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physiology test 3 > GERD > Flashcards

GERD Flashcards

1
Q

Gastroesophageal reflux disease is commonly abbreviated.

A

GERD

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2
Q

GERD is defined as symptoms or complications resulting from the reflux of gastric contents into?

A

the esophagus or beyond, such as into the oral cavity, including the larynx, or even into the lungs.

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3
Q

GERD is further classified as the presence of symptoms without what?

A

erosions on endoscopic examination.

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4
Q

GERD without erosions on endoscopic examination is also referred to as ? abbreviated?

A

non-erosive disease

abbreviated NERD

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5
Q

GERD could also be symptoms when erosions are present, which would be called and abbreviated as?

A

erosive reflux disease

ERD

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6
Q

The two characteristic symptoms of GERD are?

A

retrosternal burning commonly known as heartburn and regurgitation

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7
Q

while ________ __________ is the most common outcome of tissue injury with GERD.

A

reflux esophagitis

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8
Q

chronic reflux not adequately treated, can be complicated by what four things?

A

bleeding
development of esophageal strictures
Barrett esophagus
esophageal ardeneaux carcinoma

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9
Q

Gastroesophageal reflux disease can damage mucosal tissue how?

A

abnormal regurgitation of gastric contents into the esophagus

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10
Q

the epithelial cells lining the esophagus are resistant to _____ from foods but are sensitive to ______

A

abrasion

acid

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11
Q

GERD is a multifactorial disease in which _____ and _____ factors play a pathogenic role.

A

anatomic and functional

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12
Q

the primary pathophysiology associated with GERD is defective?

A

LES pressure

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13
Q

LES stands for?

A

lower esophageal sphincter

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14
Q

Reduced pressure or increased relaxation of the LES may result from what three things?

A

spontaneous transient LES relaxations
Transient increases in intra abdominal pressure
Atonic LES

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15
Q

The LES or lower esophageal sphincter, is normally an _____ ____ ____ with an elevated resting pressure, thereby preventing gastric contents from regurgitating into the esophagus.

A

atonic contracted state

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16
Q

Transient decreases in sphincter pressure account for approximately ______ of all episodes of reflux.

A

50%

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17
Q

Conditions that decrease LES sphincter tone or increase abdominal pressure contribute to GERD include what three things?

A

alcohol and tobacco use
Delayed gastric emptying
Increased Gastric Volume

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18
Q

What is a hiatal hernia?

A

a distention of the stomach above the diaphragm

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19
Q

hiatal hernia increases the risk for?

A

GERD

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20
Q

The anatomic disturbance from a hiatal hernia reduces what?

A

LES pressure

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21
Q

however not all patients with a hiatal hernia have _________.

A

GERD

and not all patients with GERD have a hiatal hernia

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22
Q

normally if gastric contents are regurgitated, ______ of the esophagus propels the contents back into the stomach.

A

peristalsis

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23
Q

if peristaltic contractions are reduced, the rate of esophageal _________ decreases.

A

clearance

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24
Q

GERD often results from an increased contact of gastric reflux with the esophageal mucosa and not?

