Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med III Unit I > 2 GERD and Esophageal Disorders > Flashcards

2 GERD and Esophageal Disorders Flashcards

1
Q

Prevalence of GERD in the US may be underestimated due to…

A

Frequency of self-treatment

Majority of patients with GERD do not seek medical attention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

You do an EGD on a patient with reflux Sxs. What percentage would you expect to find Barret’s Esophagus or Esophagitis?

A

43%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Some degree of reflux is normal (physiologic) as long as…

A

It does not induce Sx or esophageal mucosal abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the pathophysiology of GERD?

A

Lower esophageal sphincter (LES) transiently relaxes, allowing back flow of stomach contents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The Montreal classification defines GERD as a condition that develops when the reflux of stomach contents causes…

A

Troublesome symptoms or complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the hallmark Sx of GERD?

A

Pyrosis (aka heartburn) - typically post prandial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some extraesophageal manifestations of GERD?

A

Bronchospasm
Laryngitis/hoarseness
Chronic cough
Loss of dental enamel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Chest pain in GERD patients mimics _________.

A

Angina - squeezing, substernal, radiates to back, neck, jaw or arms

Must R/O cardiac cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

If a GERD patient presents with dysphagia, you must R/O…

A

Stricture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What things can worsen GERD?

A 
Obesity
Gravity
Pregnancy
Tobacco/EtOH
Meds
Foods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What advice about bed positioning should you give to GERD patients?

A

Elevate the head of the bed

Don’t just use a bunch of pillows - put blocks under the headboard for a gradual upward slope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What medications can increase GERD Sx by decreasing LES pressure?

A

Anticholinergics (Ditropan)

TCAs (Amitriptyline)

CCBs

Nitrates

Narcotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which meds may increase GERD Sx by injuring mucosa?

A 
BISPHOSPHONATES****
Iron supplements
NSAIDs/Aspirin
Potassium
Tetracycline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What must you document in the patient chart when prescribing bisphosphonates?

A

Patient ed about remaining upright 30-60 min after taking med to prevent mucosal injury —> GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Portion of the stomach enters above the diaphragm into the chest

A

Hiatal hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the two types of hiatal hernia?

A

Sliding hernia (most common)***

Paraesophageal hernia (may require surgical repair)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hiatal hernias generally present as…

A

Asymptomatic incidental finding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does a hiatal hernia appear on CXR?

A

Retrocardiac mass with or without an air-fluid level

Without the air-fluid level, dx is difficult to make based on CXR alone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Best diagnostic study to evaluate mucosal injury

A

EGD** (Esophagogastroduodenoscopy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Test used to observe transit of a bolus of food

A

Esophageal impedance testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Test to quantify reflux and allow patients to log Sx

A

Esophageal pH monitoring

High sensitivity for detecting reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Test for measuring the function of the LES and peristalsis

A

Esophageal nanometers

Measures pressures and pattern of esophageal muscle contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

_________ is not typically used for the Dx of GERD b/c it does not identify mucosal injury

A

Barium contrast esophagram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the two options for esophageal pH monitoring?

A

Trans nasal catheter

Wireless capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Red flags for GERD (all require further workup)

A 
Dysphagia 
Hematemesis/GI bleeding
Unexplained weight loss, fever, fatigue
Anemia
**Inadequate response to therapy**
Prior anti-reflux surgery
Personal Hx of cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How do you diagnose GERD?

A

Clinical diagnosis in most cases

Dx studies and labs usually not needed with classic hx of GERD without warning signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What lifestyle/dietary modifications should you recommend to a patient with GERD?

A

Adjustment of bed (elevate head)
No food or drink within 3 hours of bedtime
Weight loss
Selective elimination of dietary triggers
Eat smaller meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What meds can be used to treat GERD?

A

Antacids
H2 blockers (Ranitidine)
Proton pump inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

GERD is considered to be mild/intermittent if…

A

Less than 1-2 episodes/week

No evidence of erosive esophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

GERD is considered severe if…

A

Frequent (≥2 episodes/week)

Symptoms impair quality of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the pharmacological approach to mild/intermittent GERD treatment?

A

Step UP therapy

Lifestyle mods, H2RAs, +/- antacids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the pharmacological approach to severe GERD treatment?

A

Step DOWN therapy

PPI daily x 8 weeks + lifestyle mods

Gradually decrease therapy (unless maintenance PPI therapy necessary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What’s the deal with Antacids and GERD?

A

Do not PREVENT GERD

Neutralize gastric pH —> symptomatic relief

Short lived benefit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How do H2 blockers work against GERD?

