Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Surgery.(GIT 1).Esophagus > 1.GERD > Flashcards

1.GERD Flashcards

(82 cards)

Start Studying
1
Q

The cardio-oesophageal sphincter

A

is a functional intrinsic physiological sphincter-like mechanism at the cardia which normally prevents regurgitation from the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The cardio-esophageal sphincter normally prevents regurgitation from the stomach by :

A
  1. The oblique angle of insertion of the esophagus into the stomach (angle of His).
  2. Pinchcock action of the right crus of the diaphragm.
  3. The “rosette-like” arrangement of the cardiac gastric mucosa.
  4. Lower 4 cm of the oesophagus are intra-abdominal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

angle of His

A

The oblique angle of insertion of the oesophagus into the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pressure in the lower esophageal sphincter is

A

10-25 mm Hg

35- 45 cm H2O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ETIOLOGY of GERD

A

(1) 1ry : Incompetence of cardio-esophageal junction

(2) 2ry: Delayed emptying of stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

1ry : Incompetence of cardio-esophageal junction in ETIOLOGY of GERD

A

Factors

pathogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Factors of 1ry : Incompetence of cardio-esophageal junction in ETIOLOGY of GERD

A

Sliding hiatus hernia.

Obesity.
Fatty meal
Chocolate

Smoking.
Caffeine consumption
Alcohol consumption.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pathogenesis of 1ry : Incompetence of cardio-esophageal junction in ETIOLOGY of GERD

A

All these factors act by increasing the number of Transient lower esophageal sphincter relaxations (TLOSRs) which occur normally and are quite separate from swallow-induced relaxations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pathogenesis of 2ry: Delayed emptying of stomach in ETIOLOGY of GERD

A

Pyloric stenosis

Pylorospasm due to :-D.U. & gall stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PATHOLOGY of GERD

A

1- Starting of the condition

2- Progression of the condition

3- Vicious circle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Starting of the condition in PATHOLOGY of GERD

A
  • Starts by mild inflammation & hyperemia

* Followed by superficial ulcerations of the esophageal mucosa.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Progression of the condition in PATHOLOGY of GERD

A

With progression of the condition,

  • The musculosa is affected especially the longitudinal muscle layer
  • When it spasms, it draws the cardia more & more up into the thorax resulting in increased acid reflux.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Vicious circle in PATHOLOGY of GERD

A

A vicious circle goes on leading to esophageal fibrosis which may end by narrowing & shortening of the esophagus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

CLINICAL PICTURE of GERD

A

A) Classic presentation

B) Extra-esophageal reflux disease symtoms (EERD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Classic presentation in CLINICAL PICTURE of GERD

A
  1. Heart burn & retrosternal discomfort
  2. Regurgitation & water brash .
  3. Dysphagia :
  4. Odynophagia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pathogenesis of Heart burn & retrosternal discomfort in Classic presentation in CLINICAL PICTURE of GERD

A
  • It is the presenting symptom.

* brought about by bending over or lying flat in bed at night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

meaning of water brash

A

Maya betrod fe zoroh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pathogenesis of Dysphagia in Classic presentation in CLINICAL PICTURE of GERD

A
  • At 1st, it is due to esophageal spasm & edema.

* Later, it is due to fibrosis & stricture formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pathogenesis of Odynophagia in Classic presentation in CLINICAL PICTURE of GERD

A

Painful dysphagia with severe esophagitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Extra-esophageal reflux disease symtoms (EERD) in CLINICAL PICTURE of GERD

A

1- Coughing or wheezing

2- Non-cardiac chest pain.

3- Hoarseness of voice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pathogenesis of Coughing or wheezing in EERD in CLINICAL PICTURE of GERD

A

as a result of aspiration of gastric contents into the tracheo-bronchial tree.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pathogenesis of Non-cardiac chest pain in EERD in CLINICAL PICTURE of GERD

A

Reflux is the most common cause of Non-cardiac chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pathogenesis of Hoarseness of voice in EERD in CLINICAL PICTURE of GERD

A

irritation of the vocal cords by gastric refluxate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

