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Q4 Clin Med III (GI) > GERD/Esoph CA > Flashcards

GERD/Esoph CA Flashcards

1
Q

GERD classic presentation?

A

CHRONIC RELAPSING CONDITON
Post meal substernal burning/regurg,
Worse w/ position changes,
Quick relief w/ antacids

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2
Q

GERD: Esophageal sxs?

A

Heartburn
Regurg
Belching
“Water Brash” (bitter/acid taste in back of throat)

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3
Q

GERD: atypical presentation?

A 
Chest pain
Laryngitis
↓ tooth enamel
Asthma
Chronic cough
Dyspepsia
"globus" throat fullness
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4
Q

GERD: sxs of complications? (3)

A

Dysphagia
Odynophagia
Hematemesis

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5
Q

GERD-caused Chest Pain?

A

Indistinguishable from cardia angina
Test of choice = ambulatory pH monitoring
Tx w/ high-dose protein pump inhib

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6
Q

GERD-caused Asthma/Cough?

A

Nocturnal, non-allergic
Poor response to tx
Test of choice = ambulatory pH monitoring
Tx w/ high-dose protein pump inhib

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7
Q

GERD-caused Laryngitis?

A

Test of choice = ambulatory pH monitoring
Tx w/ protein pump inhib
(P) laryngoscopy = posterior laryngitis

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8
Q

Physio mechanisms that protect against GERD?

A

1) clearance
2) mucosal integritiy
3) Low esoph sphincter (LES)
4) gastric emptying

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9
Q

GERD involving LES (U) result of what?

A

transient relaxation, not gross incomp

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10
Q

GERD: meds that ↓ LES pressure? (4)

A

Theophylline (bronchodial)
Antichol
CCB
Nitrates

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11
Q

GERD: meds that injure mucosa (5)

A 
TCN
Quinidine
ASA/NSAIDs
K+
Fe salts
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12
Q

Hiatal Hernia causes reflux how?

A

No diaphragmatic support of LES,
Hernia is reservoir for gastric contents

GERD more C in pts w/ HH

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13
Q

GERD diagnostics?

A

If hx of postprandial heartburn and/or regurg that improve w/ antacid, no studies needed.

Start empiric tx

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14
Q

Reasons for GERD testing? (6)

A 
Before anti-reflux surgery
Uncertain dx
Atyp sxs
Alarm sxs
Poor response to tx
Recurrent sxs
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15
Q

GERD alarm sxs? (5)

A 
Dysphagia
Odynophagia
Weight loss
GI hemorr
Anemia
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16
Q

Dyspepsia is?

A

Episodic, recurrent or persistent referred pain into up abd

17
Q

Dyspepsia alarm sxs? (12)

A 
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
18
Q

GERD diagnostic tests? (4)

A

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)

19
Q

Endoscopy advantages?

A

Visualizes:
Esophagitis, Barrett epithelium, HH, Strictures

Can do bx

20
Q

Barrett’s Esophagus is?

Caused by?

Increases risk of developing?

A

replacement of squamous epi w/ columnar epi = specialized intestinal metaplasia

recurrent acid injury

esophageal adenocarcinoma

21
Q

Barrett’s Esophagus tx?

A

Endoscopic ablation

22
Q

GERD tx goals? (4)

A

Stop sxs
Heal esophag
Prevent complications
Maintain remission

23
Q

GERD tx? (4)

A

∆ diet
Elevate head
Acid suppression meds
Surgery (intractible GERD only)

24
Q

GERD: Acid suppression meds

A

H2 Receptor Agonists
PPI (better)
Antacids

25
Q

Esophageal CA: Types?

A

Squamous cell,

Adenocarcinoma (Barrett is precursor)

26
Q

Esophageal CA presentation? (7)

A 
Progressive dysphagia w/ solid food
Odynophagia
Constant chest/back pain
Regurg
Anorexia
Weight loss
MM wasting/malnutrition
27
Q

Esophageal CA (P) exam findings?

A

Hoarseness (laryn nn damage)
Supraclav LAD
Bronchpulm involvement

28
Q

Esophageal CA: Squ Cell Risk Factors? (4)

A

Long tobacco or alcohol abuse
Ingestion of caustic substances
Chronic esophagitis
Nutritional deficiency

29
Q

Esophageal CA: Adeno Risk Factors?

A

Barrett’s

30
Q

Esophageal CA diagnostics?

A 
Barium swallow (N doesn't r/o CA)
Endoscopy (always if dysphagia)
CT (for staging
31
Q

Esophageal CA tx?

A

Poor prognosis
Radiation (helps dysphagia)
(P) localized surgery

Q4 Clin Med III (GI) (32 decks)

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