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Medical Surgical GI Exam 3 > Gastric Esophageal Reflux > Flashcards

Gastric Esophageal Reflux Flashcards

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USMLE® Step 1 flashcards
1
Q

What is GERD?

A

Common problem

Chronic manifestation of mucosal damage

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2
Q

What causes GERD

A

Caused by reflux of gastric contents into lower esophagus

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3
Q

Is GERD a disease?

A

No it is a syndrome

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4
Q

GERD results when?

A

Defenses of lower esophagus are overwhelmed by reflux of gastric contents into esophagus

Reflux of HCl acid and pepsin secretions cause irritation and inflammation
Intestinal proteolytic enzymes and bile salts add to irritation

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5
Q

What are Predisposing factors of GERD

A

Hiatal Hernia

Decreased esophageal clearance

Decraesed Gastric Emptying

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6
Q

Hiatal hernia?

A

Incompetent lower esophageal sphincter (LES): Biggest culprate

Causing:

Antireflux barrier

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7
Q

What is decreasesed esophageal clearance?

A

incompetent LES (lower esophageal sphincter) takes longer for food to leave esophagus

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8
Q

What does incompetent LES cause?

A

Primary factor in GERD

Results in ↓ pressure in distal portion of esophagus

Gastric contents move from stomach to esophagus

Can be due to certain foods (caffeine, chocolate, peppermint) and drugs (anticholinergics): decrease pressure in LES increasing GERD

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9
Q

Other risk factors?

A

Obesity is a risk factor

Pregnant women are at increased risk

Cigarette and cigar smoking can contribute to GERD

Hiatal hernia is a common cause of GERD

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10
Q

Symptoms of GERD?

A

Heartburn (pyrosis)

Dyspesia

Regurgitation

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11
Q

Symptoms of Heartburn?

A

Most common clinical manifestation

Burning, tight sensation felt beneath the lower sternum and spreading upward to throat or jaw

Felt intermittently

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12
Q

Symptoms of Dyspepsia

A

Pain or discomfort centered in upper abdomen

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13
Q

Symptoms of regurgitation?

A

Described as hot, bitter, or sour liquid coming into throat or mouth

Hypersalivation may also be reported

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14
Q

Most individuals have mild symptoms such as?

A

Heartburn after a meal:
to consider as GERD it will happen at least twice a week
No evidence of mucosal damage

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15
Q

When does Heartburn occur?

A

Following ingestion of food or drugs that ↓ LES pressure

Directly irritates esophageal mucosa

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16
Q

Individual may also report respiratory symptoms such as?

A

Wheezing

Coughing

Dyspnea

Nocturnal coughing with loss of sleep

Can mimic asthma due to inflammation of the trachea causing voice hoarseness and sore throat

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17
Q

Otolaryngologic symptoms include

A

Hoarseness

Sore throat

Lump in throat

Choking

18
Q

Symptoms of GERD-related chest pain

A

Described as burning, squeezing, or radiating to back, neck, jaw, or arms

Can mimic angina

More common in older adults with GERD

Relieved with antacids

19
Q

Complications of GERD

A

òEsophagitis

Barrett’s esophagus (esophageal metaplasia): When healing process occurs: follow up with biopsy can be cancerous

Respiratory

Potential for asthma, bronchitis, and pneumonia

Dental erosion

From acid reflux into mouth

Especially posterior teeth

20
Q

Diagnostic Studies

A

History and physical examination
Barium swallow
Upper GI endoscopy
Biopsy and cytologic specimens
Esophageal manometric (motility) studies: measures pressure of LES

Radionuclide tests

Detect reflux of gastric contents

Demonstrate rate of esophageal clearance

Monitoring pH

Laboratory or 24-hour ambulatory

Determine esophageal pH by using specially designed probes

21
Q

Nutritional Therapy

A

Decrease high-fat foods

Take fluids between rather than with meals

Avoid milk products at night: Temporarily helps but has a rebound effect due to calcium increasing acid content

Avoid late-night snacking or meals

Avoid chocolate, peppermint, caffeine, tomato products, orange juice

Weight reduction therapy

Chewing gum and oral lozenges can increase saliva production and help patients with mild symptoms

22
Q

What kind of drug therapy is given?

