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year 5 - GIT Internal medicine > GERD > Flashcards

GERD Flashcards

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1
Q

what is the montreal definition of GERD ?

A

a condition which develops when the reflux of gastric content causes troublesome symptoms or complications, and consists of esophageal and extraesophageal syndromes

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2
Q

what are th typical symptoms associated with GERD ?

A

heart burn , regurgitation

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3
Q

what are the atypical symptoms associated with GERD?

A

non cardiac chest pain
hoarsness
chronic cough
asthma , pulmonary fibrosis
hiccups
dental erosions

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4
Q

what are the complications of GERD ?

A

esophageal erosions
strictures
barrett’s esophagus
esophageal adenocarcinoma

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5
Q

what is NERD ?

A

non erosive reflux disease , esophagus is unharmed by gastric acid

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6
Q

what is the diagnostic approach for diagnosing GERD ?

A

symptom analysis
PPI therapeutic trial
GI endoscopy
Ambulatory pH monitoring

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7
Q

when is endoscopy indicated in the diagnosis of GERD ?

A

1- failure of PPI trial
2- patients with alarming symptoms at presentation
3- pts previously endoscoped and known to have grade C or D GERD
4- patients older than 50 who have a risk for developing barrett’s oesophagus or oesophageal adenocarcinoma
5- chronic pts who report unusual disappearance of HB on no treatment

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8
Q

what drugs are associated with GERD ?

A

antimuscarinics
calcium channel blockers
nitrates

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9
Q

what is the first way that can be used to differentiate between GERD and cardiac chest pain ?

A

trial of PPI

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10
Q

what is water brash ?

A

excessive saliva production that has been mixed with gastric acid that has reached the mouth

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11
Q

what are the possible endoscopy findings associated with GERD ?

A

non-erosive reflux disease
reflux esophagitis
Barrett’s oesophagus

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12
Q

what are the grades for reflux esophagitis ?

A

Grade A - one or more mucosal breaks no longer than 5mm
Grade B - one or more mucosal break longer than 5mm
Grade C - one or more mucosal break that is continuous between the tops of two or more mucosal folds , involving less than 75% of thee circumference
Grade D - one or more mucosal breaks that involves more than 75% of the esophageal circumference

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13
Q

what are the layers of the oesophagus ?

A

mucosa
submucosa
muscular layer
adventitia

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14
Q

what is the most prevalent grade of reflux esophagitis ?

A

grade B

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15
Q

what is the gold standard investigation for the diagnosis of GERD ?

A

ambulatory 24 hr pH studies

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16
Q

what is the gold standard investigation for the diagnosis of Hiatus hernia ?

A

High resolution Manometry

17
Q

what are the two types of hiatus hernia ?

A

sliding hiatus hernia
paraesophageal hernia

18
Q

LES-CD ?

A

lower esophageal sphincter - crural diaphragm

19
Q

what are the two treatment approaches associated with GERD ?

A

step up approach - initial lifestyle changes followed by antacids like ranitidine- if symptoms persist use PPI

step down approach - treatment is initiated with a PPI 20-40 mg and subsequent maintenance on a lower dose

20
Q

if there is suboptimal response to PPI what can be used ?

A

prokinetics

21
Q

all GERD patients require long term treatment but there must be a trial to eventually stop it - except in which patients ?

A

LA grade C and D and patients with BE

22
Q

what is the effect of lifestyle modification on GERD ?

A

not the dominant factor in the pathogenesis of reflux oesophagitis

23
Q

by what mechanism can GERD cause cough ?

A

direct contact mechanism where there is micro-aspiration of refluxate
or
vasovagal reflex mechanism

24
Q

what cardiac issue has GERD been associated with ?

A

postprandial atrial fibrillation

25
Q

what is the most important factor that can lead to barrett’s oesophagus ?

A

duration of reflux symptoms

26
Q

what type of carcinoma is associated with barrett’s oesophagus ?

A

adenocarcinoma

27
Q

how can we perform screening for barrett’s ?

A

chromoendoscopy

year 5 - GIT Internal medicine (25 decks)

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