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physiology test 3 > GERD study guide > Flashcards

GERD study guide Flashcards

1
Q

______ girth can lead to reflux esophagitis, esophageal strictures, Barrett’s esophagus, and esophageal adenocarcinoma

A

Increased

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2
Q

Reflux esophagitis can cause erosion of the __________ lining due to prolonged exposure of what?

A

Epithelial lining

Prolonged exposure to reflux gastric contents

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3
Q

Esophageal strictures typically involve what portion of the esophagus?

A

Distal position

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4
Q

Esophageal strictures can cause what?

A

Dysphagia

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5
Q

Dysphagia is what?

A

Difficulty/painful swallowing

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6
Q

What two types of medications can make GERD worse?

A

Aspirin and NSAIDS

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7
Q

Prolonged GERD that develops into chronic esophagitis, overtime the normal ______ epithelial lining of esophagus is replaced by? This is called?

A

Squamous epithelial lining
Specialized columnar epithelial cells
Barretts esophagus

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8
Q

If a patient has Barrett’s esophagus, what are they at risk for developing?

A

Esophageal adenocarcinoma

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9
Q

GERD is broken down into two syndromes which are?

A

Esophageal GERD syndrome

Extra esophageal GERD syndrome

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10
Q

Esophageal GERD syndrome is brown down into what two classes?

A

Symptom-based (with or without tissue injury)

Tissue injury-based (with or without symptoms)

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11
Q

Symptom based esophageal GERD syndrome can be divided into what two classes of symptoms?

A

Typical or alarm symptoms

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12
Q

What are the typical symptoms for Esophageal GERD syndrome that is symptom based?

A

Heartburn
Regurgitation
Reflux chest pain
Hallmark is HRR

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13
Q

What are the alarm symptoms for esophageal GERD syndrome that is symptom based?

A 
Dysphagia (difficult or discomfort when swallowing)
Odynophagia (pain when swallowing)
Weight Loss
Bleeding
BOD Weight remember
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14
Q

Gastric reflux often leaves what kind of taste in the mouth?

A

Bitter acid taste in the mouth

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15
Q

Name the four common tissue injury based esophageal GERD conditions?

A

Esophagitis
Strictures
Barrett’s esophagus
Esophageal Adenocarcinoma

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16
Q

If syndromes with esophageal injury present with alarm symptoms what should happen?

A

Further diagnostic evaluation

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17
Q

Alarm symptoms of GERD necessitate what?

A

Further evaluation for potential complications

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18
Q

GERD that affects organs other than the esophagus indicate what?

A

Extra esophageal phageal syndromes

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19
Q

Extra esophageal syndrome include _______ symptoms

A

Atypical

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20
Q

List the atypical symptoms of Extra-esophageal GERD syndrome (5 things)

A 
Chronic Cough
Laryngitis
Asthma
Wheezing
Dyspepsia
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21
Q

The severity of GERD symptoms does not necessarily correlate with _________.

A

Tissue injury

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22
Q

What is the indication for a PPI trial?

A

Typical symptoms

No alarm symptoms

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23
Q

What does a negative PPI trial mean?

A

It does not rule out GERD

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24
Q

What is the indication for an Endoscopy?

A

Screening of high risk patients
Chest pain
Alarm symptom

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25
Q

When would you consider doing an endoscopy early?

A

Those at risk for Barrett’s esophagus
Non-cardiac chest pain
Patients unresponsive to PPI

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26
Q

What are risk factors for Barrett’s esophagus?

A 
Men
Caucasian men
55 years old
Obesity (especially big belly)
Smoking
Genetics
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27
Q

When is an ambulatory reflux monitoring indicated?

A

Refractory GERD symptoms
GERD diagnosis in question
Preoperatively for non-erosive disease

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28
Q

What are recommendations to duo with an ambulatory reflux monitoring test?

A

Correlate symptoms with reflux

Document abnormal acid exposure and reflux frequency.

29
Q

What are PPI trials beneficial (two reasons)?

A

Efficacy (high) and cost effective

30
Q

PPI trials can be performed on patients with typical symptoms where ______ cause has been excluded.

A

Cardiac

31
Q

Patients with typical symptoms and a positive PPI trial does not require what?

A

Further diagnostic testing

32
Q

For patients where cardiac causes of chest pain have not been excluded what is recommended by the 2013 guidelines?

A

Evaluation with endoscopy and pH monitoring

33
Q

Patients who do not respond to therapy and/or present with alarm symptoms what is recommended for diagnostic testing?

A

Endoscopy or ambulatory reflux monitoring

34
Q

What is the primary diagnostic test to evaluate the esophageal mucosa in patients with suspected GERD?

