Exam 1: GERD Flashcards
Can GERD affect people of all ages ?
Yes
What is GERD defined as ?
Chronic symptom of mucosal damage
from reflux of stomach acid
What is GERD also known as ?
Heart burn
True or False: GERD is the most common upper GI problem ?
True
What does LES stand for ?
Lower Esophageal Sphincter
GERD can be caused by what ?
Inadequate lower esophageal sphincter tone
With GERD, the reflux and irritation of the mucosal lining can be caused by what ?
- Hydrochloric acid
- Pepsin
What things affect the Lower Esophageal Sphincter Tone, ultimately leading to GERD ?
- Hiatal hernia
- Pregnancy
- Obesity
Lower Esophageal Sphincter Tone is essentially caused by what ?
- Anything that puts pressure on the esophageal sphincter (large things in the abdomen)
- Anything that decreases tone
What are EXAMPLES of things that cause a decrease in the Lower Esophageal Sphincter Tone ?
- Things that put pressure on the esophageal sphincter
- Hiatal hernia, Pregnancy, Obesity
- Things that decrease sphincter tone
- Caffeine, Chocolate, High-fat foods, cigaret smoking
What is one of the first things that people with GERD will be advised to do ?
Cut out caffeine
What are complications of GERD ?
- Esophagitis
- Barrett’s Esophagus
- Esophageal Strictures
- Pneumonia
Esophagitis causes inflammation of the esophagus, but you can also have ___________ as well ?
Scarring
Barrett’s esophagus is caused by what ?
Chronic acid
What is Barrett’s esophagus ?
Precancerous lesions
True or False: Individuals with Barrett’s esophagus are monitored much more closely with EGD due to the increased chance of esophageal cancer ?
True
True or False: when you have chronic inflammation, scar tissue can form ?
True
What are Esophageal Strictures ?
Cause narrowing of the esophagus which can lead to swallowing difficulties
Scar tissue formation –> dysphagia{difficulty swallowing}
How is Pneumonia a complication of GERD ?
Due to aspiration of stomach acid
- people who aspirate down into their trachea may cough, almost like a tickle
To treat Esophageal strictures what can be done ?
An EGD dilation procedure
- A tubes put down the esophagus and then there is pressure put against the esophageal strictures or narrowing to open them up.
(its almost like, stretching the esophagus open again so that the pt. can swallow more easily)
What procedure is typically performed outpatient int he GI lab, under conscious sedation, and NPO the night before ?
EGD dilation procedure
What are manifestations of GERD ?
- Heartburn
- Dysphagia
- Burning pain after meals (d/t hydrochloric acid being released d/t eating food)
- Hoarseness
- Cough
- Wheezing, Laryngeal spasm, bronchospasm
(D/t aspiration of stomach acid into the respiratory tract) - Sore throat (from continuous acid)
- Choking sensation (lump in throat)
(d/t inflammation from the acid)
True or False: Women especially may not have chest pain associated with an MI, but it may present with GERD symptoms
True
In general how is GERD managed ?
- Lifestyle changes
- Medications
- Surgery
Lifestyle changes, for the management of GERD, focus on what ?
Avoiding triggers !!
- Foods
- Drinks
- Alcohol
When managing GERD, by avoiding triggers (foods, drinks, alcohol), what type of things should be avoided ?
- Red wine
- Orange juice
- Acidic foods/drinks
- Cola (caffeine in it)
What types of medications are used in the management of GERD ?
- Antacids (ex: Malox)
- Histamine blockers
- Proton pump inhibitors (PPI’s) (ex: protonics, Nexeum)
What are types of Surgeries used in the management of GERD ?
- Nissen Fundoplication
- LINX (NO MRI !)
Why should alcohol be avoided if you have GERD ?
B/c it stimulates hydrochloric acid production & gastric acid secretion, which will lead to symptoms of GERD
How do Histamine blockers work, to manage GERD ?
