GER

Question 1

GER definition

Answer 1

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

Question 2

GI tract is how many feet long?

Answer 2

30

Question 3

esophagus is how many inches?

Answer 3

9

Question 4

A&P of the esophagus

Answer 4

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

Question 5

name the 3 layers of the esophagus

Answer 5

outer layer of fibrous tissue, a middle layer of smooth muscle, and an inner membrane containing tiny glands

Question 6

innervation of the esophagus cranial nerve

Answer 6

X vagus

Question 7

Laryngopharyngeal reflux vs GERD

Answer 7

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

Question 8

LPR signs and symptoms

Answer 8

• hoarseness
• sinus congestion
• excessive mucous in throat
• chronic chest congestion
• chronic cough

Question 9

T/F we all experience GER with meals

Answer 9

true

Question 10

When GER become pathologic, it is then known as ____

Answer 10

GERD

Question 11

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

Answer 11

abnormalities of motility and sphincter function cause GER

Question 12

etiologies of GERD

Answer 12

• esophageal influences
• trauma/surgery influences
• infections influences
• food/liquid influences
• other influences

Question 13

esophageal influences

Answer 13

• transient lower esophageal tone
• decreased LES resting tone
• ineffective esophageal clearing

Question 14

trauma/surgery influences

Answer 14

• gastric or duodenal surgeries
• excessive vomiting (bulimia)
• swallowed acid or foreign objects
• smoking

Question 15

infections influence

Answer 15

• fungal (candida)

- viral (herpes simplex)

Question 16

food/liquid influences

Answer 16

• alcohol
• caffeine (chocolate)
• spicy foods
• acidy foods
• fatty foods
• medications

Question 17

other influences

Answer 17

• diminished salivation
• prolonged NG intubation
• overeating
• obesity

Question 18

medications causing GERD

Answer 18

tranquilizers
birth control pills
respiratory meds

Question 19

severe reflux can lead to ____ where cells similar to cells in the stomach lining begin to line the lower esophagus and can become cancerous

Answer 19

Barrett’s esophagus

Question 20

assessing GER

Answer 20

• reflux symptom index
• VFSE/MBS
• esophagram
• UGI
• EGD

Question 21

reflux symptom index

Answer 21

pt self-rating form, 5 point scale for nine symptoms

-if score is more than 13, then significant reflux is supsected

Question 22

VFSS/MBS is done in ___ with ___

Answer 22

radiology with ST

Question 23

esophagram is done by ____

esophagram aka Barium study

Answer 23

radiologist

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

Question 24

upper GI is done in ___ by ____

Answer 24

radiology by radiologist
-looks at swallow function from the pharyngeal phase through esophageal phase and into the stomach and then further into duodenum and possibly jejunum

Question 25

EGD is done by ___

Answer 25

a GI doctor | -endoscopy camera through the mouth and into the esophagus and further into the stomach

Question 26

Tx for GERD

Answer 26

- behavioral modification - pharmacological intervention - surgery - exercises

Question 27

Tx for GERD: behavior modifications

Answer 27

- elevate HOB 6-8 inches - instead of 3 large meals, try 6 smaller meals - don't lay down at least 2 hours after eating - watch what you eat/drink

Question 28

Tx for GERD: pharmacological intervention

Answer 28

- antacids - H2 receptor blockers - proton pump inhibitors - alginates - kinetic agents

Question 29

alginates

Answer 29

"raft" formulations - foam that floats to the top of the gastric contents - physical barrier to reflux

Question 30

alginate raft forms rapidly, often in a few ___ and stays intact for ___ hours or more

Answer 30

seconds, 3-4

Question 31

alginate advantages

Answer 31

- no systemic absorption - can use during pregnancy - onset of action is almost immediate - symptom relief in minutes - no interactions with other meds

Question 32

alginates disadvantages

Answer 32

- frequent dosing (4x/day) - taste/liquid formulation - sometimes difficult to obtain

Question 33

Tx for GERD: surgical interventions

Answer 33

- esophageal dilatation - Fundoplication-Nissan (wraps part of stomach around the lower esophagus which places more pressure on LES to keep it closed) - stretta system - implantation of inert polymers

Question 34

esophageal dilation

Answer 34

for specific structures like Schatzki's ring

Question 35

Nissan surgical procedure fixes reflux, but pt still has ___

Answer 35

globus sensation

Question 36

stretta

Answer 36

thin tube (catheter) is passed through esophagus to LES - balloon is inflated, exposing 4 sharp probes on the outside of balloon - probes insert into LES and discharge high-frequency radio waves - this causes LES to become tighter

Question 37

Exercise for GERD: DIEZ technique

Answer 37

- place material into mouth - inhale through your nose using a diaphragmatic breath and hold - swallow - exhales SLOWLY