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Patho II > GERD > Flashcards

GERD Flashcards

1
Q

Common, relapsing condition of the upper GI characterized by excessive reflux of gastric contents that leads to symptoms and tissue damage

A

GERD

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2
Q

____% of Americans will suffer from GERD at some time

A

60

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3
Q

Prevalence of GERD increases after the age of ____

A

40

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4
Q

(Men or Women) are more likely to develop chronic issues/complications related to GERD

A

Men

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5
Q

Frequency of GERD is (low / high)

A

Low due to the use of OTC meds

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6
Q

What can cause increased intra-abdominal pressure that can lead to GERD? (6)

A
  1. Full stomach
  2. Obesity
  3. Poor posture, lying down, bending forward
  4. Heavy lifting
  5. Persistant coughing
  6. Pregnancy
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7
Q

What can cause excessive relaxation of the lower esophogeal sphincter muscle which can lead to GERD? (3)

A
  1. Pregnancy - due to high levels of progesterone
  2. Smooth muscle relaxants
  3. Nicotine, alcohol, caffeine, chocolate, peppermint, foods that are fatty, fried, garlic, or onion
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8
Q

What factor can cause gastric hyperacidity?

A

Zollinger-Ellison syndrome which is a genetic disease that causes an increase in gastric secretion

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9
Q

Other factors that can cause GERD (2)

A
  1. Gastroparesis or obstruction which causes delayed gastric emptying
  2. Anticholinergic medications which decrease salivary bicarbonate that buffers gastric acid
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10
Q

What are normal esophageal defenses to protect from GERD? (4)

A
  1. High pressure of LES (10-30mmHG)
  2. Esophageal peristalsis
  3. Stomach emptying
  4. Salivary bicarbonate
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11
Q

What are changes in the normal defenses that can lead to GERD? (4)

A
  1. Sphincter pressure <10mmHG
  2. Impaired peristalsis - due to delayed gastric emptying and increased intra-abdominal pressure
  3. Decreased salivary bicarbonate production - due to anticholinergic medications
  4. Delayed gastric emptying
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12
Q

What are the pathologies of GERD that relate to increased exposure of the esophagus to stomach acid? (4) (i.e. what happens to the esophagus when it is exposed to acid)

A
  1. Irritation and inflammation of esophagus
  2. Dilation of small blood vessels, increased vascular permeability, edema, tissue erosion (considered superficial), or even ulcerations (deep damage that penetrates the muscle layer)
  3. Scarring, strictures (closing or narrowing), and difficulty swallowing
  4. Esophageal metaplasia (Barrett’s esophagus)
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13
Q

What is Barrett’s esophagus?

A

Certain cell type of the esophagus is damaged and differentiates into a cell type that it is not supposed to be (similar to that of small intestine)

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14
Q

Excessive reflux of gastric contents into the esophagus causes symptoms associated with _________ ______ and ________

A

Esophageal injury and esophagitis

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15
Q

What are two components of acid reflux?

A
  1. Heartburn

2. Regurgitation

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16
Q

How many times a week must a patient report symptoms of acid reflux?

A

At least 2 times a week

17
Q

What are atypical symptoms of gastric reflux? (4)

A

Hoarseness
Sore throat
Chronic cough
Wheezing

18
Q

What are three other factors than the report of acid reflux that are commonly presented with GERD?

A
  1. Relief from empirical therapy such as a PPI
  2. Postprandial bloating in gastroparesis
  3. Dysphagia in advanced disease
19
Q

Physical and labs are often _____ in a patient with GERD

A

Normal

20
Q

What are four signs of a patient that needs additional testing?

A
  1. Dysphagia
  2. Bleeding
  3. Iron deficiency anemia
  4. Don’t respond to PPIs
21
Q

What two GERD diagnostic tests?

A

Upper endoscopy

Ambulatory 24h pH

22
Q

When is an upper endoscopy used, and what does it look for?

A

Used when symptoms of GERD extend for 5 years or more, or if a patient is on chronic maintenance with medication.
The endoscopy looks at the type and extent of tissue damage

23
Q

When is an ambulatory 24h ph monitoring used in patients?

A

Indicated before surgery, for those not responding to PPIs, or patients displaying atypical symptoms

24
Q

Grade I esophagitis is indicated by

A

Erythema (red/inflamed)

25
Q

Grade II esophagitis is indicated by

A

Linear non-confluent erosions

26
Q

Grade III esophagitis is indicated by

A

Circular confluent erosions

27
Q

Grade IV esophagitis is indicated by

A

Stricture or Barrett’s esophagus

28
Q

What is a barium swallow used for?

A

To look at stricture location and gastric emptying

29
Q

What is manometry used for?

A

To monitor LES pressure, peristalsis, and pH

30
Q

What are the three main complications of GERD?

A
  1. Esophagitis
  2. Stricture
  3. Barrett’s esophagus
31
Q

Prevalence of esophagitis?

A

50%

32
Q

Prevalence of stricture?

A

10%

33
Q

Prevalence of Barrett’s esophagus, as well as the increase risk of developing cancer

A

10% in patients with chronic disease, with a 40x increase in risk of cancer

34
Q

Relapsing after ceasing treatment for GERD is ______ and indicates the need for _______ maintenance

A

Common; continuous

Patho II (13 decks)

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