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Clin Med III Exam 1 > GERD > Flashcards

GERD Flashcards

1
Q

sx of GERD

A 
pyrosis (heartburn)*
regurgitation*
chest pain (mimics angina) - r/o cardiac cause
dysphagia - r/o stricture
water brash/hypersalivation
globus sensation
odynophagia
nausea

Extraesophageal sx:

  • bronchospasm
  • laryngitis/hoarsness (consider laryngoscopy)
  • chronic cough
  • loss of dental enamel
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2
Q

worsens GERD

A 
obesity
gravity (elevate HOB)
pregnancy
tobacco/ETOH (pressure to LES)
meds
foods
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3
Q

Decrease LES pressure meds (worsen GERD)

A 
anticholinergic (ditropan)
TCA (amitriptyline)
CCB
Nitrates
Narcotics

(CANNT)

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4
Q

Injure mucosa meds (worsen GERD)

A 
bisphosphonates****(Fosamax, actonel)
iron supplements
NSAIDs/ASA
potassium
Tetracycline

(by the PIN)

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5
Q

hiatal hernia: what is it?

A

portion of stomach enters above diaphragm into chest

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6
Q

Most common hiatal hernia

A

sliding

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7
Q

types of hiatal hernias

A 
sliding (most common)
paraesophageal hernia (may require surgery)
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8
Q

Sx of hiatal hernias

A

asymptomatic

GERD

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9
Q

CXR of hiatal hernia

A

incidental
seen as retrocardiac mass w/ or w/o air fluid levels

dx difficult w/o air fluid levels

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10
Q

tests for GERD

A 
barium contrast esophagram (not often used) 
EGD
Esophageal impedence testing
Esophageal pH monitoring
Esophageal manometry
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11
Q

Barium contrast esophagram

A

shows hernia and strictures; mucosal inflammation NOT seen

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12
Q

EGD

A

BEST dx study to evaluate mucosal injury

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13
Q

dx mucosal injury

A

EGD

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14
Q

esophageal impedence testing

A

observation of bolus transit: complete or incomplete

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15
Q

Esophageal pH monitoring

A

quantify reflux and allow pt to log Sxs
high sensitivity for detecting reflux

mechanism: trans nasal cath vs. wireless capsule

(find non-acidic reflux)

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16
Q

Esophageal manometry

A

measure function of LES and peristalsis- pressure and pattern of esophageal mm contractions

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17
Q

Red flags for GERD

A 
dysphagia
hematemesis/GI bleed
unexplained weight loss, fever, fatigue
anemia
inadequate response to tx**
prior anti-reflux surgery
personal hx of CA
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18
Q

dx for GERD

A

labs usually not needed w/ GERD w/o warning signs

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19
Q

Tx for GERD

A

lifestyle/diet mod (adjust bed, no food/drink 3 hrs before bed, weight loss, eliminate diet triggers)

Meds:

  • antacids (TUMS)
  • H2 blockers (ranitidine)
  • PPI (prilosec, prevacid, nexium)

anti-reflux surgery

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20
Q

tx for mild/intermittenet sx (<1-2x/week, no esophagitis)

A

STEP UP tx:
lifestyle mod
H2RA’s
+/- antacids

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21
Q

severe sx (>2/week; impairs QOL)

A

STEP DOWN tx:

  • PPI daily x 8 weeks + lifestyle mod
  • gradually decrease tx (unless maintenance necessary)
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22
Q

when to take PPI

A

30 min before breakfast - better on empty stomach

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23
Q

antacids

A

don’t prevent GERD
neutralize pH
short lived benefit

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24
Q

H2 blockers/antagonists MOA

A

block action of histamine at H2 receptors of gastric parietal cells
leads to decrease secretion of stomach acid

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25
Q

H2 blocker drugs

A

ranitidine (zantac)

Famotidine (pepcid)

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26
Q

PPI MOA

A

reduce amount of acid produced by glands in the stomach

TAKE 30 MIN BEFORE 1ST MEAL OF DAY

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27
Q

PPI drugs

A

Omeprazole (prilosec)
Lansoprazole (prevacid)
Esomeprazole (nexium)
Pantoprazole (protonix)

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28
Q

Risk of PPI

A

infection (acid is protective- C. diff, etc)

Malabsorption (Mg*, Ca, B12, Fe)

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29
Q

F/u for PPI

A

Mg level periodically
yearly B12?
bone density scan?

