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GI_EB > GERD and esophagogastric motility > Flashcards

GERD and esophagogastric motility Flashcards

1
Q

The proximal 5% of the esophageal body is made of _____ muscle; the proximal third is a _______; the distal 2/3 is _____

A

striated muscle
transition mix of smooth and striated muscle
smooth muscle

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2
Q

The two muscle layers of the esophagus are:

A

inner circular

outer longitudinal

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3
Q

What is the excitatory neurotransmitter of the ENS?

A

ACh

causes contraction of muscle layers

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4
Q

What is the inhibitory neurotransmitter of the ENS?

A

NO, VIP

causes relaxation of muscle layers

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5
Q

List three considerations when classifying pathologic GERD

A
  • Typical or Classic (heartburn/regurgitation) vs. Atypical reflux
  • Mucosal disruption description: Erosive/Ulcerative vs. Non Erosive
  • Extent of reflux: Esophageal vs. Laryngopharyngeal Reflux
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6
Q

List classic symptoms of GERD

A

heartburn/ pyrosis
regurgitation
water brash

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7
Q

When _____ and _____ occur together, it is 90% predictive of GERD

A

regurgitation and heartburn

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8
Q

What are some atypical symptoms of GERD

A 
asthma
chronic cough
chronic hoarseness
non-cardiac chest pain
loss of dental enamel
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9
Q

_____ results from a multifactorial failure of the reflux barrier

A

GERD

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10
Q

Progression of _______ over time leads to chronic LES changes

A

Transient lower esophageal sphincter relaxations

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11
Q

______ disrupts diaphragmatic positioning at the LES and leads to loss of sphincter integrity

A

hiatal hernia

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12
Q

Poor ____ of the esophagus leads to inadequate clearing of refluxed material

A

peristalsis

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13
Q

Reduced epithelial resistance is caused by

A

decreased bicarbonate from saliva and mucosa

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14
Q

List caustic substances (other than HCl) that can be present in refluxate from the stomach

A 
deconjugated bile salts
pancreatic enzymes
pepsin
medications
ingested food
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15
Q

presumptive diagnosis of ____ can be made based on symptoms alone

A

GERD

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16
Q

When is further testing for GERD warranted?

A

if the patient has dysphagia or other “red

flag” symptoms, or who’s GERD symptoms have not responded to typical treatment regimen.

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17
Q

_______ is the most sensitive test for viewing esophagitis, strictures, and findings of Barrett’s esophagus

A

upper endoscopy with biopsy

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18
Q

_______ is a test that can give information about motility and amount of reflux

A

esophogram or GI x ray

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19
Q

In ______, an acid sensor is used to quantify the amount of reflux and correlate to reported symptoms

A

24 hour pH monitoring

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20
Q

List lifestyle changes that can be used in treatment of GERD

A

elevate head of bed
stop smoking, decrease alcohol
reduce fat intake
decrease size of meals
avoid meals before bed
avoid tea, coffee, citrus, chocolate, mint, tomato juice, cola
avoid anticholinergics, diazepam, theophylline, CCBs, narcotics

21
Q

List drug therapy for GERD

A

Antacids (OTC)
H2 antagonists (OTC and prescription)
PPIs (OTC and prescription, more potent acid suppression)

22
Q

What surgical procedure can be used electively by GERD patients?

A

Nissen fundoplication is an elective surgical procedure that can be performed either laparoscopically or as an open surgery. The fundoplication functions to correct any hiatal hernia and to re-establish the anti-reflux barrier by wrapping the stomach around the GEJ to recreate a high pressure barrier from gastric content reflux

23
Q

List complications of GERD

A

strictures
Barrett’s esophagus
bleedign
esophageal cancer

24
Q

______ are formed when chronic inflammation leads to scarring of the esophageal wall, compromising its diameter and function.

A

Strictures
most commonly found near GEJ
will lead to dysphagia more with solids than liquids

25
Q

How are strictures treated?

