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Clinical Medicine III > GERD & Esophageal D/O > Flashcards

GERD & Esophageal D/O Flashcards

1
Q

GERD can facilitate the transition of normal squamous epithelial cells to intestinal columnar cells. This is called ____plasia, and leads to what esophageal condition?

A

Metaplasia

Barrett’s Esophagus

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2
Q

Barrett’s esophagus puts patients at 30x increased risk for what?

A

adenocarcinoma

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3
Q

On CXR you notice an air-fluid level above the diaphragm… what does this indicate?

A

hiatal hernia

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4
Q

what are three conditions that increase risk of GERD?

A

hiatal hernia
scleroderma
ZES

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5
Q

Pt. p/w:

  • retrosternal CP
  • regurgitation
  • Burning sensation/pyrosis
  • nocturnal asthma/cough/SOB

What GI condition is this concerning for?

A

GERD

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6
Q

The below are the 9 alarm sxs for GERD/Esophageal d/os that necessitate what study?

Dys/odynophagia
GI bleed sxs
wt. loss
anemia
poor tx response
new onset dyspepsia > 60
prior surg intervention
CA hx
A

EGD

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7
Q

Describe how GERD is typically diagnosed…

A

clincal diagnosis (pyrosis, cough, better upright, relief with antacids)

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8
Q

What body position can help alleviate GERD? What about while sleeping

A

upright after meals

elevate head of the bed 30 degrees (using blocks, don’t bend at the waist)

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9
Q

What approach to GERD therapy if mild sxs with 1-2 episodes a week?

A

Step up:

Lifestyle + H2RA

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10
Q

What approach to GERD therapy if mod/severe sxs and 2+ episodes a week?

A

Step Down:

lifestyle + PPI x 8 weeks

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11
Q

What dosing instructions should be given to patients taking a PPI?

A

take 30 minutes before 1st meal

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12
Q

What are 2 complications of PPIs?

A 
increased infx (c. diff risk)
Malabsorption
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13
Q

What 4 nutrients may be malabsorbed while taking PPIs, requiring you to monitor?

A

Mg, B12 (IF), Ca, Vit. D

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14
Q

After 8 weeks of PPI tx, sxs have resolved. How to you get the patient off the drug?

A

gradually

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15
Q

A patient’s GERD sxs have resolved after an 8 week course of a PPI, but they had severe sxs +/- Barrett’s Esophagus… what can be done next?

A

QD maintenance dose PPI

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16
Q

After 8 week trial of PPI, sxs haven’t improved. What diagnostics should be administered initially?

A

24 hr pH study + EGD/Bx

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17
Q

What are four indications for Nissen Fundoplication after EGD surveillance of GERD complications?

A

non-response to meds
esophagitis
Barrett’s
non-compliance w. meds

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18
Q

What are three complications of GERD?

A

Esophagitis (Barrett’s & Erosive)

Esophageal strictures

Esophageal CA (Adenocarcinoma, squamous cell carcinoma)

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19
Q

A pt. p/w the below… what can these be concerning for/included on your DDx?

laryngitis/hoarseness
loss of dental enamel
angina-like CP
dysphagia
water brash
Globus
A

GERD

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20
Q

The below 5 meds worsen GERD sxs by what mechanism?

TCAs
CCBs
Nitrates
Narcotics
Anticholinergics/histamines
A

decreasing LES pressure

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21
Q

The below 5 meds worsen GERD sxs by what mechanism?

Bisphosphonates
Fe
NSAIDs
K+
Tetracycline
A

injuring mucosa

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22
Q

What are the 5 risk factors for GERD development?

A

Obesity/fat rich diet
caffeine intake
EtOH, TOBB

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23
Q

A patient p/w GERD sxs + dysphagia or odynophagia should be concerning for…

A

esophagitis

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24
Q

What are the 5 types of esophagitis?