They stop a step in the hydrochloric acid production
How do PPI’s work in the management of GERD ?
They reduce the traveling of hydrogen ions into the stomach.
- If you don’t have hydrogen ions you can’t make hydrochloric acid
What are GERD patient teaching points ?
- High protein, low-fat diet
- Small frequent meals (less hydrochloric acid being secreted)
- AVOID alcohol, smoking, caffeine
- Avoid tight clothes at the waist (b/c it increases the pushing up of the acid against the lower esophageal area)
- Sleep w/ the head of bed elevated (6in or 2-3 pillows)
- Weight loss (less pressure against the and sphincter)
- Life style modifications
- Avoid lying down 2-3hrs after meals`
What type of diets IMPAIR the lower esophageal sphincter tone ?
High-fat diets
What complication of GERD, is a pre-cancerous condition ?
Barrett’s Esophagus
Barrett’s esophagus is manifested by what ?
Replacement of flat epithelial cells with columnar epithelium
- The columnar epithelium cells can change into cancer cells
Barrett’s esophagus, is thought to be primarily due to ?
GERD
GERD = risk for ___________________, which is a risk for _____________________ ?
GERD = risk for Barrett’s esophagus, = risk for Esophageal cancer
What complication of GERD, is represented by a change in epithelial cells in the lining of the esophagus ?
Barrett’s Esophagus
The signs and symptoms of Barrett’s esophagus, can range from ______ to ______________ ?
None to Perforation (if the epithelium is damaged enough. Worst case scenario)
With Barrett’s esophagus, you must be monitored how often ? and how ?
- Every 2-3 years
- Via Endoscopy (AKA: EGD)
True or False: The Nissen Fundoplication surgery is a Laproscopic procedure ?
True
In what surgical procedure for GERD, do they take part of the stomach and wrap it around the lower portion of the esophagus and suture it, to strengthen the area ?
Nissen Fundoplication
What is the goal of the Nissen Fundoplication surgery ?
To reduce reflux by maintaining the function of the lower esophageal sphincter
What is the LINX ?
a ring of small flexible magnets that are enclosed in the titanium beeds and connected by titanium wires
Where is the LINX implanted ?
Inserted laproscopically, and implanted right at the end of the esophagus
How does the LINX work ?
- When the pt. swallows, the LINX opens and allows the food to go into the stomach
- Once the food is in the stomach, the magnets pull back together and close, to keep the lower esophageal area closed.
- It protects the lower esophageal sphincter !
True or False: Pt’s with The LINX implanted MUST cary an implant card ?
True !
Why must pt’s with the LINX, carry an implant card ?
It explains how much magnetic exposure they can be exposed to without serious damage
What is a Hiatal Hernia defined as ?
Herniations of a portion of the stomach into the esophagus through the diaphragm
What are the 2 types of Hiatal Hernias ?
- Rolling
- Sliding
A ________ Hiatal Hernia occurs when a part of the stomach will slide through when the pt. is lying flat, and then when they stand up ti drops back down ?
Sliding Hiatal Hernia
A ________ Hiatal Hernia occurs when part of the stomach kind of rolls up and forms through that opening in the diaphragm and forms like a pocket next to the esophagus, and putting pressure is that area, and thus discomfort ?
Rolling Hiatal Hernia
What is the Etiology of Hiatal Hernias ?
- Weakening of muscles
- Increased intra-abdominal pressure
(obesity, pregnancy, ascites, heavy lifting)
What is the Management of a Hiatal Hernia ?
- Reduce pressure
- Possible surgery
- To repair the hole in the diaphragms that the stomach cannot sneak through that area
How can you reduce pressure for the management of a Hiatal Hernia for each of the following…
- Pregnancy:
- Obesity:
- Ascites:
- Pregnancy: will eventually come to an end
- Obesity: Weight loss
- Ascites: can be difficult b/c its more of a chronic condition
- May undergo a paracentesis, although the fluid will tend to re-accumulate (Not a permanent solution !)
