogen and progesterone (during pregnancy or hormone therapy) can make the LES weak (Sharma & Yadlapati, 2020). Also, extra pressure in the belly (from being overweight or pregnant) can make GERD worse. If acid keeps coming up, it can hurt the esophagus and cause problems like esophagitis or Barrett’s esophagus.

HOW WOULD YOU TEACH THE PATHOPHYSIOLOGY TO THE PATIENT AND/OR FAMILY (1 point)
I would explain to the patient that GERD is when the valve (LES) between the esophagus and stomach does not close tightly. This allows stomach acid to move up and cause burning in the chest. I will use pictures and easy words to help the patient understand.

SIGNS AND SYMPTOMS

BODY SYSTEMS THAT ARE DIRECTLY IMPACTED BY THIS MEDICAL PROBLEM (2 points)

EXPLAIN HOW EACH SYSTEM YOU CHOSE IS AFFECTED – IT CAN BE A POSSIBLE COMPLICATION OF THE DISEASE. (Ex. Integumentary affected from diabetes related to a diabetic wound OR Neurologic system affected by diabetes related to vision changes). (Minimum 3 body systems)

Gastrointestinal System: The acid from the stomach irritates the esophagus and can cause inflammation or ulcers.

Respiratory System: Acid can go into the lungs and cause coughing, wheezing, or even infection.

Cardiovascular System) GERD does not harm the heart, but chest pain from GERD can feel like a heart problem

PRIORITY SUBJECTIVE SYMPTOMS / HISTORY OF PRESENT ILLNESS (HPI)

(on SOAP notes – the S stands for subjective – which is information from the patient)

Align the subjective symptoms to the pathophysiology of the disease. These are the things that a patient may tell you if they have the disease. (2 points)

Start of symptoms: A few weeks ago, getting worse

Location: Burning pain in the chest, goes up to the throat

How long it lasts: After eating, about 30–60 minutes

What it feels like: Burning, sour liquid in mouth

Gastroesophageal reflux (GERD) Women’s Health – CONNECTING PATHOPHYSIOLOGY TO CLINICAL PRACTICE

What makes it worse: Spicy foods, lying down, big meals

What helps: Antacids, sitting up

Treatment tried: Over-the-counter antacids

Pain level: Moderate to strong, hard to sleep

PRIORITY PHYSICAL EXAMINATION

OBJECTIVE SYMPTOMS

(on SOAP notes – the O stands for objective – which is information from the provider)

Align the examination / findings to the body systems that affected. (Minimum 2 systems)

(2 points)

You should build a “clinical picture” for each symptom to start ruling in or out diagnoses. In other words, viral pharyngitis vs strep vs tonsillitis vs epiglottitis, etc.

General look: Slightly overweight, mild pain

Mouth and throat (HEENT): Bad breath, no sore throat

Heart: Normal sounds, no problem

Lungs: Wheezing sometimes when lying down

Stomach (GI): Tender in the upper belly, no serious signs

Endocrine: Normal

Arms/Legs (Extremities): Normal

Skin, muscles, blood, and urinary systems: All normal

MAKING THE CONNECTION:

Patho-Clinical Manifestations

Write a paragraph explaining how the subjective and objective findings are linked to the pathophysiology of the disease. (150-300 words) (2 points)

Gastroesophageal Reflux Disease (GERD) occurs when the lower esophageal sphincter (LES), a ring-like muscle between the esophagus and stomach, becomes weak or relaxes inappropriately, allowing stomach acid to flow back into the esophagus. This backflow, or acid reflux, irritates the esophageal lining and leads to common symptoms such as heartburn and chest discomfort. When this happens frequently, it can cause inflammation, erosion, or other damage to the esophageal tissue (Sharma & Yadlapati, 2020). In women, hormonal changes, especially during pregnancy or menopause, can further weaken the LES, making reflux more likely. Additionally, the pressure from the growing uterus during pregnancy can worsen symptoms. GERD can also affect the respiratory system; when stomach acid reaches the throat or airways, it may cause chronic cough, wheezing, or a feeling of tightness in the chest. Upper abdominal pain, especially after meals or when lying down, indicates irritation in both the stomach and lower esophagus. Without proper management, GERD may lead to complications such as esophagitis or Barrett’s esophagus.

LABS / DIAGNOSTIC TESTING

LAB AND DIAGNOSTIC FINDINGS THAT MAY BE ABNORMAL

List the appropriate tests / labs (minimum 2) and explain the normal / abnormal result and how the lab test helps the APRN differentiate this diagnosis from others on the differential list. (1 points)

EGD (Endoscopy): Shows if the esophagus is red, swollen, or damaged. Normal is healthy pink tissue. Bad is red, ulcers, or white patches.

24-Hour pH Test: Measures how often acid goes up into the esophagus. Normal is pH above 4 most of the time. Bad is pH below 4 many times a day Gastroesophageal reflux (GERD) Women’s Health – CONNECTING PATHOPHYSIOLOGY TO CLINICAL PRACTICE.

MAKING THE CONNECTION:

Patho-Diagnostic Tests / Labs

Write a paragraph explaining how the labs and/or diagnostic tests are linked to the pathophysiology of the disease. (150 – 300 words) (2 points)

Diagnostic tests are important to understand how serious GERD is and how it affects the esophagus. An upper endoscopy, also called esophagogastroduodenoscopy (EGD), helps the provider see the lining of the esophagus and look for signs of acid damage, such as redness, swelling, or open sores (Chhabra & Ingole, 2022). This test shows if GERD has already caused inflammation or injury inside the esophagus. Another useful test is the esophageal pH monitoring, which measures how much acid is present in the esophagus over a 24-hour period. If the test shows high acid levels, it means the lower esophageal sphincter (LES) is not closing properly. This proves that acid is flowing back into the esophagus from the stomach. These test results help confirm the diagnosis of GERD and show how strong or weak the LES is. With this information, the healthcare provider can choose the right treatment plan, such as medications or lifestyle changes, to prevent further acid damage and improve symptoms.

