E1: GERD Flashcards

1
Q

What are the possible complications of GERD?

A
  • Barretts esophagus
  • Erosive esophagitis
  • Strictures
  • esophageal cancer
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2
Q

What is it called when the lower esophageal sphincter is relaxed, allowing backflow of stomach contents?

A

GERD

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3
Q

What are the extraesophageal manifestations of GERD?

A
  • Bronchospasm/wheezing
  • Larngitis
  • chronic cough
  • loss of dental enamel
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4
Q

What medications decrease the LES pressure?

A

Anticholinergics, TCAs, CCBs, nitrates, and narcotics

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5
Q

What drugs can injure the GI mucosa?

A

-Bisphosphonates, Iron supplements, NSAIDs, potassium, tetracycline

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6
Q

What is the most common type of Hiatal hernia?

A

Sliding hernia

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7
Q

What will you see on CXR of a patient with a hiatal hernia?

A

A retro cardiac mass with or without an air fluid level

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8
Q

What is the best diagnostic study to evaluate mucosal injury?

A

EDG

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9
Q

What is the treatment of GERD?

A
  • Lifestyle: Elevate head of bed, weight loss, selective elimination of triggering food
  • Medication: Tums, PPIs, H2 blockers
  • Anti-reflux surgery
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10
Q

What is the treatment of mild/intermittent GERD?

A

-Lifestyle modification, H2 blockers, and antacids

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11
Q

What is the treatment of GERD with severe symptoms?

A

-PPI daily x 8 weeks and lifestyle modification

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12
Q

How do H2 blockers treat GERD?

A

They block histamine at H2 receptors of gastric parietal cells, which leads to decreased secretion of stomach acid

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13
Q

How do PPIs treat GERD?

A

They reduce the amount of acid being produced by glands in the stomach
-take 30 minutes before the first meal of the day

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14
Q

What are the possible complications of long term PPI use?

A
  • Risk of infection (acidic environment is protective)
  • Malabsorption: Mg, B12, calcium, iron
  • *Check Mg periodically
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15
Q

How long should a patient with GERD be on medication if they do not have severe erosive esophagitis and Barrett’s esophagus?

A

-They should have the lowest dose and shortest duration appropriate and discharge meds completely in patients without symptoms

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16
Q

How should patients with GERD and severe esophagitis or Barretts esophagitis be treated?

A

They require maintenance acid suppression with a PPI

17
Q

What are the indications for surgical management of GERD?

A
  • Failed optimal medical management
  • GERD complications (barretts)
  • Noncompliance
18
Q

What is the most common cause of esophagitis?

A

GERD

19
Q

What is Barrett’s esophagus?

A

When squamous epithelium in the distal esophagus is replaced with columnar epithelium

20
Q

What is a patient with Barrett’s esophagus at increased risk for?

A

Adenocarcinoma

21
Q

What is the treatment of Barrett’s esophagus?

A
  • Indefinite use of PPI
  • EDG surveillance to detect evidence of dysplasia
  • Endoscopic eradication therapy
22
Q

What are the two main types of esophageal cancer?

A

Adenocarcinoma and squamous cell carcinoma

23
Q

What are the risk factors for esophageal adenocarcinoma?

A

Barretts, smoking, and obesity

24
Q

What are the risk factors for esophageal squamous cells carcinoma?

A

Smoking, ETOH, diet low in fruits/vegetables, caustic esophageal injury, and nutritional deficiencies

25
Q

What test us recommended in all patients with dysphagia?

A

EGD

26
Q

If a patient has DM, asthma, and recent ABx use, what kind of esophagitis are they at increased risk for?

A

Infectious (candida)

27
Q

If a patient has asthma, rhinitis, food allergies, and chronic eczema, what kind of esophagitis are they at increased risk for?

A

Eosinophilic esophagitis

28
Q

What is it called when there is high pressure contractions in the esophagus and normal relaxation of the esophagogastric junction?

A

Hypercontractile (jackhammer) esophagus

29
Q

How is hypercontractile esophagus diagnosed?

A

DES manometry

30
Q

What is the treatment of Hypercontractile esophagus?

A

Control GERD and relax hypercontractile smooth muscle (PPI, CCB)

31
Q

If a patient has aperistalsis on manometry and birds beak on the barium esophagram, what should you be concerned about?

A

Achalasia

32
Q

What causes achalasia?

A

Progressive inflammation and degeneration of esophageal neurons

33
Q

What are the symptoms of achalasia?

A

Dysphagia, regurgitation, difficulty belching, CP, and heart burn

34
Q

How is achalasia diagnosed?

A
  • Manometry is required
  • EGD necessary to r/o CA
  • Barium swallow: dilation of esophagus and birds beak
35
Q

What is the treatment of achalasia?

A
  • Mechanical disruption of LES muscle fibers (pneumatic dilation and heller myotomy- incision into the muscles of the LES)
  • Biochemical reduction in LES pressure
36
Q

What is Mallory Weiss syndrome?

A

-mucosal laceration in distal esophagus and proximal stomach

37
Q

What are the predisposing factors of Mallory Weiss syndrome?

A

Heavy alcohol use and hiatal hernia

38
Q

What is the treatment of Mallory Weiss syndrome?

A
  • Stabilize patient
  • PPI
  • endoscopic bleeding control if it doesn’t stop on its own
  • address other predisposing factors
39
Q

What medications can be used in achalasia to biochemically reduce the LES pressure?

A

Botulinum toxin, nitrates, and CCBs