30
Q

Length of medication w/o esophagitis/barett’s

A

lowest down and shortest duration; dc meds in pts w/o sxs

31
Q

Duration of pts w/ severe esophatitis or barett’s

A

maintenance PPI

32
Q

Indications for acid-reflux surgery

A

failed med management
GERD complication (esophagitis, barrett’s)
noncompliance

33
Q

Type of surgery for GERD

A

Nissen fundoplication- passage of gastric fundus behind esophagus to encircle the distal esophagus (open vs laparoscopic)

34
Q

Most common cause of esophagitis

A

GERD- gastric acid, pepsin and bile irritate squamous epithelium

35
Q

Types of esophagitis

A 
reflux * most common
infectious
pill
eosinophilic
radiation
36
Q

S/sx of esophagitis

A

GERD sx (heartburn, regurgitation, cough, CP)

37
Q

Complications of esophagitis

A

bleeding
stricture
barrett’s

38
Q

Barrett’s Esophagus definition

A

Squamous epithelium in distal esophagus is replaced w/ columnar epithelium * (due to recurrent acid injury)

M>F (~55 YO)

39
Q

Barrett’s predisposed to

A

adenocarcinoma of esophagus (repeat EGD frequently)

40
Q

Tx of Barrett’s

A
  • indefinite use of PPI (qd vs bid)
  • EGD surveillance to detect dysplasia
  • Endoscopic Eradication Therapy (EET) = Endoscopic ablation (EA) and/or Endoscopic resection (ER)
41
Q

ER

A

remove segment of barrett mucosa – therapeutic and provides info on involvement

42
Q

EA (esophageal ablation)

A

thermal or photochemical energy to destroy barrett mucosa

43
Q

Esophageal CA types

A

squamous cell carcinoma (SCC)

adenocarcinoma

44
Q

SCC epidemiology

A

higher in urbanc
African american men
incidence decreasing

45
Q

Risk factors of SCC

A 
smoking**
ETOH
low fruit/veggies
deficiency selenium, Sn
caustic esophageal injury (hot coffee)
HPV
46
Q

Cause of adenocarcinoma

A

Barrett’s **
smoking
obesity

47
Q

Epidemiology of Barrett’s

A

Caucasians
M>F (6:1)
incidence increasing
PREVENTION AND EARLY DETECTION

48
Q

Prognosis of esophageal CA

A

50-80% have incurable, unresectable or metastatic disease

palliative tx- chemo, radiation, surgery depending on stage

49
Q

Dysphagia

A

GET EGD!!!!

need to prevent

50
Q

Infectious esophagitis

A

DM
Asthma
Tb

51
Q

Pill esophagitis

A

pill gets stucked

52
Q

Systemic illness

A

sclerosis- poor acid clearance leads to epithelial damage

53
Q

Eosinophilic esophatitis causes

A

asthma, rhinitis, food allergy, chronic eczema

chronic, immune/antigen-mediated esophageal disease- EOSINOPHIL predominant inflammation

54
Q

Sxs of eosinophilic esophagtitis

A

DYSPHAGIA, food impaction, CP, refractory GERD

55
Q

Dx of eosinophilic esophagitis

A

Clinical + EGD (stacked circular rings, stricture)

56
Q

Tx of eosinophilic esophagitis

A

diet (avoid allergens)
PPI topical corticosteroids (ICS: spray and swallow, not inhale)
+/- Esophageal dilation

57
Q

Sx of esophageal motility disorders

A

dysphagia
noncardiac CP
refractory GERD

58
Q

Major disorders of esophageal peristalsis

A

hypercontractile (Jackhammer) esophagus

Achalasia

59
Q

Dx tests for motility

A

manometry
barium swallow
esophageal pH?
impedence monitoring

60
Q

Manometry results for jackhammer (hypercontractile)

A 
high pressure (high amplitude) contractions in esophagus
normal relaxation of esophagogastric junction
mimics angina (w/ meals)
61
Q

Tx of Jackhammer esophagus

A

CCB (diltiazem)
TCA (imipramine)
+/- botulinum toxin

62
Q

Achalasia

A

aperistalsis on manometry: no contraction on distal 2/3 of esophagus and incomplete LES relaxation
esophageal dilation
BIRD’S BEAK (persistently contracted LES)
Aperistalsis
Poor emptying of barium

63
Q

Cause of achalasia

A

progressive degeneration of esophageal neurons leading to failure of relaxation of LES and no peristalsis

64
Q

Sx of achalasia

A 
dysphagia
regurg
difficulty belching, CP, heartburn
gradual onset
4.7 yrs til dx
65
Q

Dx of achalasia

A

Manometry
EGD necessary to r/o malignancy
barium swallow: dilation of esophagus and BIRD”s BEAK

66
Q

Tx of achalasia

A

disrupt LES mm fibers (pneumatic dilation, heller myotomy)

Biochemical reduction in LES pressure (botulinum toxin, nitrates, CCB)

67
Q

Mallory Weiss tear

A

mucosal laceration in distal esophagus and proximal stomach – associated w/ repetitive vomiting, retching

68
Q

Predisposing factors for mallory weiss

A 
excessive alcohol consumption
hiatal hernia (increased abdominal pressure)
69
Q

Boerhaave’s Syndrome

A

esophageal rupture

EMERGENCY

70
Q

Dx of mallory weiss

A

EGD

clinical if issue already resolved

71
Q

Tx of Mallor weiss

A

stabilize pt
control bleeding - EPI or electrocoagulation
address predisposing factors

Clin Med III Exam 1 (5 decks)

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