DIAGNOSIS (ASSESSMENT) (on SOAP notes – the A stands for assessment – which is the diagnosis)

2 POSSIBLE DIFFERENTIAL DIAGNOSES (DD) (1 point)

1. Peptic Ulcer Disease (PUD)

2. Chest Pain from Muscles or Stress

EXPLAIN THE PATHOPHYSIOLOGY OF THE 2 DIFFERENTIAL DIAGNOSES

(2 points)

1. PUD: Happens when the lining of the stomach or small intestine is damaged by acid. It can be from H. pylori or medicines like NSAIDs. Pain is usually in the stomach but not always with acid going up the esophagus.

2. Chest Pain from Stress or Muscles: Happens from tight muscles or anxiety. Not from acid. Pain can feel like GERD but is not helped by antacids.

PHARMACOTHERAPY / NON-PHARMACOTHERAPY / PLAN

PLAN

(on SOAP notes – the P stands for plan)

(2 points)

EDUCATION (DISEASE, DIET, LIFESTYLE, ACTIVITY):

Avoid spicy and greasy foods, eat small meals, stay upright after eating, sleep with head raised, lose weight if needed.

MEDS: Omeprazole 20–40 mg once a day for 8 weeks.

FURTHER TESTING: EGD if symptoms do not get better in 8 weeks or if there are serious signs like trouble swallowing Gastroesophageal reflux (GERD) Women’s Health – CONNECTING PATHOPHYSIOLOGY TO CLINICAL PRACTICE

FOLLOW-UP: Return in 8 weeks or sooner if worse

CLINICAL GUIDELINE FOR THIS DISEASE:

Look up the most recent clinical guidelines of the disease you have chosen and add the link to the guidelines here.

(1 point)
ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease (Katz et al. 2021)

https://doi.org/10.14309/ajg.0000000000001538

MAKING THE CONNECTION:

Patho-Pharm

Write a paragraph explaining how the pharmacotherapy (medications) is linked to the pathophysiology of the disease. (150-300 words) (2 points)

GERD occurs when acid from the stomach damages the lining of the esophagus. This happens because the lower esophageal sphincter (LES) is weak and does not close well, allowing acid to move upward. Medications like omeprazole, a proton pump inhibitor (PPI), help by reducing the amount of acid the stomach makes. PPIs block the acid-producing pumps in the stomach lining, giving the esophagus time to heal and stopping the burning pain (Chhabra & Ingole, 2022). With less acid, there is also less chance of damage and inflammation. Omeprazole is often taken once daily and works best when used regularly. Other medications, such as antacids and H2 blockers, provide fast relief but do not last as long as PPIs. While antacids neutralize acid already in the stomach, and H2 blockers reduce acid for a few hours, PPIs are preferred for long-term control. All of these medicines help by targeting acid, which is the main cause of symptoms and injury in GERD.

SOCIAL DETEREMINANTS OF HEALTH (SDoH)

Identify one SDoH that could affect a patient with this disease. Explain how it would affect the individual and the disease process AND explain your plan – as the provider – to maneuver treatment with the SDoH concern . (150-300 words) (2 points)

Low income can make GERD worse because people with limited money often eat cheaper, unhealthy foods that trigger acid reflux, like fried or processed meals. They might not afford healthy groceries, medications, or regular doctor visits. Without health insurance, they may skip treatment or delay care until symptoms become severe. Stress from financial hardship can also increase stomach acid and make symptoms worse. As the provider, I would recommend affordable treatment options such as generic omeprazole, which is low-cost and available over the counter. I would use simple, clear language to explain the condition and treatment to make sure the patient understands. I would also suggest home remedies, like eating smaller meals, avoiding spicy food, and staying upright after meals. If needed, I would connect the patient with free or low-cost community resources, including food banks, health clinics, or prescription assistance programs. The goal is to give care that respects the patient’s financial situation while still improving health outcomes.

THIS ASSIGNMENT ALIGNS WITH THE FOLLOWING COURSE OBJECTIVES:

1.Apply the model of homeostasis to the understanding of the theoretical/empirical basis of physiologic regulation and pathophysiologic phenomena of the human body

Describe abnormal physiological disorders in the human population.

Examine the interaction between genetics and environmental factors in the development of a given disorder

Distinguish the signs, symptoms, and diagnostic test results associated with disorders affecting the human population

Integrate the cultural, socioeconomic, gender, and age-related differences in the pathophysiologic response and treatment associated to disease or injury.

6.Interpret physiologic function and pathophysiologic dysfunction in the context of preparing to make competent clinical decisions in an advanced practice role

References

Chhabra, P., & Ingole, N. (2022). Gastroesophageal reflux disease (GERD): Highlighting diagnosis, treatment, and lifestyle changes. Cureus. https://doi.org/10.7759/cureus.28563

Katz, P. O., Dunbar, K. B., Schnoll-Sussman, F. H., Greer, K. B., Yadlapati, R., & Spechler, S. J. (2021). ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. American Journal of Gastroenterology, 117(1), 27-56. https://doi.org/10.14309/ajg.0000000000001538

Sharma, P., & Yadlapati, R. (2020). Pathophysiology and treatment options for gastroesophageal reflux disease: Looking beyond acid. Annals of the New York Academy of Sciences, 1486(1), 3-14. https://doi.org/10.1111/nyas.14501 Gastroesophageal reflux (GERD) Women’s Health – CONNECTING PATHOPHYSIOLOGY TO CLINICAL PRACTICE