Brainscape's Knowledge GenomeTM

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


See full index

Esophagus Master > Esophageal Reflux > Flashcards

Esophageal Reflux Flashcards

1
Q

Prevelance of GERD in Western world

A

14-20% of population

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

2 primary pathophysiolic MOA of GERD

A
  1. Inability of esophagus to clear refluxate due to altered esophageal motility
  2. Loss of reflux barriers due to anatomic changes:
    1. hiatal hernia
    2. intrinsic LES hypotension
    3. increased intragastric pressure (obesity or delayed gastric emptying or outlet obstruction)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Results of pathologic reflux

A
  • esophagitis
  • ulceration
  • peptic strictures
  • Barrett’s esophagus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Risk associated with Barrett’s esophagus

A

Histologic changes (metaplasia) represent premalignant lesion with development of dysplasia and esophageal adenocarcinoma

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

Risk of esophageal adenocarcinoma associated with Barrett’s esophagus

A

40-fold increased risk

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

Sx associated with GERD

A
  • Heartburn
  • Dysphagia
  • Odynophagia
  • Hypersalivation
  • Astham
  • Laryngitis
  • Persistent cough
  • Globus sensation
  • Non-cardiac chest pain
  • Nausea
  • Assymptomatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Diagnostic eval of GERD

A
  • Initial diagnosis based history
    • Typical sx of heartburn or regurgitation responsive to PPI
      • Further testsing if PPI therapy fails
  • Endoscopy with biopsy
  • UGI swallow
  • Manometry
  • pH testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Biopsy and survillence approach for Barrett’s Esophagus

A
  • Biopsies: four quadrants of esophagus
    • every 2 cm for no dysplasia or low-grade dysplasia
    • every 1 cm for high-grade dysplasia
  • Surveillance: depends on grade of dysplasia
    • No dysplasia on 2 separate occassions: 3-5 years
    • Low-grade dysplasia: annual
    • High-grade dysplasia:
      • esophagectomy
      • local endoscopic therapy (EMR, PDT) with q3 month EGD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Mainstay of GERD treatment

A

Medical managment

  • H2 blocker or PPI
    • PPI better efficacy in resolution of heartburn/healing esophagitis
  • Diet counseling:
    • avoid fatty food and EtOH
    • avoid acidit/irritating foods (citrus and carbonated beverages)
  • Lifesyle modification
    • smoking cessation
    • weight reduction (BMI 20-25)
    • avoidance of meals witin 3 hrs of bedtime
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

2 conditions that must be satisfied before surgical treatmet of GERD

A
  1. Failure of medical managment
    1. persistence of sx
    2. documented presence of mucosal injury
  2. Preop studies demonstrate loss of barrier function that may improve with surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Goals of surgery for GERD

A
  • Ensure intra-abdomina location of GE junction
  • Reconstruct extrinsic sphincter (reduce esophageal hiatus to more physiologic size
  • Reinforce intrinsic LES with fundoplication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

T/F

Barrett’s esophagus alone is an indication for surgery

A

False

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

Potential complication of long-standing GERD

A

Esophagel shortening due to chronic scarring

  • GE junction often in thorax
  • Requires esophageal lengthing procedure
    • Collis gastroplasty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Description of Collis gastroplasty

A
  • 3-6 cm, selectively vagotimized, proximal stomach is tubularized to create a neo-esophagus
  • Re-approximation of crura
  • Fundoplication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MC perfomed fundoplications for GERD

A
  • Nissen (360 degree): no esophageal dysmotility
  • Toupet (270 degreee: presence of quesion of esophageal dysmotility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Desired length of tension free intra-abdominal esophagus prior to fundoplication

A

2.5 - 3.0 cm

17
Q

Surgical principles of fundoplication

A
  • Fundus completely mobilized with division of short gastric vessels
  • Vagus nerves preserved
  • Diphragmatic crural defects closed (deep, non-absorbable suture)
  • Floppy, tension free fundoplication
18
Q

Overall success of surgical therapy for GERD

A

80-90% success in symptom relief (heartburn and regurgitation)

  • Rate of success for healing esophagis equivalent between surgery and medical therapy
    • Thus, surgery best for patients who have failed medical therapy
19
Q

Potential complications of surgery for GERD

A
  • Persistent bloating
  • Inabiltity to belch
  • Severe dysphagia (fundoplication too narrow)
  • Need for reoperation
20
Q

T/F

Definitive evidence exists demonstrating that surgical correction for GERD reduces or reverses Barrett’s esophagus

A

False

  • Managment of GERD should primarily involve medical managment with selective use of surgical therapy
21
Q

American Gastroenterlogical association of GERD

A

•reflux that causes “troublesome symptoms and/or complications.

22
Q

Atypical symptoms of GERD

A
  1. Asthma
  2. Chronic Cough
  3. Laryngitis
  4. Pulmonary Fibrosis
  5. Pharyngitis
  6. Sinusitis
  7. Otitis media
  8. Dental erosions
23
Q

The three dominant pathophysiologic mechanisms causing esophagogastric junction (EGJ) incompetence are:

A
  1. Transient lower esophageal sphincter relaxations (TLESRs) Belch
  2. A hypotensive lower esophageal sphincter (LES)
  3. Anatomic disruption of the gastroesophageal junction, often associated with a hiatal hernia
24
Q

Normal LES length

A

2-4cm

25
Q

LES normal resing pressure

A

6mmHg - 35mmHg

26
Q

What is normal intrabdominal length of the LES

A

>1cm

27
Q

What is high nadir relaxation pressure for the LES

A

10mm Hg

Esophagus Master (11 decks)

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