Study Q's - SSL Flashcards
What percentage of Americans have a sliding hiatal hernia?
10-80% (uptodate)
40% hiatal hernia (>60% if you add HHS)
95% sliding / 5% paraesophageal
What differentiates hiatal hernia (HH) from hiatal hernia syndrome (HHS)?
upward pressure without protrusion a picture (endoscopy, barium, CT)
with no visualization, you have a collection of sx -> syndrome
What are the common sx hiatal hernia / HHS?
fatigue anxiety shallow breathing chest oppression stitching pain tickling cough easy satiety reflux / regurg dysphagia
What are the common dx hiatal hernia / HHS?
Onset of sx following: constipation pregnancy illness w/vomiting or violent coughing new exercise program
What are the common tx hiatal hernia / HHS?
- visceral manipulation (caudal pull)
- functional breathing
- NMT or myofascial release (focus at occiput and T10-11)
- energetic clearing
- post manip exercises
- heel drop (drink h20, drop 11x)
- core exercise
- leg raise, knee raise
What is the relationship between spinal levels and hiatal hernia syndrome?
T 10-11 left paravertebral area C 0 (occiput)
What are the various options for determining if a pt has hypochlorhydria?
- Heidelberg test
- gastric string test (screening)
- riddler’s gastric acid point (fxnl)
- BL weakness of pec major clavicular (fxnl)
- clinically
- HCl challenge
What is the relationship between hypochlorhydria and gastroparesis? How could gastroparesis be life-threatening?
poorly digested food can sit in the stomach
How does the temperature of food and drink affect orocecal transit time?
cold - slows
hot - speeds/increases motility
What is the explanation for reflux causing sx (including heartburn) if a pt has hypochlorhydria?
x
What are the available txs for hypochlorhydria?
x
What are the sx/signs 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?
vomiting ceases
abd pain lessens
appearance better - regain color
temp and pulse normal
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 2” above the costal margin
To what location is pain referred from a perforated peptic ulcer?
top of shoulder, supraspinous fossa, acromion, 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?)
free air btw liver and diaphragm
Summarize the prevention of dysplasia and adenocarcinoma of the esophagus in patients with long segment Barrett esophagus.
x
What is NERD? What are dilated intercellular spaces? What is DGER?
Non-erosive reflux disease - NERD
DIS - “leaky esophagus”
Duodenal-gastro-esophageal reflux - DGER
Understand the spectrum of GERD including NERD, erosive and non-erosive esophagitis, Barrett esophagus, dysplasia and adenocarcinoma.
x
What are the components of the mnemonic – “cut out the CRAP?”
C - coffee, cigs, chocolate
R - rx, refined carbs (carbs in general)
A - alcohol, allergic foods, acid foods
P - pop, peppermint, progesterone, packin food in hs
Understand the flowchart of Naturopathic GERD evaluation.
x
What is the most distal site that may be assessed by upper endoscopy (EGD)?
What can be assessed, beyond PUD status?
first two portions of duodenum
- H. pylori status
- celiac disease biopsies (D3, D4)
- aspirate for SIBO
- flap valve assessment
Discuss why H. pylori screening of patients who do not have sx of PUD may lead to unnecessary treatment.
Because it’s normal flora, and protective against conditions such as GERD, Barrett’s, adenocarcinoma, Crohn’s, etc.
Labs can’t test commensal vs virulent, only research is doing that at this time.
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”)
