Chapter 26 Upper GI tract

Question 1

Clinical symptoms associated with GERD

Answer 1

Dental Corrosion
Dysphagia
Heartburn (pyrosis)
Odynophagia (painful swallowing)
Regurgitation
Noncardiac chest pain
Extraesophageal symptoms

Question 2

Odynophagia

Answer 2

Painful swallowing

Question 3

Dysphagia

Answer 3

Difficulty initiating a swallow

Question 4

Barrett’s esophagus

Answer 4

Precancerous condition in which normal squamous epithelium of the esophagus is replaced by an abnormal columnar-lined epithelium known as intestinal metaplasia

Question 5

When acid reflux occurs with a hiatal hernia the gastric contents remain ___

Answer 5

above the hiatus longer than normal

Question 6

Type I hernia

Answer 6

Sliding hiatal hernia: most common type; gastroesophageal junction is pushed above the diaphragm, causing a symmetric herniation of the proximal stomach

Question 7

Type 2 hernia

Answer 7

True paraoesophageal hernia: fundus slides upward and moves above the gastroesophageal junction

Question 8

Type 3: mixed paraesophageal hernia

Answer 8

Combined sliding and paraoesophageal herniation

Question 9

Type 4

Answer 9

Complex Paraoesophageal hernia
-less common form; intrathoracic hernation of other organs such as colon and small bowel

Question 10

Patients with type 3 hernia may present with severe

Answer 10

chest pain, retching, vomiting, hematemesis

Question 11

Hematemesis

Answer 11

vomiting of blood

Question 12

Aim in acid suppression therapy is to raise the gastric pH above ___ during periods when reflux is most likely to occur

Answer 12

4

Question 13

What do proton pump inhibitors do

Answer 13

decrease acid production by the gastric parietal cell have been associated wtih superior healing rates and decreased relapses

Question 14

Mild forms of reflux are managed by

Answer 14

H2 receptor
antagonists
and antacids

Question 15

What do H2 blockers do

Answer 15

blocks action of histamine on parietal cells, decreasing the production of acid

Question 16

Nissen fundoplication

Answer 16

first described treatment for severe reflux esophagitis and still most commonly performed antireflux surgery
-stomach is wrapped 360 degrees around a lower esophagus and is sutured in place

Question 17

addition of psyllium fiber into a diet three times a day for a total of 12.5 grams a day improves what

Answer 17

improves gerd

Question 18

Primary indication for esophagectomy is

Answer 18

esophageal cancer or BE with a high grade dysplasia

Question 19

What type of feeding is used for an esophagectomy

Answer 19

eternal nutrition is preferred

Question 20

Gastric pull up

Answer 20

removal of a segment or the entire esophageal tract and replacing it with stomach tissue
-jejunostomy feeding tube may be placed at surgery to provide postoperative nutrition until oral adequate intake is achieved

Question 21

Approximately 35-65% of all patients with head and neck cancer are

Answer 21

malnourished

Question 22

odynophagia

Answer 22

painful swallowing

Question 23

Dysphagia is a hallmark of –____

Answer 23

head and neck cancer

Question 24

What type of tube is placed after head and neck surgery

Answer 24

gastrostomy tube

Question 25

Prophylactic swallowing therapy is a recent development in the treatment of

Answer 25

dysphagia in patients with head and neck cancer

Question 26

Dyspepsia

Answer 26

nonspecific, persistent upper amdominal discomfort or pain

Question 27

Functional dyspepsia

Answer 27

umbrella term to include patients with postprandial distress syndrome and epigastric pain syndrome

Question 28

Gastritis

Answer 28

inflammation of the stomach

Question 29

Heliobacter pylori

Answer 29

gram negative bacteria that is somehwat resistant to acidic enviornment in the stomach

Question 30

atrophic gastritis

Answer 30

chronic inflammation with deterioration of the mucous membrane resulting in achlorhydria and loss of intrinsic factor