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GI/Hepatic > Reflux and Esophageal Disease > Flashcards

Reflux and Esophageal Disease Flashcards

1
Q

GERD definition

A

sx or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus
Heartburn 2/+ times a week

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2
Q

GERD is

A

a disease

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3
Q

Heartburn is

A

a sx

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4
Q

Esophagitis is

A

an endoscopic finding

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5
Q

What causes aggressive GERD?

A

Gastric acid
Pepsin
Bile acids
Pancreatic enzymes

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6
Q

What causes defensive GERD?

A

Impairment of lower esophageal sphincter pressure

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7
Q

What is the typical lower esophageal sphincter state?

A

contracted

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8
Q

Impairment of LES usually involves what?

A

Transient LES relaxation
Increased abdominal pressure
Atonic LES

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9
Q

What causes increased abdominal pressure

A

Straining
Bending
Coughing
Eating

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10
Q

What causes atonic LES?

A

Fatty foods
Gastric distention
Smoking
Medication

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11
Q

How do hiatal hernias affect LES?

A

The larger the hiatal hernia, the more frequently the patient’s LES will transiently relax allowing acid to flow back into the esophagus

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12
Q

What is the main determinant that causes damage and sx of GERD

A

Length of time acid spends in contact with the esophagus

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13
Q

GERD typical sx

A 
Pyrosis (heartburn)
Regurgitation
Belching
Dyspepsia
Epigastric pain & nausea
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14
Q

GERD extraesophageal (atypical) sx

A 
Cough
Asthma
Laryngitis
Chest pain
Dental erosions
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15
Q

GERD alarm sx

A 
Dysphagia
Odynophagia
Unexplained weight loss
Bleeding
Anemia
Chocking
Continual pain despite standard therapy
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16
Q

Diagnosis of GERD

A

Clinical (most common)
Endoscopy
Ambulatory pH monitoring
Manometry

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17
Q

Complications of GERD

A

Esophagitis
Strictures
Barrett’s esophagus

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18
Q

Barrett’s esophagus

A

Precancerous condition
More frequent/severe sx = increased risk
Lower esophageal tissues begins to look like the stomach
Hx of heartburn and regurgitation
Endoscopy (every 3-5 years) and biopsy for diagnosis

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19
Q

GERD lifestyle interventions

A

Weight reduction
Raising head of the bed
Avoid eating 3 hs before bedtime
Avoid lying down for 3 hours postprandially
Avoid foods and medications that reduce LES pressure
Dietary restriction of fat

20
Q

Drugs that lower LES

A 
Anticholinergics
Benzos
DHP CCBs
Estrogens, progesterone
Theophylline
Tetracycline
Narcotics
EtOH
Smoking
21
Q

Foods that lower LES

A 
Caffeine
Peppers
Onions
Garlic
Chocolate
Spearmint/peppermint
Coffee, tea, soda
Fatty meals, spicy food
22
Q

Drugs that irritate the esophagus

A 
Bisphosphonates
ASA
Fe
NSAIDs
K Cl
23
Q

Foods that irritate the esophagus

A

Tomato juice
Citrus juice
Spicy foods
Coffee

24
Q

Aluminum causes

A

Constipation

25
Q

Magnesium causes

26
Q

Antacids change the pH for which drugs that require an acidic environment?

A

dig
phentoin
isoniazid
Fe

27
Q

Antacids chelate?

A

Quinolones

Tetracyclines

28
Q

Cimetidine is eliminated how?

29
Q

Famotidine, ranitidine and nizatidine are eliminated how?

30
Q

Cimetidine inhibits which enzymes?

A

1A2
2C9
2D6
3A4

31
Q

H2RA SE

A

CNS (HA, dizziness, fatigue, somnolence, depression, hallucinations) especially in elderly with reduced renal function
GI: diarrhea/constipation

32
Q

PPI elimination

33
Q

PPI DDIs

A

Decreased absorption of azoles

34
Q

Prilosec and nexium inhibit which enzyme?

A

2C19 - decreases the metabolism of diazepam, phenytoin and warfarin

35
Q

Lansoprazole induces which enzyme?

A

1A2 - increases metabolism of theophylline

36
Q

Which enzyme are all PPIs metabolized by?

37
Q

What is protonix metabolized by?

A

cytosolic sulfotransferase

38
Q

How do PPIs and plavix interact?

A

Plavix requires 2C19 to be converted to active metabolite

39
Q

Long term effects of PPIs

A

Reduced calcium absorption and vit b-12 deficiency
C diff
CAP
AKI/CKD
Hypomagnesemia
Tetany, tremors, seizures, QT prolongation and arrhythmias

40
Q

PPIs in children

A

Nexium (1 month)
Prilosec/Pepcid (1 yr)
Protonix (5 yr)
Aciphex/Dexilant (12 yrs)

41
Q

Promotility drugs in GERD

A

Metoclopramide - increases LES pressure and accelerates gastric emptying
Bethanechol - promotility
Baclofen - decreases the number of transient relaxations of LES

42
Q

Treatment of intermittent, mild heartburn

A

Lifestyle +

  • Antacids +/-
  • OTC H2RA BID or OTC PPI qd
43
Q

Sx relief of GERD

A

Lifestyle plus Rx:

G2RA bid for 6-12 weeks or PPI qd for 4-8 weeks

44
Q

Treatment of mod-severe sx or healing of erosive esophagitis

A

Lifestyle +

PPI qd to BID for 4-16 weeks or high dose H2RA bid-qid 8-12 weeks

45
Q

What condition is refractory to PPI therapy

A

Eosinophilic esophagitis

46
Q

How to diagnose eosinophilic esophagitis

47
Q

Treatment of eosinophilic esophagitis

A

Dietary exclusions

Inhaled corticosteroids: fluticasone and budesonide - swallowed

GI/Hepatic (7 decks)

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