GI Quiz 1 - GERD

Question 1

What is GERD? What is the prevalence?

Answer 1

Gastroesophageal Refulx Dz
Incompetence of LES, allows reflux of gastric contents into Eso. -> burning pain

Common! 30-40% adults, freq. infants (birth)

Question 2

What is the cause of GERD?

Answer 2

LES incompetence - loss of intrinsic tone, recurrent inappropriate transient relaxation

Question 3

What are some contributing lifestyle factors of GERD?

Answer 3

Weight gain
Fatty foods
Caffeine/Carbonated beverages
Alcohol
Tobacco/Smoking
Drugs: anticholinergics, antihistamines, TCAs, Ca channel blockers, Progesterone, Nitrates

Question 4

What are the SSx of GERD? What about infant SSx?

Answer 4

Heart burn (w or w/o regurg. of gastric contents into mouth)

Infants: vomiting, irritability, anorexia, chronic aspiration (cough, hoarseness, wheezing)

Question 5

How do you Dx GERD?

Answer 5

Clinical Hx
Endoscopy (if not responding to empiric Tx)
24-hr pH testing
Barium swallow: ulcers (not for mild-mod reflux)

Question 6

What are 5 complications of GERD?

Answer 6

Esophagitis
Peptic esophageal ulcer
Esophageal stricture
Barret's esophagus
Adenocarcinoma

Question 7

If a pt has GERD and presents w/odynophagia, eso. hemorrhage (usu. occult, m/b massive), what complication could they have?

Answer 7

Esophagitis

Question 8

If a pt has GERD and presents with gastric/duodenal ulcer pain (usu. localized to xiphoid/high substernal region), what complication could they have?

Answer 8

Peptic esophageal ulcer

Question 9

If a pt has GERD and presents w/gradually progressive dysphagia for solid foods, what complication could they have?

Answer 9

Esophageal stricture

Question 10

What is Barret’s Esophagus?

Answer 10

Metaplastic, columnar, glandular, intestine like mucosa w/brush border & globlet cells replaces norm. strat. squamous epithe. of distal eso

Question 11

What is the risk of getting Esophageal Adenocarcinoma in a pt w/GERD?

Answer 11

30-60x greater than the average population

Question 12

What is a EMERGENT complication of GERD?

Answer 12

Esophageal rupture (common site = distal eso. on the L)

Question 13

What are some other causes of Esophageal rupture?

Answer 13

Primary: iatrogenic (endoscopic procedures/other instruments)
Spontaneous/Boerhaave’s Syndrome: vomiting/swallowing large food bolus

Question 14

What are the SSx of esophageal rupture?

Answer 14

Chest/abdominal pain
Vomiting
Hematemesis

Question 15

What is the PE of esophageal rupture?

Answer 15

Mediastinal crunch/Hamman’s Sign: crackling sound synchronous w/heartbeat

Question 16

What is the full workup of esophageal rupture?

Answer 16

Chest/Abdomen X-ray: mediastinal air, pleural effusion, mediastinal widening
Esophagography: confirms Dx, water soluble contrast agent
Endoscopy: might miss sml perforation