A

Will resolve with acid suppression if mild

More prominent strictures need balloon dilation

26
Q

Barrett’s esophagus is metaplastic change from ____ to ____ epithelium and is a step on the way to developing adenocarcinoma of the esophagus

A

squamous to columnar

27
Q

What are symptoms of esophageal motility disorders?

A

dysphagia to BOTH solids and liquids
chest pain (atypical)
heartburn
regurgitation

28
Q

How are esophageal motility disorders diagnosed?

A

Esophagram (barium study)
Endoscopy
Esophageal manometry following imaging study

29
Q

In _____, the LES cannot relax due to loss of neurons

A

achalasia

30
Q

What are the typical symptoms of achalasia?

A 
Dysphagia
vomiting undigested food
chest pain
weight loss
regurgitation and aspiration at night
pyrosis
31
Q

Achalasia involves a gradual loss of ____ neurons from the lower esophageal sphincter, which moves proximally. The LES loses the capability to relax, followed by a loss of esophageal body peristalsis

A

enteric

32
Q

How is achalasia treated?

A

Medications: CCBs, nitrates, anticholinergics used to relax the spastic LES
Botulinum toxin
Endoscopic balloon dilation of LES
Surgical myotomy- most long lasting intervention

33
Q

The gastric pacemaker cells are the ________

A

interstitial cells of Cajal

34
Q

The _____ nervous system is responsible for the general motility pattern of the stomach. The ______ nervous system functions to modulate the automatic motility

A

Enteric

Central

35
Q

In addition to the circular and longitudinal layers of muscle, the stomach also has a 3rd layer of _______ muscle, which facilitates the forceful contractions needed for mixing and churning food.

A

oblique

36
Q

Describe the two motility patterns of the stomach

A

Fed pattern: accommodation and more random contraction of ingested food.

Fasting pattern: increasing frequency and strength of sequential muscle contractions (peristaltic-like). Maximum cycling of this sequence is 3 cycles per minute. This phase functions to grind, mix, and ultimately empty stomach contents.

37
Q

Diabetes mellitus is the most common cause of ______, a disorder of “too slow” gastric motility

A

gastroparesis

38
Q

What is the pathophysiology of gastroparesis related to DM?

A

Hyperglycemia leads to abnormal nerve conduction

39
Q

List non-DM causes of gastroparesis

A

Medications: antidepressants, anticholinergics, nitrates, CCBs, phosphodiesterase inhibitors
Iatrogenic: surgical vagotomy

40
Q

Because the signs/symptoms of gastroparesis can mimic __________, this must be ruled out first.

A

mechanical obstruction

41
Q

________ is the most useful study for diagnosing gastroparesis

A

gastric emptying study

42
Q

How is gatroparesis treated

A

glycemic control in DM
adjusted gastroparetic diet- low in roughage and fatty foods, small meals
medications: motilin analogues erythromycin and meoclopramide
gastric pacemakers
surgical options: partial gastrectomy, feeding tube

43
Q

The smooth muscle of the lower esophageal sphincter is tonically ______ at rest

A

contracted

44
Q

What are hypothesized causes of achalasia?

A

Virus, other infectious agents, autoimmune

45
Q

List other conditions on the differential diagnosis for achalasia

A

Malignancy: especially gastric cardia
Chaga’s disease: trypanasomi cruzi
Amyloidosis
Chronic idiopathic intestinal pseudo-obstruction
Post-radiotherapy
Severe esophageal stricture/end-stage GERD

46
Q

What are dietary recommendations for a person with achalsia?

A

Liquid or semi-liquid foods only
Small infrequent meals
Increased time after meal prior to reclining

47
Q

What are causes for acute delayed gastric emptying

A

Opioids

Viral illness, hyperglycemia

48
Q

Describe the dietary recommendations for a person with gastroparesis

A

Small, frequent meals
Reduced fiber to avoid bezoar
Liquid and simple starch foods
Liquid caloric supplementation if necessary

GI_EB (39 decks)

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