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Fall '15-227 (Exam 2) > Gastroesophageal Reflux (GER) > Flashcards

Gastroesophageal Reflux (GER) Flashcards

1
Q

What is the definition of GER?

A

The movement of partially digested food or acid up from the stomach into the esophagus &/or beyond into the larynx/oral cavity.

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2
Q

What does GER stand for?

A

GASTROESOPHAGEAL Reflux

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3
Q

What are the GERD statistics?

A

10,000 Americans are diagnosed each year.

$6.2 billion dollars spent on prescription antacids.

70,000 anti-reflux operations performed per year, requiring 7-13 days of recovery.

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4
Q

What is the role of a SLP & GERD?

A

ASHA Scope of Practice: “…swallowing or other upper aerodigestive functions such as infant feeding & aeromechanical events (evaluation of esophageal function is for the purpose of referral to medical professionals).”—Scott says to stay away from “evaluation” and just say “screening”

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5
Q

How long is the GI tract?

A

GI tract is 30 ft. long

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6
Q

How long is the esophagus?

A

about 9 inches long

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7
Q

What is the GI tract responsible for?

A

GI tract is responsible for transferring nutrients from the external world to the internal cells via the circulatory system, while preventing retrograde movement of gastric contents.

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8
Q

When does digestion begin?

A

When chewing by breaking the food into smaller pieces. It begins with mastication

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9
Q

What do salivary glands add?

A

Enzymes to help break it down

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10
Q

People with esophageal dysphagia typically have what chronic issue?

A

xerostomia

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11
Q

When someone has chronic xerostomia how much more bacteria do you have in your mouth?

A

10x the amount Saliva is important because it cleans your mouth

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12
Q

People who have head and neck cancer have what issues in regards to their dentition which can lead to what?

A

buildup of bacteria

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13
Q

What is the number #1 thing people must do with their mouths?

A

Keep that oral cavity clean

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14
Q

What are some products you can use to keep your mouth clean when you have xerostomia?

A

Biotene: Comes in a toothpaste, mouthwash, spray, gel, and gum
This is helpful because they are alcohol free-and alcohol helps dry you out even more. –the gel is super helpful for being able to eat.
It has an antibacterial component to it
Biotine replenishes the enzymes that are found in saliva

Orojel: puts out a product for dry mouth

Stoppers 4 dry mouth spray: –fantastic!

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15
Q

What provides a pathway for the ingested food and liquid to reach the stomach?

A

Pharynx & esophagus

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16
Q

What is a wavelike muscular contraction which moves the food through the esophagus into the stomach?

A

Peristalsis

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17
Q

What does the stomach add?

A

Hydrochloric acid

enzymes

pepsin

good particles

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18
Q

What is a muscular tube which extends from the pharynx through the esophageal hiatus of the diaphragm.

A

The esophagus

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19
Q

What are the layers of the esophagus?

A

3 layers
Outer layer of fibrous tissue

 a middle layer of smooth muscle

 an inner membrane containing tiny glands.
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20
Q

What nerve innervates the esophagus?

A

CN X Vagus

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21
Q

What does LES stand for?

A

Lower esophageal sphincter

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22
Q

Where is the LES located?

A

Lower end of the esophagus

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23
Q

What keeps the stomach contents in the stomach

A

LES

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24
Q

What does the LES do before the last contraction allowing food into the stomach?

A

It relaxes and then immediately contracts to prevent regurgitation

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25
Q

What is a hiatal hernia

ON EXAM

A

When part of the stomach gets pulled through the diaphragm

26
Q

Look at pictures of the esophagus

A

.

27
Q

What does LPR stand for?

A

Laryngopharyngeal Reflex

28
Q

What is the difference between LPR and GERD?

A

LPR
Backflow from stomach all the way into the throat
50% report heartburn
Daytime Reflux

GERD
Backflow of stomach contents into the esophagus
Usually reports heartburn
Night-time reflux

29
Q

What are the s/s of LPR?

