Adolescent With Diabetes Mellitus (DM) Case Studies, Esophageal_Reflux and healthcare legislature (Due 24 hours)

Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition

Esophageal Reflux Case Studies

A 45-year-old woman complained of heartburn and frequent regurgitation of “sour” material into her mouth. Often while sleeping, she would be awakened by a severe cough. The results of her physical examination were negative.

Studies	Results
Routine laboratory studies	Negative
Barium swallow (BS), p. 941	Hiatal hernia
Esophageal function studies (EFS), p. 624
Lower esophageal sphincter (LES) pressure	4 mm Hg (normal: 10–20 mm Hg)
Acid reflux	Positive in all positions (normal: negative)
Acid clearing	Cleared to pH 5 after 20 swallows (normal: <10 swallows)
Swallowing waves	Normal amplitude and normal progression
Bernstein test	Positive for pain (normal: negative)
Esophagogastroduodenoscopy (EGD), p. 547	Reddened, hyperemic, esophageal mucosa
Gastric scan, p. 743	Reflux of gastric contents to the lungs
Swallowing function, p. 1014	No aspiration during swallowing

Diagnostic Analysis

The barium swallow indicated a hiatal hernia. Although many patients with a hiatal hernia have no reflux, this patient’s symptoms of reflux necessitated esophageal function studies. She was found to have a hypotensive LES pressure along with severe acid reflux into her esophagus. The abnormal acid clearing and the positive Bernstein test result indicated esophagitis caused by severe reflux. The esophagitis was directly visualized during esophagoscopy. Her coughing and shortness of breath at night were caused by aspiration of gastric contents while sleeping. This was demonstrated by the gastric nuclear scan. When awake, she did not aspirate, as evident during the swallowing function study. The patient was prescribed esomeprazole (Nexium). She was told to avoid the use of tobacco and caffeine. Her diet was limited to small, frequent, bland feedings. She was instructed to sleep with the head of her bed elevated at night. Because she had only minimal relief of her symptoms after 6 weeks of medical management, she underwent a laparoscopic surgical antireflux procedure. She had no further symptoms.