GERD/Esoph CA Flashcards
GERD classic presentation?
CHRONIC RELAPSING CONDITON
Post meal substernal burning/regurg,
Worse w/ position changes,
Quick relief w/ antacids
GERD: Esophageal sxs?
Heartburn
Regurg
Belching
“Water Brash” (bitter/acid taste in back of throat)
GERD: atypical presentation?
Chest pain Laryngitis ↓ tooth enamel Asthma Chronic cough Dyspepsia "globus" throat fullness
GERD: sxs of complications? (3)
Dysphagia
Odynophagia
Hematemesis
GERD-caused Chest Pain?
Indistinguishable from cardia angina
Test of choice = ambulatory pH monitoring
Tx w/ high-dose protein pump inhib
GERD-caused Asthma/Cough?
Nocturnal, non-allergic
Poor response to tx
Test of choice = ambulatory pH monitoring
Tx w/ high-dose protein pump inhib
GERD-caused Laryngitis?
Test of choice = ambulatory pH monitoring
Tx w/ protein pump inhib
(P) laryngoscopy = posterior laryngitis
Physio mechanisms that protect against GERD?
1) clearance
2) mucosal integritiy
3) Low esoph sphincter (LES)
4) gastric emptying
GERD involving LES (U) result of what?
transient relaxation, not gross incomp
GERD: meds that ↓ LES pressure? (4)
Theophylline (bronchodial)
Antichol
CCB
Nitrates
GERD: meds that injure mucosa (5)
TCN Quinidine ASA/NSAIDs K+ Fe salts
Hiatal Hernia causes reflux how?
No diaphragmatic support of LES,
Hernia is reservoir for gastric contents
GERD more C in pts w/ HH
GERD diagnostics?
If hx of postprandial heartburn and/or regurg that improve w/ antacid, no studies needed.
Start empiric tx
Reasons for GERD testing? (6)
Before anti-reflux surgery Uncertain dx Atyp sxs Alarm sxs Poor response to tx Recurrent sxs
GERD alarm sxs? (5)
Dysphagia Odynophagia Weight loss GI hemorr Anemia
Dyspepsia is?
Episodic, recurrent or persistent referred pain into up abd
Dyspepsia alarm sxs? (12)
Anorexia Weight loss Constant/severe pain Referred pain in back Recurrent vomiting Dysphagia Odynophagia Hematemesis FHx PUD No response to OTC meds New onset > 45yo Long-term sxs > 45yo
GERD diagnostic tests? (4)
1) Barium swallow
2) UGI endoscopy (recommended test, best to eval mucosal injury)
3) Ambulatory pH monitoring (best test to confirm dx)
4) Esophageal manometry (LES pressure, peristalsis)
Endoscopy advantages?
Visualizes:
Esophagitis, Barrett epithelium, HH, Strictures
Can do bx
Barrett’s Esophagus is?
Caused by?
Increases risk of developing?
replacement of squamous epi w/ columnar epi = specialized intestinal metaplasia
recurrent acid injury
esophageal adenocarcinoma
Barrett’s Esophagus tx?
Endoscopic ablation
GERD tx goals? (4)
Stop sxs
Heal esophag
Prevent complications
Maintain remission
GERD tx? (4)
∆ diet
Elevate head
Acid suppression meds
Surgery (intractible GERD only)
GERD: Acid suppression meds
H2 Receptor Agonists
PPI (better)
Antacids
Esophageal CA: Types?
Squamous cell,
Adenocarcinoma (Barrett is precursor)
Esophageal CA presentation? (7)
Progressive dysphagia w/ solid food Odynophagia Constant chest/back pain Regurg Anorexia Weight loss MM wasting/malnutrition
Esophageal CA (P) exam findings?
Hoarseness (laryn nn damage)
Supraclav LAD
Bronchpulm involvement
Esophageal CA: Squ Cell Risk Factors? (4)
Long tobacco or alcohol abuse
Ingestion of caustic substances
Chronic esophagitis
Nutritional deficiency
Esophageal CA: Adeno Risk Factors?
Barrett’s
Esophageal CA diagnostics?
Barium swallow (N doesn't r/o CA) Endoscopy (always if dysphagia) CT (for staging
Esophageal CA tx?
Poor prognosis
Radiation (helps dysphagia)
(P) localized surgery