ON EXAM

A 
Hoarseness (esp. in morning)
Sinus congestion
PND (Post Nasal Drip) 
Excessive mucous in throat (chronic throat clearing)
Chronic chest congestion
Chronic cough
Morning throat clearing
Halitosis (bad breath)
Heartburn
Globus sensation/Pain in chest
Tooth decay
Ear infections
30
Q

What is the difference between GER and GERD?

A

We all experience GER with meals.

“Heartburn” is describes when the acid irritates the walls of the esophagus.
By the time you feel heartburn, the damage is done.

When GER becomes pathologic, it is then known as GERD.

If you have chronic irritation of the lining of the esophagus the cells start to change and they start to mirror the cells that line your stomach. Known as Barrett’s esophaguswhich is a precursor to cancer. Not something to take likely.

31
Q

Manifestations of GER are not effects of gastric acid, BUT…

A

abnormalities of motility (movement) and sphincter function cause GER.

32
Q

What are the etiologies of GERD?

ON EXAM

A

Esophageal Influences

Trauma/Surgery Influences

Infections Influences

Food/liquid Influences

Other Influences

Medications causing GERD

33
Q

What are the esophageal influential etiologies of GERD?

A

Transient lower esophageal tone (Muscle relaxers play a huge role in this)

Decreased LES resting tone (think about what an NG tube does to the sphincters)

Ineffective esophageal clearing (this happens as we get older and some disease can cause this)

Inability of esophageal tissue to resist injury or repair itself (if you scar more than others, you can develop a stricture or a ring)

Mechanical obstructions (hiatal hernia, strictures, rings, cancer)

Motility disorders (Scleroderma, spasms, age)

34
Q

What are the trauma/surgery influential etiologies of GERD?

A

Gastric or duodenal surgeries

Excessive vomiting (Bulimia)

Swallowed acid or foreign objects

35
Q

What are the infections influential etiologies of GERD?

A

Fungal (Candida)

Viral (Herpes Simplex)

36
Q

What are the food/liquid influential etiologies of GERD?

A

Alcohol

Caffeine (chocolate)

Spicy foods

Acidy foods (processed tomato products, OJ)

Fatty foods

Medications

37
Q

What are the “other” influential etiologies of GERD?

A

Diminished salivation

Prolonged NG intubation

Overeating

Obesity

Tight clothing

Pregnancy

Body posture

Hormones

38
Q

What medications cause GERD?

A

Tranquilizers (Valium, Xanax)

Birth control pills

Respiratory meds (Theophyllin)

Anticholinergics (Donatol, Scopolamine)

Beta blockers (Tenormin)
Vitamin C

Anti-osteoporosis meds (Fosamax)

Calcium channel blockers (Procardia, Cardizem)

Non-steroidal anti-inflammatory (Motrin, Advil, Ibuprofen)
Aspirin (KNOW THIS!)

Erectile Dysfunction Meds (Viagra)

39
Q

What are some interesting statistics about GERD?

A

10% of GERD patients have refluxed material aspirated into the lungs or tracheobronchial tree.

45-65% of adult asthmatics have GERD

62% of children with asthma have GERD

Strictures occur in 10% of GERD patients Strictures occur due to scar tissue building up from the GERD

Study: 33% (1/3) of 450 sleep apnea patients had GERD

40
Q

What are the complications of GERD?

A

If left untreated, GERD can cause scarring and narrowing of the esophagus and make swallowing difficulty. Severe reflux can lead to Barrett’s esophagus where cells similar to the cells in the stomach lining begin to line the lower esophagus and can become cancerous.

Granulomas can also be a result

If aspiration PNA occurs from reflux, it is known as Chemical Pneumonitis or Aspiration Pneumonitis.

10 % of GERD patients will develop Barrett’s esophagus.

 10% of those with Barrett’s esophagus go on to have esophageal CA.

 KNOW WHAT BARRETT'S ESOPHAGUS IS

7.7 times more likely to develop esophageal cancer if you have weekly GER symptoms (43.5 times if severe symptoms).

41
Q

Look at REFLUX symptom index

ON EXAM- Assessing GER

A

.

42
Q

What does RSI stand for?

A

Reflex Symptom Index

43
Q

What is RSI?