A 
Pill induced
Infectious
Eosinophilic
Caustic
GERD induced
25
What are three complications of esophagitis?
bleed, stricture, barrett's esophagus
26
A patient p/w GERD sxs + dysphagia or odynophagia ... What diagnostics could be ordered? which is best?
EGD + barium esophagram EGD best
27
Most cases of esophagitis necessitate tx with...
PPIs
28
This condition is caused by a recurrent acid injury to the esophagus
Barrett's esophagus | GERD --> Squamous Damage --> columnar replacement --> metaplasia
29
How is barrett's esophagus treated?
indifinite PPI +/- endoscopic resection or ablation
30
How is barrett's esophagus monitored?
EGD to detect meta/dysplasia
31
Infectious esophagitis can be caused by fungal overgrowth... what three populations are at risk?
immunocompromised inhaled CS users recent abx users
32
Describe how systemic illness can lead to esophagitis
systemic sclerosis --> poor acid clearing --> esophagitis
33
this is a chronic, immune mediated cause of esophagitis...
eosinophilic
34
A patient with food allergy, rhinitis, asthma, atopic derm is at increased risk for what esophageal d/o?
eosinophilic esophagitis
35
A patient p/w the following, concerning for... ``` Dysphagia food impaction CP refractory GERD UGI Pain Atopic hx ```
eosinophilic esophagitis
36
You suspect eosinophilic esophagitis for a pt. w. GERD + esophagitis + atopic hx. What diagnostics should be ordered and what findings should support your Dx?
Hx + EGD showing stacked circular rings +/- stricture
37
How is eosinophilic esophagitis treated?
diet mods, PPI, topical CCS +/- esophageal dilation
38
Dysphagia, non-cardiac CP, refractory GERD are suggestive of what class of disorders?
esophageal motility d/o
39
A patient p/w progressive dysphagia (solids --> liquids) non-cardiac CP, refractory GERD necessitates what diagnostic and why?
EGD to r/o structural abnormality
40
If EGD is WNL for a patient w. dysphagia and motility d/o sxs, what treatment should be tried?
QD or BID PPI
41
A pt. w. dysphagia and motility d/o sxs has failed PPI tx... what diagnostics are indicated for refrectory sxs?
Manometry, barium esophagram + pH and impedence monitoring
42
Manometry for a patient w. refractory GERD and dysphagia shows: increased pressure contractions in esophagus normal esophagogastric junction relaxation What does this suggest?
Hypercontractile/jackhammer esophagus OR distal esophageal spasm
43
increased pressure contractions in esophagus and normal esophagogastric junction relaxation in DES and jackhammer esophagus causes what sxs and when?
angina sxs during meals
44
What are two mechanisms/goals of medical tx of DES/jackhammer esophagus?
control GERD | Relax muscles
45
How is GERD controlled in tx of DES/jackhammer esophagus?
PPI
46
how is esophageal muscle relaxed in DES/jackhammer esophagus?
Diltiazem (CCB) or Imipramine (TCA) +/- botox Peppermint oil b4 meals if no GERD
47
What combo therapy should be initiated for DES/jackhammer esophagus?
PPI + Diltiazem (CCB) or Imipramine (TCA) +/- botox
48
A patient p/w the below, concerning for... dismotility sxs (non-cardiac CP, refractory GERD) + Gradual onset of (4 years or so): Dysphagia regurgitation difficulty belching
Achalasia
49
You suspect achalasia on a patient w. gradual onset dysmotility sxs, dysphagia. What diagnostics should be ordered?
EGD (r/o malignancy/structural d/o) Manometry + Barium Esophagram
50
What two signs on barium esophagram can indicate achalasia?
bird's beak sign | aperistalsis
51
What two signs on manomentry can indicate achalasia?
aperistalsis in distal 2/3 | incomplete LES relaxation
52
Which diagnostic for achalaisa is required for diagnosis?
manometry
53
Tx for achalasia is either mechanical or biochemical. They both try to disrupt the LES... What are two mechanical txs for achalasia?
``` pneumatic dilation Heller Myotomy (surg. release of LES) ```
54
Tx for achalasia is either mechanical or biochemical. They both try to disrupt the LES... What is the progression of biochemical treatments?
botox --> nitrates --> CCBs
55
This d/o is a mucosal laceration in distal esophagus or proximal stomach.
mallory-weiss syndrome
56
What are three disorders that can cause mallory-weiss syndrome?
EtOH abuse, hiatal hernia, bulemia
57
What physiological process is the cause of a mallory-weiss syndrome (not disorders that lead to it, what physical action)
repetitive vomiting/retching
58
How is mallory-weiss syndrome diagnosed and treated?
dx: EGD tx: electrocoag, band ligation or epi

Clinical Medicine III (21 decks)

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