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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
When would you consider doing an endoscopy early?
Those at risk for Barrett’s esophagus Non-cardiac chest pain Patients unresponsive to PPI
26
What are risk factors for Barrett’s esophagus?
``` Men Caucasian men 55 years old Obesity (especially big belly) Smoking Genetics ```
27
When is an ambulatory reflux monitoring indicated?
Refractory GERD symptoms GERD diagnosis in question Preoperatively for non-erosive disease
28
What are recommendations to duo with an ambulatory reflux monitoring test?
Correlate symptoms with reflux | Document abnormal acid exposure and reflux frequency.
29
What are PPI trials beneficial (two reasons)?
Efficacy (high) and cost effective
30
PPI trials can be performed on patients with typical symptoms where ______ cause has been excluded.
Cardiac
31
Patients with typical symptoms and a positive PPI trial does not require what?
Further diagnostic testing
32
For patients where cardiac causes of chest pain have not been excluded what is recommended by the 2013 guidelines?
Evaluation with endoscopy and pH monitoring
33
Patients who do not respond to therapy and/or present with alarm symptoms what is recommended for diagnostic testing?
Endoscopy or ambulatory reflux monitoring
34
What is the primary diagnostic test to evaluate the esophageal mucosa in patients with suspected GERD?
Upper endoscopy
35
Describe an upper endoscopy?
A flexible endoscope is inserted down the esophagus into the stomach and the duodenum, allowing for visualization of intraluminal mucosa and obtaining biopsies
36
Name three conditions that can be findings of GERD with an endoscopy?
Erosive esophagitis Strictures Barretts esophagus
37
Even though the upper endoscopy can be used to identify ERD it may miss identifying characteristics of?
NERD, because pets have GERD without evidence of esophageal injury
38
Describe ambulatory reflux monitoring?
A small probe is placed in the esophagus, just above the LES in order to monitor for 24 hour acid levels
39
What are the four classes of risk factor for GERD?
Genetic Demographic Behavioral Comorbid Conditions
40
Name the three demographic risk factors for GERD?
Pregnancy Older age Decreased educational level
41
What behavior risk factors for GERD are there?
Smoking Alcohol consumptions Foods (fatty/heavy meals; peppermint; caffeine; chocolate; coffee;cola; tea; garlic; onions; chili peppers)
42
what are the comorbid conditions that increase risk for GERD?
``` Hiatal hernia Obesity (big belly) IBS Asthma Angina Anxiety; depression ```
43
When can GERD occur during pregnancy?
May occur at any trimester
44
Severity of GERD can increase during pregnancy, but usually resolves when?
After delivery
45
For patients who were frequent, GERD persists one year post delivery risk factors include?
Pregnancy and the amount of weight gain that occurred during pregnancy
46
Significant predictors fo heart burn include what for pregnancy patients?
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
Maternal age is _________ correlated with heartburn symptoms.
Inversely
48
What is NERD?
Non-erosive reflux disease
49
What is ERD?
Erosive reflux disease
50
Name the primary patho process associated with GERD is due to ?
Defective LES (decreased)
51
LES is normally in a _______ state with an elevated resting pressure?
Tonic
52
Transient decrease in the LES take place in _______ of reflux patients.
HAlf
53
Name the four things that decrease LES or increased abdominal pressure?
Alcohol Tobacco Delayed gastric emptying Increase in gastric volume
54
What is the major anatomic factor that is a pathophysiological reason for GERD
Hiatal hernia
55
Hiatal hernia may __________ acid clearnance?
Slow
56
Hiatal hernia _________LES pressure
Reduces
57
What are the three ways to impair esophageal clearance and cause GERD?
Ineffective peristalsis Reduced salivary secretion Reduced secretion from esophageal submucosal glands
58
When gastric contents are regurgitated, _______ of the esophagus propels contents back into the stomach.
Peristalsis
59
GERD results from increased contact of gastric reflux with the _______ mucosa and not from excessive ______ production
Esophageal | Acid
60
At night GERD can be problematic because of what two things?
Decreased swallowing and prone positioning
61
Swallowing increases what?
Salivary flow
62
Salivary flow aids in the clearance and _____ of ingested contents
Buffering
63
What two patients population have decreased salivary production
Elderly and dry mouth syndrome
64
Mucus secreting cells of the esophagus secrete _______ rich mucus which protects the esophagus how?
Bicarbonate | By neutralizing gastric reflux
65
Repeated exposure to gastric acid contents does what to the mucus secreting cells of the esophagus?
Decrease their protective mechanism, allowing more damage to occur to the mucosa
66
How can gastric volume cause GERD?
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
GERD often occurs immediately after?
Consuming a meal (especially large and fatty)
68
What is the composition of refluxate in the esophagus, stomach, and duodenum?
Esophagus 5-7 Stomach 2-5 Duodenum 6.8
69
Refluxate contributes to _______ since the pH is very ____ and contains ______ which degrades proteins
Gastric juice Low Active pepsin

physiology test 3 (11 decks)

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