A

Proton pump inhibitors (PPIs)

23
Q

What are common PPI’s?

A

omeprazole (Prilosec)

esomeprazole (Nexium)

24
Q

How do PPI’s help?

A

Promote esophageal healing in 80% to 90% of patients

Decrease incidence of esophageal strictures

Decrease the rate of gastric acid secretion

25
Q

What is the most common side effect of PPI’s and why?

A

Headache:

It interferes with the absorption of Magnesium and Calcium. Magnesium is crucial for nerve transmission

26
Q

What other drug alerts are there with PPI’s?

A

Long-term use or high doses of PPIs may increase the risk of fractures of hip, wrist, and spine: Due to interfering with the absorption of calcium

27
Q

PPI’s are asssociated with an increased incidence of what and why?

A

C. difficile infection in hospitalized patients:

Due to altering gastric contents: usually seen in those with a hx

28
Q

What other types of drugs are used in GERD?

A

Histamine-2 receptor (H2R) blockers

Cholinergic

Prokinetic drugs

Antacids

Drugs with cytoprotective properties

29
Q

Histamine-2 receptor (H2R) blockers

Name

How they work

side effects

A

Decrease secretion of HCl acid

Reduce symptoms and promote esophageal healing in 50% of patients

Example: cimetidine (Tagamet), famotidine (Pepcid): Prophylactic in hospitals to prevent stress ulceres, rantidine

Side effects uncommon

30
Q

Drugs with cytoprotective properties and teaching needed

A

sucralfate (Carafate):

Give 30 minutes before you eat because it works better in low Ph

31
Q

Cholinergic Drugs

Name

How they work

A

Increase LES pressure

Improve esophageal emptying

Increase gastric emptying

Example: bethanechol (Urecholine):

32
Q

Prokinetic drugs

Name

How they work

A

Promote gastric emptying

Reduce risk of gastric acid reflux

Example: metoclopramide (Reglan)

33
Q

Antacids

Name

How they work

Pt teaching

A

Quick but short-lived relief

Neutralize HCl acid

Taken 1–3 hours after meals/at bedtime

Example: Maalox, Mylanta

34
Q

What kind of surgical therapy can be done?

A

laparoscopic Nissen fundoplication

35
Q

When is surgical therapy necessary?

A

Failure of conservative therapy

Medication intolerance

Barrett’s metaplasia

Esophageal stricture and stenosis

Chronic esophagitis

36
Q

Patient Teaching

A

Elevation of head of bed 30 degrees

Not lying down for 2–3 hours after eating

Avoidance of late-night eating

Avoidance of factors that cause reflux

Stress reduction techniques

Weight reduction, if appropriate
Small, frequent meals

37
Q

Postoperative care Focus

A

Prevention of respiratory complications

Maintenance of fluid/electrolyte balance

Prevention of infection

38
Q

Postoperative care

Respiratory assessment

A

Respiratory rate/rhythm

Pulse rate/rhythm

Signs of pneumothorax

39
Q

What are Signs of pneumothorax

A

Dyspnea

Chest pain

Cyanosis

40
Q

Post Operative Care General

A

Deep breathing techniques

Accurate I/O

Observing for fluid/electrolyte imbalance

Pain medication

Medications to prevent nausea/vomiting

41
Q

Postoperative care diet

A

When peristalsis returns, only fluids given initially

Solids added gradually

Normal diet gradually resumed

Patient must avoid gas-forming foods and must chew foods thoroughly

42
Q

Postoperative care after teaching for after D/C

A

First month after surgery, patient may report mild dysphagia; should resolve after edema subsides
Patient should report persistent symptoms such as heartburn and regurgitation

Medical Surgical GI Exam 3 (21 decks)

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