GERD, PUD, and Barrett Esophagus - Week 2 Flashcards
What are the signs and symptoms that change in the intermediate phase of perforated peptic ulcer that might incorrectly cause you to think that the patient’s condition is improving and that a surgical consult is not needed?
- Intensity of the pain subsides
- Patient looks better (color and temperature)
- Patient is more comfortable
- Pulse is normal
- Vomiting ceases
What is the finding found on percussion of the abdomen that is highly correlated with perforated peptic ulcer?
- Resonance over the liver in the midaxillary line about two or more inches above the costal border
To what location is pain referred from a perforated peptic ulcer?
Region of the distribution of the cutaneous branches of the fourth cervical nerve
- Top of shoulder
- In the supraspinous fossa
- Over the acromion
- Over the clavicle
What is the finding on a plain x-ray film that is a highly likely sign of a perforated peptic ulcer (80-85% of cases are positive for this)?
- Small quantities of free gas between the liver and diaphragm
How can you prevent dysplasia and adenocarcinoma of the esophagus in patients with long segment Barrett esophagus?
- Treat GERD
- UDCA (ursodeoxycholic acid)
- Antioxidants
- Polyphenon E (green tea extract)
- Retinoids/ berry extract
- Selenium
- Curcumin
- Increased fruits and vegetables
- Treat SIBO if present
- PPIs?
What is NERD?
- Non-erosive esophageal reflux disease
- No abnormalities shown on upper endoscopy
What are dilated intercellular spaces?
- Leaky esophageal spaces
- Come from weakly acidic reflux
- Cause persistent heartburn symptoms
What is DGER?
- Duodenogastroesophageal reflux
Understand the spectrum of GERD including NERD, erosive and non-erosive esophagitis, Barrett esophagus, dysplasia, and adenocarcinoma.
- …
What are the components of the mnemonic - “cut out the CRAP?”
- C: coffee, cigarettes, chocolate
- R: refined carbohydrates and carbs in general, Rx
- A: acid foods, alcohol, allergic foods
- P: pop (soda), peppermint, packin’ food in hs, progesterone
Understand the flowchart of Naturopathic GERD evaluation.
- Patient presents with pyrosis
- R/O HH using imaging and/or reflex or muscle testing
- R/O food sensitivities, gluten or lactose intolerance using elimination diet, IgE/IgG, EAV/Carroll
- R/O SIBO using breath test, Serum TTG, AGA, DGP
- If suspect a serious pathology, do EGD and Barium study
- Evaluate pancreatic function using stool chymotrypsin
> If it’s low, patient has pancreatic insufficiency - Evaluate gastric pH using Heidelberg, string test, or trial
> For all results, evaluate GI flora including H. pylori
What is the most distal site that may be assessed by upper endoscopy (EGD)?
- Visualizes through the 2nd portion of the duodenum
- H. pylori status will be assessed
- Celiac biopsies are performed with this procedure (not colonoscopy)
- Biopsies for Barrett metaplasia and dysplasia or adenocarcinoma taken
Why might the H. pylori screening of patients who do not have symptoms of PUD lead to unnecessary treatment?
- It is often believed that H. pylori colonization is only detrimental to patients, so treatment may be given even when unnecessary
- H. pylori can be beneficial, and shouldn’t always be eradicated (esp in kids) - can protect against GERD, Barrett esophagus, adenocarcinoma
**What cause of GERD might be managed with phosphatidylcholine and Huperzine A?
(- sphincter tone mucosal health GI motility)
**Why might both hyperchlorhydria and hypochlorhydria cause pyrosis?
(- reflux without acid - “neutral” reflux, still get sx d/t DIS (“leaky esophagus”))
- Functional heartburn occurs when there are symptoms without evidence of reflux…
