Brainscape's Knowledge GenomeTM

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


See full index

UGI > GERD > Flashcards

GERD Flashcards

1
Q

Etiology of GERD

A

Insufficient acid suppression
Reflux hypersensitivity
Functional heartburn

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

Ddx for GERD

A

Achalasia
Oesophagitis
Gastroparesis
Esophageal stricture/cancer

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

LA Grade A

A

>1 mucosal break <5mm
Does not extent between tops of two mucosal folds

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

LA Grade B

A

>= 1 mucosal break >5mm
Does not extend between the tops of two mucosal folds

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

LA Grade C

A

>1 mucosal continuous between >2 mucosal folds
<75% of circumference

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

LA Grade D

A

Mucosal break
>75% of esophageal circumference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is HRM?

A

High resolution manometry
GI motility diagnostic system that measure intraluminal pressure with closely spaced sensors, analyses and displays in an esophageal pressure topography plotting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is difference between HRM and conventional manometry?

A

HRM has greater number of sensors and less spacing in between

HRM: 1cm apart

Conventional: 3-8 sensors, 3-5cm apart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is EPT

A

Esophageal pressure topography

  • 3D plotting
  • X axis: time
  • Y axis: location
  • Pressure: magnitude converted to color
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

HRM study protocol

A
  • Insert and position the manometry catheter
  • Supine
  • 10 swallows of 5ml water/saline
  • Change to upright position
  • Min 5 liquid swallows
  • Rapid drink challenge (ingestion of water, 200 mL, as quickly as possible through a straw)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

HRM findings for GERD

A
  • impaired peristalsis
  • decreased peristaltic amplitude
  • hypotensive LES
  • excessive transient relaxations

HRM excludes esophageal motility disorder, not diagnostic for GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is 24 hours ambulatory pH monitoring?

A

Measures reflux in oesophagus over 24 hours

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

Protocol for 24 hour pH monitoring

A
  • Stop PPI 7 days before, H2RA 3 days before and antacids for 24 hours
  • FAMN
  • Insertion of catheter
  • Normal eating habits with diary
  • Remove catheter after 24 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the DeMeester score? What is the score diagnostic for GERD

A

Composite score calculated from 6 parameters of pH monitoring

DMS > 14.7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the six parameters of DeMeester score?

A
  • Total reflux duration (<5%)
  • Upright reflux time; pH<4 (<8%)
  • Supine reflux time (<3%)
  • Number of reflux episodes (<50)
  • Number of episodes greater than 5 min in duration (<3)
  • Longest reflux episode
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Types of fundoplication

A
  • Complete
    • Nissen 360
  • Partial
    • Posterior: Toupet 270
    • Anterior: Dor 180
    • Hills: recreation of angle of His and posterior gastropexy
17
Q

Pros and cons of complete vs partial fundoplication

A
  • Complete
    • more dysphagia, may need re-op if too tight
    • more gas related symptoms
    • more durable
  • Partial
    • allows patient to vomit
    • less gas symptoms
    • less durable
18
Q

Anterior vs Posterior partial fundoplication

A

Reflux control better with posterior fundoplication

Posterior more side effects and complications (mobilisation of posterior stomach more technically demanding)

19
Q

Complications of fundoplication

A
  • Dysphagia
  • Gas bloating
  • Paraesophageal hernia (lap>open)
  • Bilobed stomach (technical error, wrapping of too distal)
  • Flatulence
  • Pneumothorax, PE
  • Vascular injury
  • Perforation
  • Recurrence (25% of patients require medication within time)
20
Q

Lap vs open fundoplication

A

Lap: fewer complications, faster recovery

Long term outcome: lap comparable to open

21
Q

Nissen procedure

A
  • Open phrenoesophageal ligament L to R
  • Dissect both crura
  • Transhiatal mobilisation to allow 3 cm of intra-abdominal oesophagus
  • Posterior crural closure with non-absorbable suture
  • Fundus brought behind distal eso, ensure tension free by shoe-shining manoeuvre
  • Create 2-3 cm wrap, distal most suture incorporating ant ms wall of eso
  • Bougie placement at time of wrap construction
22
Q

Indications for anti-reflux surgery

A
  • Failed medical mx
  • Patient preference
  • Complications of GERD (ex. peptic stricture)
  • Extraesophageal manifestations ( asthma, hoarseness, cough, aspiration)
23
Q

Predictors of good outcome with ARS

A
  • Good correlation with symptoms and reflux
  • Temporary/partial PPI response
  • Impaired eso fx 2nd to reflux damage
  • large hiatus hernia
    • pH study
24
Q

Predictors of good outcome with ARS

A
  • Good correlation with symptoms and reflux
  • Temporary/partial PPI response
  • Impaired eso fx 2nd to reflux damage
  • large hiatus hernia
    • pH study
25
Q

Evidence for ARS vs PPI and conclusion

A
  • Rhodes
  • Anvari
  • Landell
  • Cochrane rev 2010
  • REFLUX study BMJ 2013

Conclusion: at least equally effective, but associated with risks/morbidities/cost, to be done in specialised center

UGI (8 decks)

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