A

Uses a patient self-rating form

Based on a 5 point scale to be completed for nine symptoms

If score is >13, then significant reflux is suspected

44
Q

What is a MBS/VFSE done?

A

in Radiology with ST

45
Q

What is an esophagram?

A

Done in Radiology by RADIOLOGIST

Looks at swallow function from the pharyngeal phase
through the esophageal phase and into the stomach

Good for looking at esophageal function

Also known as a barium study

46
Q

What is an UGI?

A

Done in radiology by radiologist

Looks at swallow function from the pharyngeal phase through the esophageal phase and into the stomach & then further into the duodenum and possibly jejunum

Good for assessing esophageal and upper GI function

47
Q

What does EGD stand for?

A

esophagogastroduodenoscopy

48
Q

What is a EGD?

A

Done by a GI doctor with endoscopy camera through the mouth and into the esophagus and further into the stomach

Can be done in the MD office or as an outpatient procedure under “twilight” anesthesia

Good for looking at anatomy

49
Q

What is pH probe monitoring? (Scott loves this!!)

A

Done with nasal endoscopy by a GI doctor or an ENT

Tube left in place for 24 hrs

Monitors how much acid reaches the esophagus and to what level it reaches

Patients wear a monitor to also allow them to document when they feel a symptom

Instructed to not alter eating habits during assessment

50
Q

What is Bravo pH study

A

Brand new

Done during an EGD by a GI doctor

A capsule is placed and pinned into the esophagus

Measures acid reflux over 48 hours

Patient wears monitor to allow documentation of symptoms

Capsule falls off on its own & disposed of during a BM

Instructed to not alter eating habits during assessment

51
Q

What is manometry?

A

Not very common

Measures internal pressures

Usually done by GI doctor

52
Q

Know which test is best for Barrett’s esophagus???

A

??

53
Q

What are the treatments for GERD?

A

Behavioral Modification

Pharmacological intervention

Surgery

Exercises

54
Q

Describe behavioral modification treatment for GERD

A

Elevate the head of bed 6-8 inches

Instead of 3 large meals a day, try 6 smaller meals (spread out)

Don’t lie down at least 2 hours after eating (don’t eat/drink before bedtime)

Don’t exercise right after eating

Don’t wear tight clothing

Watch what you eat/drink

Watch your weight

55
Q

Describe pharmacological intervention treatments for GERD

A

review word notes for answer

56
Q

Describe surgery treatments for GERD

A

Esophageal dilatation

Fundoplication-Nissan (Wraps part of stomach around the lower esophagus which places more pressure on LES to keep it closed)

Stretta system
A thin tube (catheter) is passed through esophagus to LES.
A balloon is inflated, exposing 4 sharp probes on the outside of the balloon.
Probes insert into LES and discharge high-frequency radio waves.
This causes LES to become tighter.
May take several “rounds”.
Implantation of Inert Polymers

57
Q

Describe exercises for GERD

A

DIEZ technique: for esophageal dysphagia—not reflux—but not all benefit—you’ve gotta know why they’re having reflux/esophageal dysphagia. KNOW ABOVE FOR EXAM!

Developed by Roxanne Diez Gross, PhD, CCC-SLP

Studies have shown that swallows occur when the lungs have sufficient air in them so that exhalation will follow

Lung volume & respiratory cycle affects swallowing, including transport of food through the esophagus & into the stomach

Flexibility/elasticity of both the lungs & chest wall can also have an effect of swallowing function. Lung volume & respiratory system flexibility (recoil) work together. This is one of the reasons for using a diaphragmatic breath.

  1. Place the material in your mouth.
  2. Inhale through your nose using a diaphragmatic breath and hold.
  3. Swallow.
  4. Exhale S-L-O-W-L-Y.
58
Q

What do we look for in the esophagus?

A

Any physiologic abnormalities causing material to “hang up”, not go down smoothly, or reflux.

Any anatomical abnormalities

59
Q

Review pictures of the esophagus disorders

A

.

60
Q

What are tertiary contractions?

A

smaller version of diffuse esophageal spasm—small bumps viewed in the esophagus

61
Q

Schatzki’s Ring??

A

??

Fall '15-227 (Exam 2) (6 decks)

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