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Ccfp Abdo Pain > GERD > Flashcards

GERD Flashcards

1
Q

When does gastroesophageal reflux become GERF

A

When it impacts function

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2
Q

Symptoms of GERD in the pediatric population

A

•Refusal to feed
• frequent vomiting
• poor weight gain
• poor sleep
•Recurrent respiratory sx
•Irritability

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3
Q

Symptoms of GERD in older children

A

•Cough
•Asthma
• hoarseness
•dysphagia
• abdominal pain
• recurrent vomiting

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4
Q

Red flags for GERD in the pediatric population

A
  • bilious vomiting
  • gi bleed
  • bulging fontanelles
    -Fever
  • lethargy
  • micro/macrocephaly
  • seizures
  • abdo tenderness
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5
Q

Pediatric pt with vomiting + weight loss. What Ix Will do you

A

CBC - WBC, hb
Lytes - na, k, Cl
Creatinine
Urinalysis
Celiac
Upper gi series ( if -indicated)

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6
Q

Rx of child with GERD

A
  • Avoid overfeeding and tobacco smoke
  • 2 wk trial of thickened feeds
  • then 2.4wk trial of avoiding cows milk protein
  • then ppl X 4-8 wk ( increased risk of resp and gi infections and # )
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7
Q

Symptoms of GERD in adults

A

Heartburn + acid reflux → presumptive diagnosis of GERD
ExtraesophageaI symptoms → chest pain, cough, globus sensation

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8
Q

Red flag sx of GERD in adults

A

Chest pain
Weight loss
Vomiting
Dysphagia
Gi blood loss
Anemia

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9
Q

Atypical sx of GERD when you should considera differential

A

Epigastric pain
Dyspepsia
Bloating
Belching
Nausea

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10
Q

Complications of GERD

A

Erosion, ulceration, hemorrhage, strictures,Barrett’s

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11
Q

Surveillance for Barretts and dysplasia

A

Barretts → routine surveillance
High grade dysplasia → repeat endoscopy in 3 months. Consider ablation in those not a candidate for surgery.

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12
Q

Extra esophageal complications of GERD,

A

Dental erosions
Laryngitis
Asthma
Aspiration pneumonia
Pulmonary fibrosis

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13
Q

Medications that decrease sphincter pressure

A

Anticholinagics
Progesterone
Estrogen
CCB
Theophylline
Caffeine
Nicotine
Opioids
Ethanol

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14
Q

Medications that are mucosal irritants

A

NSAID
Asa
Iron
Quinidine
Álendronate
Potassium citrate
Tetracycline
Clindamyún

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15
Q

Routine investigations done for GERD

A

Hemoglobin to rule out anemia

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16
Q

What are the indications of endoscopy in GERD

A

-Presence of alarm symptoms
-Failure of therapy X 4-8wks
-Continuing dysphagia after 2-4 wks of ppi
-To determine the severity of erosive esophagitis
-To detect Barretts

17
Q

Management of GERD

A
  • Lifestyle → weight loss, incline head of bed, avoid meals 2-3 3hr prior to sleeping.
    -Mild GERD → alginates , antacids, low dose h2 receptor antagonist. Assess after 1 month
  • mod to severe GERD → ppi x 4-8 Wks once daily with reassessment. Taper/ discontinue if good response. If poor response try bid, increased dose or alternate ppi. If no response after 8-16 was refer for endoscopy
  • surgical anti reflux therapy
18
Q

What is mild GERD

A

<3 episodes/week, short , duration, low intensity

19
Q

Management of moderate to severe GERD

A

Ppi for 4-8 weeks at low dose od (20mg) unless severe esophagitis (bid). If goodresponse attempt taper /discontinuation
Maintenance option→ H2antagonist ( non erosive disease)or on demand ppi therapy
Poor/inadequate response → double dose ppi or bid ppi a switch ppi. Reassess in 4 wks
Refer for endoscopy if no response to ppl after 8-16 wKs. Should be off meds x 2-4wks

20
Q

When is longterm Rx with ppl indicated?

A
  • Barrett
  • grade c/d esophagitis
  • erosive esophagitis
    -esophageal stricture
  • eosinophilic esophagitis
  • gastroprotection
  • prevention of progression of idiopathic pulmonary fibrosis
  • bleeding pud
    Consider in those with hx of previous complicated vices, regular NSAID, concomitant SSRI/nsaid, 3 or more of age > 65, high dose NSAID, previous uncomplicated pup, concurrent asa/steroid /anticoagulant
21
Q

Adjunctive therapy for GERD

A

Breakthrough symptoms → alginates
Nocturnal symptoms → H2 antagonists
Regurge/belching→baclofen
Gastroparesis → prokinetics

22
Q

Risks of long term use of ppi

A

Hip fracture
C. difficult
Pneumonia
Deficiency of it B12, magnesium, iron
Hypoparathyroid

Ccfp Abdo Pain (11 decks)

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