A

Block action of histamine at H2 receptors of gastric parietal cells

Leads to decreased secretion of stomach acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Examples of H2 blockers

A

Ranitidine (Zantac)

Famotidine (Pepcid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How do Proton Pump Inhibitors work?

A

Reduce the amount of acid produced by glands in the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Examples of PPIs

A

Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Esomeprazole (Nexium)
Pantoprazole (Protonix)

38
Q

When should PPIs be taken?

A

30 min before 1st meal of the day

39
Q

What are the main concerns related to long term PPI use?

A

Risk of infection

Malabsorption

40
Q

Why do PPIs increase risk of infection?

A

B/c the acidic environment of the stomach is protective

Decreasing acid can increase risk of C. diff and other infections

41
Q

What deficiencies can result from long-term PPI use?

A

MAGNESIUM, Calcium, B12, Iron

Check Mg level periodically

Consider yearly B12 (controversial)

Consider checking bone density

42
Q

How long should GERD patients without severe erosive esophagitis or Barrett’s esophagus stay on acid suppression meds?

A

Lowest dose and shortest duration appropriate

D/c meds completely in patients without Sx

43
Q

How long should GERD patients with severe esophagitis or Barrett’s esophagus stay on acid suppression meds?

A

Require maintenance acid suppression with a PPI

Recurrent Sx and complications likely if meds d/c

44
Q

What are the indications for surgical management of GERD?

A

Failed optimal medical management

GERD complications (Esophagitis, Barret’s esophagus)

Noncompliance

45
Q

What is the surgical treatment for GERD?

A

Nissan Fundoplication

Passage of the gastric fundus behind the esophagus to encircle the distal esophagus

Laparoscopic and open options exist

46
Q

How do you decide whether to start a patient on an H2 blocker or a PPI?

A

If full BID dosed H2 blocker was already used, start with PPI

If patient hasn’t tried BID H2 blocker, try that first

H2 blockers are effective for many patients

47
Q

The most common cause of esophagitis is…

A

GERD!

48
Q

How does esophagitis develop?

A

Gastric acid, pepsin, and bile irritate the squamous epithelium

Can lead to irritation, inflammation, erosion, or ulceration

49
Q

What are the five different types of esophagitis?

A 
Reflux esophagitis (most common***)
Infectious esophagitis
Pill esophagitis
Eosinophilic esophagitis 
Radiation esophagitis
50
Q

What are the possible complications of esophagitis?

A

Bleeding, stricture, Barrett’s esophagus

51
Q

What IS Barrett’s Esophagus?

A

Squamous epithelium in distal esophagus replaced with COLUMNAR epithelium due to recurrent acid injury

52
Q

Barrett’s esophagus predisposes patients to…

A

Adenocarcinoma of the esophagus

53
Q

Barrett’s esophagus is found in ______% of patients undergoing EGD for GERD Sx

A

10-15%

2-3:1 M>F

Average age at Dx is 55

54
Q

What is the progression of Barrett’s esophagus?

A

GERD —> Barrett’s Esophagus —> Low Grade Dysplasia —> High Grade Dysplasia —> Adenocarcinoma

55
Q

What is the pharmacological treatment for Barrett’s Esophagus?

A

Indefinite use of PPI - aggressive anti-reflux meds may prevent cancer

QD dosing may be sufficient vs. BID

EGD Surveillance to detect evidence of dysplasia

56
Q

What are the different options for surgical treatment of Barrett’s esophagus?

A

Endoscopic Eradication Therapy (EET) or Endoscopic Ablation (EA) - Thermal or photochemical energy to destroy Barrett mucosa

Endoscopic Resection - Removal of segment of Barrett mucosa (therapeutic and provides info on depth of involvement)

57
Q

What are the two types of esophageal cancer?

A

Squamous cell carcinoma

Adenocarcinoma

58
Q

Incidence of squamous cell carcinoma is higher in ….

A

Urban areas of US

African American men

59
Q

Risk factors for Squamous Cell Carcinoma

A

SMOKING*
EtOH*
Diet low in fruits/veggies
Nutritional deficiencies (selenium, zinc)
Caustic esophageal injury (ie hot coffee)
HPV

60
Q

What increases the risk for adenocarcinoma?

A

Barrett’s****

Smoking

Obesity

61
Q

Adenocarcinoma is 4 times more common in ______ than ______

A

Caucasians > African Americans

Also, M>F 6:1

62
Q

What are you thinking if a patient has progressive dysphagia with solid food?