A

excessive acid production

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25
GERD can be bothersome at night for many patients due to what two things?
decreased swallowing while asleep | prone position
26
Swallowing increases what, that aids in the clearance and buffering of ingested contents?
salivary flow
27
Reflux can be particularly bothersome in patients with decreases saliva, such as what two populations?
elderly | patients with dry mouth syndrome
28
esophageal clearance is impaired by what three things?
ineffective peristalsis reduced salivary secretion reduced secretion from esophageal submucosal glands
29
numerous mucus secreting cells are located in the mucosa of the _____________.
esophagus
30
The _____ rich mucus protects the esophagus by neutralizing gastric reflux.
bicarbonate
31
Repeated exposures of acid gastric contents damaged the mucosa and mucus secreting cells. This in turn limits the ?
protective mechanisms, further perpetuating damage to the mucosa
32
name three factors that are interrelated and if increased contribute to GERD?
gastric volume, gastric contents, and delayed emptying of the stomach
33
gastric volume is influenced by what four factors?
volume and contents of the ingested food gastric secretions rate of gastric emptying duodenal reflux into the stomach
34
GERD is often reported immediately after? especially if?
consuming a meal | especially if its a large meal that has particular contents into it.
35
the composition of the refluxate is?
active pepsin
36
reluxate has what kind of pH?
very low pH
37
the esophagus pH is?
5-7
38
the pH of the stomach is?
2-5
39
the pH of the duodenum is?
6.8
40
Active pepsin which degrades _____.
proteins
41
Duodenum reflux from the small intestine can also occur which contains what two things?
bile duct and pancreatic juices
42
Duodenum reflux can severely damage?
the mucosal cells in the esophagus
43
GERD can lead to what complications of the esophagus?
reflux esophagitis development of esophageal strictures barrets esophagus esophageal adenocarcinoma
44
reflux esophagitis can cause erosion of the epithelial lining due to prolong exposure to ?
reflux gastric contents
45
Esophageal strictures, generally involved the ______ portion of the esophagus, resulting in possible ______.
distal | dysphagia
46
dysphagia is also known as?
difficulty swallowing or even painful swelling
47
medications such as ____ and _____ often worsen complications of GERD
aspirin and NSAIDS
48
Patients who experience GERD for years can develop chronic ________.
chronic esophagitis
49
Over time the normal squamous epithelial lining of the esophagus is replaced by abnormal specialized ________ type epithelial cells, resulting in?
columnar | Barrett esophagus
50
what condition greatly increases the risk of developing esophageal adenocarcinoma?
barretts esophaus
51
The clinical manifestations of GERD can be classified as _______ and _______ syndromes.
esophageal and extra esophageal syndromes
52
esophageal syndromes are _____ based or _______ based.
symptom based | esophageal tissue injury based
53
list the typical symptoms of typical reflux syndrome associated with esophageal GERD syndromes
heartburn regurgitation, belching reflux chest pain
54
heartburn is described as retrosternal burning or warmth arising from the stomach and may radiate all the way up to the _____.
neck
55
Regurgitation often leaves a ____ taste in the mouth
bitter acid taste
56
Patients with GERD can present with what two types of symptoms which should be distinguished from other cuases?
chest pain or pulmonary symptoms
57
syndromes with esophageal injury may present with alarm symptoms which are?
dysphagia odynophagia weight loss bleeding
58
alarm symptoms with syndromes with esophageal injury necessitate further? indicating what?
diagnostic evaluation and may indication complications of GERD
59
list the four tissue injury-based Esophageal GERD syndromes that can present with alarm symptoms?
esophagitis strictures Barrett's esophagus Esophageal adenocarcinoma
60
GERD that affects organs other than the esophagus indicates?
extra esophageal syndromes
61
Extra esophageal syndromes includes ____ symptoms.
atypical
62
list the atypical symptoms that can present with extra esophageal syndromes?
``` chronic cough laryngitis asthma wheezing Dyspepsia ```
63
The severity of GERD symptoms ____ correlate with the tissue injury.
does not always
64
a clinical diagnosis of GERD is generally based on what three things?
symptoms risk factors response to empiric trial of acid suppression therapy
65
empiric trial of acid suppression therapy is often started with a ?
proton pump indibitor
66
patients with typical symptoms of GERD usually _______ require further diagnostic test.
do not
67
A PPI trial can be beneficial due to?
its efficacy and cost effectiveness in patients where cardiac cause has been excluded.
68
what are common risk factors associated with GERD
``` family history obesity smoking alcohol consumption (especially high amounts) respiratory disease reflux chest pain syndrome certain medications some foods ```
69
there is a strong association between GERD and _______
obesity
70
what are indications that are associated with symptoms and complications of GERD
increased BMI waist circumference weight gain
71
what population does GERD frequently occur in
pregnancy at any trimester
72
during pregnancy, GERD severity can ______ during this time period but should resolve ____ post delivery
severity increase | typically resolves after deliver
73
In patients that GERD does not resolve 1 year post delivery, what factors should be considered
the amount of weight gain that occurred during the pregnancy
74
maternal age is ____ related to heartburn symptoms
inversely
75
what are the significant predictors of heart burn with pregnancy
increased gestational age, heartburn before pregnancy, and parity
76
what are the demographic risk factors for GERD
pregnancy older age decreased education level
77
what are examples of foods and medications that decrease LES pressure
* fatty/heavy meals * peppermint/spearmint * caffeine, chocolate, coffee, cola, tea * garlic, onions, chili pepers * anticholinergics, barbiturates, dopamine, nitrates, dihydropyridine, CCB, tetracycline, theophylline, estrogen, progesterone
78
what are foods and medications that act as direct irritants to esophageal mucosa
spicy food, coffee, orange juice, tomato juice, aspirin, NSAIDS, quinidine, potassium chloride, iron, oral bisphosphonates
79
what position increased the risk for GERD
recumbent position, bending over
80
what are examples of comorbid conditions that are risk factors for developing GERD
``` hiatial hernia obesity IBS asthma angina anxiety/depression ```
81
2013 guidelines for diagnosis and management of GERD they recommended consideration of of a diagnostic evaluation with what two things before a PPI in patients were cardiac causes of chest pain have not been excluded.
endoscopy and pH
82
Diagnostic evaluation is useful to assess treatment failure, investigate potential ___________, and prevent misdiagnosis.
complications
83
diagnostic test are indicated in what two types of patients?
do not respond to therapy and in patients who present with alarm symptoms
84
What is the primary diagnostic test to evaluate the esophageal mucosa in patients with suspected GERD?
upper endoscopy
85
Describe what happens with an upper GI endoscopy? | what you can see, what you can do?
illuminated flexible endoscope is inserted down the esophagus into the stomach and the duodenum, which allows the practitioner to visualize the intra luminal mucosa and obtain specimens for biopsies if necessary.
86
What can the provider find with an upper GI endoscopy?
erosive esophagitis strictures barretts esophagus
87
Upper GI endoscopy can identify ERD but may potentially miss identifying characteristics of ______.
NERD
88
upper endoscopy is not required in the presence of _______ alone
typical symptoms alone
89
Endoscopy is indicated for what three situations?
presence of Alarm symptoms to screen high risk patients evaluate non-cardiac chest pain patients unresponsive to a PPI
90
ambulatory reflux monitoring enables the detection for presence fo abnormal?
esophageal acid exposure reflex frequency symptoms associated with reflux episodes
91
Ambulatory esophageal reflux monitoring is indicated for?
before consideration of endoscopic or surgical therapy in patients with NERD Evaluation patients refractory to the PPI therapy Where diagnosis of GERD is in Question
92
what happens with ambulatory reflux monitoring?
a small probe is placed in the esophagus, just above the LES in order to monitor for 24 hour acid levels.
93
_____________ allows for detection of reflux episodes.
impotence.
94
PPI trial is indicated for?
typical GERD symptoms | no alarm symptoms
95
a negative PPI trial _________ GERD
does not rule out
96
Endoscopy is indicated for?
screening of high risk patients chest pain alarm symptoms
97
One should consider performing an endoscopy early for what populations?
those at risk for Barrett's esophagus non-cardiac chest pain patients unresponsive to PPI
98
Ambulatory reflux monitoring is indicated for?
refractory GERD symptoms GERD diagnosis in question Preoperatively for Non-erosive disease
99
When performing an ambulatory reflux monitoring a provider should document?
abnormal acid exposure and/or reflux frequency
100
When performing an ambulatory reflux monitoring a provider should correlate symptoms with?
reflux
101
hiatal hernias can occur when the stomach slides into the _____ or when a pouch of the stomach is pinched above the _________.
thorax | diaphragm
102
in cases where GERD and a large hiatal hernia coexist, the hernia may slow what? and contribute to severe?
acid clearance | severe esophagitis
103
list a few causes of GERD? 10 total, see how many you can get!
``` decreased salivation impair esophageal clearance impaired tissue resistance hiatal hernia decreased LES resting tone Increased total LES resistance increased gastric acid/pepsin secretion delayed gastric emptying pyloric incompetence bile reflux ```

physiology test 3 (11 decks)

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