A

Upper endoscopy

35
Q

Describe an upper endoscopy?

A

A flexible endoscope is inserted down the esophagus into the stomach and the duodenum, allowing for visualization of intraluminal mucosa and obtaining biopsies

36
Q

Name three conditions that can be findings of GERD with an endoscopy?

A

Erosive esophagitis
Strictures
Barretts esophagus

37
Q

Even though the upper endoscopy can be used to identify ERD it may miss identifying characteristics of?

A

NERD, because pets have GERD without evidence of esophageal injury

38
Q

Describe ambulatory reflux monitoring?

A

A small probe is placed in the esophagus, just above the LES in order to monitor for 24 hour acid levels

39
Q

What are the four classes of risk factor for GERD?

A

Genetic
Demographic
Behavioral
Comorbid Conditions

40
Q

Name the three demographic risk factors for GERD?

A

Pregnancy
Older age
Decreased educational level

41
Q

What behavior risk factors for GERD are there?

A

Smoking
Alcohol consumptions
Foods (fatty/heavy meals; peppermint; caffeine; chocolate; coffee;cola; tea; garlic; onions; chili peppers)

42
Q

what are the comorbid conditions that increase risk for GERD?

A 
Hiatal hernia
Obesity (big belly)
IBS
Asthma
Angina 
Anxiety; depression
43
Q

When can GERD occur during pregnancy?

A

May occur at any trimester

44
Q

Severity of GERD can increase during pregnancy, but usually resolves when?

A

After delivery

45
Q

For patients who were frequent, GERD persists one year post delivery risk factors include?

A

Pregnancy and the amount of weight gain that occurred during pregnancy

46
Q

Significant predictors fo heart burn include what for pregnancy patients?

A

Increasing gestational age, heart burn prior to pregnancy, and parity (the number of times that she has given birth to a fetus with a gestational age of 24 weeks or more).

47
Q

Maternal age is _________ correlated with heartburn symptoms.

A

Inversely

48
Q

What is NERD?

A

Non-erosive reflux disease

49
Q

What is ERD?

A

Erosive reflux disease

50
Q

Name the primary patho process associated with GERD is due to ?

A

Defective LES (decreased)

51
Q

LES is normally in a _______ state with an elevated resting pressure?

A

Tonic

52
Q

Transient decrease in the LES take place in _______ of reflux patients.

A

HAlf

53
Q

Name the four things that decrease LES or increased abdominal pressure?

A

Alcohol
Tobacco
Delayed gastric emptying
Increase in gastric volume

54
Q

What is the major anatomic factor that is a pathophysiological reason for GERD

A

Hiatal hernia

55
Q

Hiatal hernia may __________ acid clearnance?

A

Slow

56
Q

Hiatal hernia _________LES pressure

A

Reduces

57
Q

What are the three ways to impair esophageal clearance and cause GERD?

A

Ineffective peristalsis
Reduced salivary secretion
Reduced secretion from esophageal submucosal glands

58
Q

When gastric contents are regurgitated, _______ of the esophagus propels contents back into the stomach.

A

Peristalsis

59
Q

GERD results from increased contact of gastric reflux with the _______ mucosa and not from excessive ______ production

A

Esophageal

Acid

60
Q

At night GERD can be problematic because of what two things?

A

Decreased swallowing and prone positioning

61
Q

Swallowing increases what?

A

Salivary flow

62
Q

Salivary flow aids in the clearance and _____ of ingested contents

A

Buffering

63
Q

What two patients population have decreased salivary production

A

Elderly and dry mouth syndrome

64
Q

Mucus secreting cells of the esophagus secrete _______ rich mucus which protects the esophagus how?

A

Bicarbonate

By neutralizing gastric reflux

65
Q

Repeated exposure to gastric acid contents does what to the mucus secreting cells of the esophagus?

A

Decrease their protective mechanism, allowing more damage to occur to the mucosa

66
Q

How can gastric volume cause GERD?

A

If gastric volume increases due to volume and contents of food ingested, increased gastric secretions, decreased gastric emptying, or duodenal reflux into the stomach

67
Q

GERD often occurs immediately after?

A

Consuming a meal (especially large and fatty)

68
Q

What is the composition of refluxate in the esophagus, stomach, and duodenum?

A

Esophagus 5-7
Stomach 2-5
Duodenum 6.8

69
Q

Refluxate contributes to _______ since the pH is very ____ and contains ______ which degrades proteins

A

Gastric juice
Low
Active pepsin

physiology test 3 (11 decks)

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