A

Possible esophageal cancer

May progress to dysphagia with soft foods, then liquids

Pay attention to weight loss, odynophagia, malnutrition, anorexia

63
Q

________ is recommended in all patients with dysphagia

A

Endoscopy

Can also do a barium contrast esophagram but EGD is a must

64
Q

Regardless of histology, _______ of esophageal cancer patients present with incurable, unresectable, or metastatic disease

A

50-80%

Endoscopy if warning signs allows for earlier detection

Palliative treatment is the goal for the majority of patients

65
Q

What would you think the cause of esophagitis would be in a patient with DM and asthma (using ICS) who was recently on 2 rounds of Abx for PNA?

A

Infectious esophagitis (possibly candida overgrowth)

66
Q

How would infectious esophagitis due to TB present?

A

+PPD
Night sweats
Cough

67
Q

Patient has trouble swallowing pills and occasionally his ibuprofen gets stuck

A

Pill esophagitis

68
Q

A patient has collagen vascular disease (systemic sclerosis). How might esophagitis occur?

A

Poor acid clearing —> epithelial damage

69
Q

If a patient with hx of asthma, rhinitis, food allergies, and chronic eczema develops GERD sx…

A

Consider Eosinophilic esophagitis

70
Q

“Worms, wheezes, weird diseases”

A

Eosinophilic

71
Q

Chronic immune/antigen-mediated esophageal disease

A

Eosinophilic esophagitis

Eosinophil-predominant inflammation —> dysphagia, food impaction, CP, refractory heartburn, upper abdominal pain

72
Q

How is eosinophilic esophagitis diagnosed?

A

Clinical Hx + EGD (stacked circular rings, stricture)

73
Q

How do you treat eosinophilic esophagitis?

A

Diet (avoid allergens)

Acid suppression (PPI)

ICS but SPRAY AND SWALLOW (don’t inhale)

+/- esophageal dilation

74
Q

Esophageal motility disorders should be considered in patients with…

A

Dysphagia, noncardiac CP, and refractory GERD Sx

Must perform EGD first to exclude structural abnormality

75
Q

What are the two major disorders of esophageal peristalsis?

A

Hypercontractile (Jackhammer) esophagus

Achalasia

76
Q

If instead of heartburn, a patient has dysphagia with solids AND liquids and CP, consider…

A

Achalasia

77
Q

What diagnostic studies should be performed on patients with suspected esophageal motility disorders?

A

Manometry
Barium Swallow
Possibly esophageal pH and impedance monitoring

78
Q

Manometry shows high pressure contractions in esophagus, normal relaxation of the esophagogastric junction

Pain mimics angina, but typically occurs with meals

A

Hypercontractile (Jackhammer) Esophagus

79
Q

Treatment for jackhammer esophagus

A

CCB (Diltiazem) or TCA (Imipramine)

+/- botulinum toxin injection

80
Q

Manometry shows aperistalsis in the distal two-thirds of the esophagus and incomplete LES relaxation

A

Achalasia

81
Q

How will achalasia show on barium esophagram?

A

Esophageal dilation

BIRDS BEAK (caused by persistently contracted LES)

Aperistalsis

Poor emptying of barium

82
Q

What causes achalasia?

A

Progressive degeneration of esophageal neurons leading to failure of relaxation of LES and no peristalsis

83
Q

SSx of achalasia

A 
Dysphagia
Regurgitation
Difficulty belching
CP
Heartburn

Gradual onset

84
Q

_____ is required for dx of achalasia

A

Manometry, showing defect in LES relaxation and aperistalsis in distal 2/3 of esophagus)

EGD NECESSARY TOO to r/o malignancy

85
Q

Consider achalasia in patient who is …

A

Unresponsive to PPI trial (4 weeks) with dysphagia to solids and liquids and regurgitation

86
Q

How do you treat achalasia?

A

Disruption of LES muscle fibers
• Pneumatic dilation
• Heller myotomy

Biochemical reduction in LES pressure
• Botulinum toxin
• Nitrates
• CCBs

87
Q

Mucosal laceration in distal esophagus and proximal stomach

A

Mallory Weiss tear

88
Q

Mallory Weiss tears are usually associated with…

A

Repetitive vomiting, retching

Predisposing factors:
• Excessive EtOH consumption
• Hiatal hernia (increased abdominal pressure)

89
Q

How is a Mallory Weiss tear diagnosed?

A

Endoscopy or clinical exam if issue has already resolved

90
Q

How do you treat a Mallory Weiss tear?

A

Stabilize patient

Control bleeding if doesn’t stop on its own

Treat with PPI

Address predisposing factors if present

Clin Med III Unit I (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions