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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
Q

GERD can be bothersome at night for many patients due to what two things?

A

decreased swallowing while asleep

prone position

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26
Q

Swallowing increases what, that aids in the clearance and buffering of ingested contents?

A

salivary flow

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27
Q

Reflux can be particularly bothersome in patients with decreases saliva, such as what two populations?

A

elderly

patients with dry mouth syndrome

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28
Q

esophageal clearance is impaired by what three things?

A

ineffective peristalsis
reduced salivary secretion
reduced secretion from esophageal submucosal glands

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29
Q

numerous mucus secreting cells are located in the mucosa of the _____________.

A

esophagus

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30
Q

The _____ rich mucus protects the esophagus by neutralizing gastric reflux.

A

bicarbonate

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31
Q

Repeated exposures of acid gastric contents damaged the mucosa and mucus secreting cells. This in turn limits the ?

A

protective mechanisms, further perpetuating damage to the mucosa

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32
Q

name three factors that are interrelated and if increased contribute to GERD?

A

gastric volume, gastric contents, and delayed emptying of the stomach

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33
Q

gastric volume is influenced by what four factors?

A

volume and contents of the ingested food
gastric secretions
rate of gastric emptying
duodenal reflux into the stomach

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34
Q

GERD is often reported immediately after? especially if?

A

consuming a meal

especially if its a large meal that has particular contents into it.

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35
Q

the composition of the refluxate is?

A

active pepsin

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36
Q

reluxate has what kind of pH?

A

very low pH

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37
Q

the esophagus pH is?

A

5-7

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38
Q

the pH of the stomach is?

A

2-5

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39
Q

the pH of the duodenum is?

A

6.8

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40
Q

Active pepsin which degrades _____.

A

proteins

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41
Q

Duodenum reflux from the small intestine can also occur which contains what two things?

A

bile duct and pancreatic juices

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42
Q

Duodenum reflux can severely damage?

A

the mucosal cells in the esophagus

43
Q

GERD can lead to what complications of the esophagus?

A

reflux esophagitis
development of esophageal strictures
barrets esophagus
esophageal adenocarcinoma

44
Q

reflux esophagitis can cause erosion of the epithelial lining due to prolong exposure to ?

A

reflux gastric contents

45
Q

Esophageal strictures, generally involved the ______ portion of the esophagus, resulting in possible ______.

A

distal

dysphagia

46
Q

dysphagia is also known as?

A

difficulty swallowing or even painful swelling

47
Q

medications such as ____ and _____ often worsen complications of GERD

A

aspirin and NSAIDS

48
Q

Patients who experience GERD for years can develop chronic ________.

A

chronic esophagitis

49
Q

Over time the normal squamous epithelial lining of the esophagus is replaced by abnormal specialized ________ type epithelial cells, resulting in?

A

columnar

Barrett esophagus

50
Q

what condition greatly increases the risk of developing esophageal adenocarcinoma?

A

barretts esophaus

51
Q

The clinical manifestations of GERD can be classified as _______ and _______ syndromes.

A

esophageal and extra esophageal syndromes

52
Q

esophageal syndromes are _____ based or _______ based.

A

symptom based

esophageal tissue injury based

53
Q

list the typical symptoms of typical reflux syndrome associated with esophageal GERD syndromes

A

heartburn
regurgitation, belching
reflux chest pain

54
Q

heartburn is described as retrosternal burning or warmth arising from the stomach and may radiate all the way up to the _____.

A

neck

55
Q

Regurgitation often leaves a ____ taste in the mouth

A

bitter acid taste

56
Q

Patients with GERD can present with what two types of symptoms which should be distinguished from other cuases?

A

chest pain or pulmonary symptoms

57
Q

syndromes with esophageal injury may present with alarm symptoms which are?

A

dysphagia
odynophagia
weight loss
bleeding

58
Q

alarm symptoms with syndromes with esophageal injury necessitate further? indicating what?

A

diagnostic evaluation and may indication complications of GERD

59
Q

list the four tissue injury-based Esophageal GERD syndromes that can present with alarm symptoms?

A

esophagitis
strictures
Barrett’s esophagus
Esophageal adenocarcinoma

60
Q

GERD that affects organs other than the esophagus indicates?

A

extra esophageal syndromes

61
Q

Extra esophageal syndromes includes ____ symptoms.

A

atypical

62
Q

list the atypical symptoms that can present with extra esophageal syndromes?

A 
chronic cough 
laryngitis
asthma
wheezing 
Dyspepsia
63
Q

The severity of GERD symptoms ____ correlate with the tissue injury.

A

does not always

64
Q

a clinical diagnosis of GERD is generally based on what three things?

A

symptoms
risk factors
response to empiric trial of acid suppression therapy

65
Q

empiric trial of acid suppression therapy is often started with a ?

A

proton pump indibitor

66
Q

patients with typical symptoms of GERD usually _______ require further diagnostic test.

A

do not

67
Q

A PPI trial can be beneficial due to?

A

its efficacy and cost effectiveness in patients where cardiac cause has been excluded.

68
Q

what are common risk factors associated with GERD

A 
family history
obesity
smoking
alcohol consumption (especially high amounts)
respiratory disease
reflux
chest pain syndrome
certain medications
some foods
69
Q

there is a strong association between GERD and _______

A

obesity

70
Q

what are indications that are associated with symptoms and complications of GERD

A

increased BMI
waist circumference
weight gain

71
Q

what population does GERD frequently occur in

A

pregnancy at any trimester

72
Q

during pregnancy, GERD severity can ______ during this time period but should resolve ____ post delivery

A

severity increase

typically resolves after deliver

73
Q

In patients that GERD does not resolve 1 year post delivery, what factors should be considered

A

the amount of weight gain that occurred during the pregnancy

74
Q

maternal age is ____ related to heartburn symptoms

A

inversely

75
Q

what are the significant predictors of heart burn with pregnancy

A

increased gestational age, heartburn before pregnancy, and parity

76
Q

what are the demographic risk factors for GERD

A

pregnancy
older age
decreased education level

77
Q

what are examples of foods and medications that decrease LES pressure

A
  • 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
Q

what are foods and medications that act as direct irritants to esophageal mucosa

A

spicy food, coffee, orange juice, tomato juice, aspirin, NSAIDS, quinidine, potassium chloride, iron, oral bisphosphonates

79
Q

what position increased the risk for GERD

A

recumbent position, bending over

80
Q

what are examples of comorbid conditions that are risk factors for developing GERD

A 
hiatial hernia
obesity
IBS
asthma
angina
anxiety/depression
81
Q

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.

A

endoscopy and pH

82
Q

Diagnostic evaluation is useful to assess treatment failure, investigate potential ___________, and prevent misdiagnosis.

A

complications

83
Q

diagnostic test are indicated in what two types of patients?

A

do not respond to therapy and in patients who present with alarm symptoms

84
Q

What is the primary diagnostic test to evaluate the esophageal mucosa in patients with suspected GERD?

A

upper endoscopy

85
Q

Describe what happens with an upper GI endoscopy?

what you can see, what you can do?

A

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
Q

What can the provider find with an upper GI endoscopy?

A

erosive esophagitis
strictures
barretts esophagus

87
Q

Upper GI endoscopy can identify ERD but may potentially miss identifying characteristics of ______.

A

NERD

88
Q

upper endoscopy is not required in the presence of _______ alone

A

typical symptoms alone

89
Q

Endoscopy is indicated for what three situations?

A

presence of Alarm symptoms to screen high risk patients
evaluate non-cardiac chest pain
patients unresponsive to a PPI

90
Q

ambulatory reflux monitoring enables the detection for presence fo abnormal?

A

esophageal acid exposure
reflex frequency
symptoms associated with reflux episodes

91
Q

Ambulatory esophageal reflux monitoring is indicated for?

A

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
Q

what happens with ambulatory reflux monitoring?

A

a small probe is placed in the esophagus, just above the LES in order to monitor for 24 hour acid levels.

93
Q

_____________ allows for detection of reflux episodes.

A

impotence.

94
Q

PPI trial is indicated for?

A

typical GERD symptoms

no alarm symptoms

95
Q

a negative PPI trial _________ GERD

A

does not rule out

96
Q

Endoscopy is indicated for?

A

screening of high risk patients
chest pain
alarm symptoms

97
Q

One should consider performing an endoscopy early for what populations?

A

those at risk for Barrett’s esophagus
non-cardiac chest pain
patients unresponsive to PPI

98
Q

Ambulatory reflux monitoring is indicated for?

A

refractory GERD symptoms
GERD diagnosis in question
Preoperatively for Non-erosive disease

99
Q

When performing an ambulatory reflux monitoring a provider should document?

A

abnormal acid exposure and/or reflux frequency

100
Q

When performing an ambulatory reflux monitoring a provider should correlate symptoms with?

A

reflux

101
Q

hiatal hernias can occur when the stomach slides into the _____ or when a pouch of the stomach is pinched above the _________.

A

thorax

diaphragm

102
Q

in cases where GERD and a large hiatal hernia coexist, the hernia may slow what? and contribute to severe?

A

acid clearance

severe esophagitis

103
Q

list a few causes of GERD? 10 total, see how many you can get!

A 
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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