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Patho > GERD > Flashcards

GERD Flashcards

0
Q

What is the LES?

What is its function?

A
  • lower esophageal sphincter
  • tonically contracted smooth muscle (maintained by Ach)
  • main function is to protect the esophagus from noxious stomach contents
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1
Q

How is the esophagus protected from stomach acid in a healthy patient?

A
  • peristalsis of esophagus (to push contents back down)

- saliva contains bicarbonate to neutralize acid

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2
Q

What is the function of the pyloric sphincter?

A

to control the emptying of stomach contents into the duodenum

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3
Q

What do parietal cells do?

A

secrete HCl and intrinsic factor (B12)
intrinsic factor helps to absorb B12
B12 helps to make RBCs

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4
Q

What do G cells do?

A

secrete gastrin

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5
Q

What do enterochromaffin-like cells (ECL) do?

A

secrete histamine

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6
Q

What do chief cells do?

A

secrete pepsinogen

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7
Q

What is pepsinogen?

A
  • the inactive form of pepsin
  • pepsin is needed to break down protein
  • activated in low pH
  • will inactivate at higher pH when in duodenum, so we don’t digest ourselves
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8
Q

What are the 3 producers of gastric acid?

A

stimulated by vagus nerve…

  1. Acetylcholine
    - sight, smell, taste of food
    - stomach distension
  2. Gastrin
  3. Histamine
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9
Q

Explain the H+/K+ ATPase proton pump.

A
  • located on parietal cell
  • exchanges H+ (cytsol) for K+ (canaliculi) using energy from ATP
  • K+ and Cl- move passively into the canaliculus
  • when H+ are transported out, they combine with Cl- to from HCl
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10
Q

What is the definition of GERD?

A

a chronic disorder related to the retrograde flow of gastro-duodenal contents into esophagus and/or adjacent organs resulting in a spectrum of symptoms, with or without tissue damage.

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11
Q

What are the signs and symptoms of GERD?

A

CHEST

  • heartburn
  • regurgitation
  • chest pain
  • dysphagia/odynophagia (hard to swallow/pain swallowing)
  • belching

PULMONARY

  • non-allergic asthma
  • cough
  • aspiration
  • hoarseness

ORAL

  • tooth decay
  • gingivitis

THROAT

  • globus sensation
  • hoarseness
  • laryngitis

EAR
- earache

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12
Q

When does symptoms of GERD usually occur?

What are they aggravated by?

A
  • after a meal

- aggravated by bending over

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13
Q

How do you tell the difference between GERD and MI?

A
  • when did it start?
  • if pain gets worse after meals = GERD
  • if pain gets worse after exertion = MI
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14
Q

What are the 3 dysfunctions associated with LESP?

A
  1. spontaneous LES relaxation not associated with swallowing = TLESR
    - most common cause
  2. increases in intra-abdominal pressure
    - eating, straining, coughing
  3. sphincter is atonic
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15
Q

What happens when there is impaired acid clearance?

A
  • decreased peristalsis
  • decreases salivation
  • increased frequency of reflux
16
Q

How does delayed gastric emptying contribute to GERD?

A
  • increase in gastric volume = increase frequency and volume to be refluxed
  • fatty meals and smoking contribute
17
Q

How do you diagnose GERD?

A
  • endoscopy
  • 24 hour pH monitoring
  • proton pump administering
  • manometry (measures pressures differences)
  • MOST IMPORTANT is a clinical history
18
Q

What are some complications of GERD?

A
  • esophagitis
  • bleeding
  • esophageal erosions and ulcers
  • stricture formation
  • Barrett’s esophagus
  • adenocarcinoma of the esophagus
19
Q

What factors trigger GERD?

A
  1. Food
    - large meals induce TLESRs
    - don’t eat meals 2-3 hrs before bed
  2. Obesity
  3. Pregnancy
  4. Meds
  5. Smoking
  6. Hiatial Hernia
20
Q

What is a hiatial hernia?

A
  • When the proximal stomach is dislocated through the hiatus of the diaphragm into the chest
  • the diaphragm becomes separated from the LES
21
Q

What are some treatment options for GERD?

A
  1. lifestyle modifications
  2. Antacids
  3. Alginic acids
  4. H2 receptor agonists
  5. Proton pump inhibitors
    - superior treatment
  6. Prokinetics
    - will cause diarrhea
  7. Mucosal protectants
    - doesn’t allow acid to penetrate foods
    - digestion will suck really bad

Patho (15 decks)

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