EERD stands for

A

Extra-esophageal reflux disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Complications of GERD
1) Esophageal stricture & Schatzki ring. 2) Short esophagus. 3) Barrett's esophagus 4) Malignancy 5) 2ry anemia 6) Inhalation pneumonia
26
Pathogenesis of Esophageal stricture & Schatzki ring in Complications of GERD
Fibrosis in inner circular muscle layer
27
Pathogenesis of Short esophagus in Complications of GERD
Fibrosis in outer longitudinal muscle layer
28
Pathogenesis of Barrett's esophagus in Complications of GERD
Columnar metaplasia of the squamous lining in the lower esophagus which is pre cancerous to adenocarcinoma
29
Pathogenesis of Malignancy in Complications of GERD
Adenocarcinoma of the lower esophagus
30
Pathogenesis of 2ry anemia in Complications of GERD
minor occult bleeding from esophagitis
31
Pathogenesis of Inhalation pneumonia in Complications of GERD
recurring reflux.
32
INVESTIGATIONS of GERD
1. Barium meal in Trendelenburg's & anti Trendelenburg's position. 2. Upper GIT endoscopy : 3. 24 hours pH monitoring 4. Esophageal manometry 5. Investigations for Saint's triad
33
the reason why Barium meal is done in Trendelenburg's & anti Trendelenburg's position in INVESTIGATIONS of GERD
To detect degree of severity by reversibility of reflux
34
Upper GIT endoscopy in INVESTIGATIONS of GERD
* Normal finding * Abnormal finding * Belsey grading for GERD by upper GIT endoscopy
35
Normal finding in Upper GIT endoscopy in INVESTIGATIONS of GERD
Normally the cardia closes on inspiration due to its presence normally intra-abdominal and its pressure increase during inspiration closing the cardia
36
Pathogenesis of closed cardia on inspiration in Upper GIT endoscopy in INVESTIGATIONS of GERD
due to its presence normally intra-abdominal and its pressure increase during inspiration closing the cardia
37
Abnormal finding in Upper GIT endoscopy in INVESTIGATIONS of GERD
* The cardia opens in cases of hiatus hernia on inspiration * May reveal reflux of gastric juice through the cardia. * Also complications will be apparent
38
Pathogenesis of abnormally opened cardia on inspiration in Upper GIT endoscopy in INVESTIGATIONS of GERD
The cardia opens in cases of hiatus hernia on inspiration due to its presence abnormally intra-thoracic and its pressure decrease during inspiration opening the cardia
39
Belsey grading for GERD by upper GIT endoscopy in INVESTIGATIONS of GERD
Grade I : esophageal hyperemia. Grade II : esophageal erosions. Grade III : esophageal ulcerations. Grade IV : Stricture formation, Schatzki ring or Barrett's oesophagus
40
24 hours PH monitoring in INVESTIGATIONS of GERD
Reliability Procedures Results
41
Reliability of 24 hours pH monitoring in INVESTIGATIONS of GERD
The most important reliable test to diagnose the presence of reflux.
42
Procedures of 24 hours pH monitoring in INVESTIGATIONS of GERD
1. A special pH electrode is introduced in the lower esophagus 2. A 24 hour study of the pH of the esophagus is recorded 3. The patient is asked to record the periods when he gets the symptoms of reflux esophagitis
43
Results of 24 hours pH monitoring in INVESTIGATIONS of GERD
If the timing of these periods coincides with a low pH recording, this signifies that these symptoms are actually due to reflux esophagitis
44
Esophageal manometry in INVESTIGATIONS of GERD
It reveals: * Low pressure at LOS e.g: 7 8 9 mm Hg * The peristalsis power
45
Benefits of revealing the peristalsis power in Esophageal manometry in INVESTIGATIONS of GERD
Helps to choose the proper surgical procedure Weak peristalsis )> Partial wrap. Good peristalsis )> Complete wrap
46
Investigations for Saint's triad in INVESTIGATIONS of GERD
Abdominal U.S.
47
Saint's triad
A Triad of : | Gall stones, Hiatus hernia & Diverticulosis coli.
48
TREATMENT of GERD
(A) Conservative treatment (B) Surgical Treatment (C) MANAGEMENT OF COMPLICATIONS
49
Conservative treatment of GERD
The majority of cases can be controlled by Conservative treatment 1. Waiting 3 hours after a meal before lying down. 2. Elevating the head of the bed during sleep. 3. Reduction of weight is very important. 4. Frequent small, non-irritant meals. 5. Stop smoking and alcohol consumption. 6. Drugs
50
The reason why we should wait 3 hours after a meal before lying down in Conservative treatment of GERD
To ensure gastric emptying
51
Drugs in Conservative treatment of GERD
* Proton pump inhibitors ( PPIs ) * H2 receptors blockers * Prokinetics * Anti-cholinergic drugs are contraindicated
52
Proton pump inhibitors ( PPIs ) in Conservative treatment of GERD
as Omeprazole The most effective drugs.
53
H2 receptors blockers in Conservative treatment of GERD
as Famotidine are also effective
54
Prokinetics in Conservative treatment of GERD
as Metoclopramide and Domperidone produce brief improvement of the symptoms but with no healing of esophagitis
55
The reason why Anti-cholinergic drugs are contraindicated in Conservative treatment of GERD
as they cause gastric stasis, increasing esophageal reflux
56
Surgical Treatment of GERD
* Indications * Surgical modalities * Recent surgical modalities
57
Indications of Surgical Treatment of GERD
1. Failure of medical treatment. 2. Reflux in both Trendelenburg's & anti -Trendelenburg's position. 3. Complicated cases as ulcer, stricture or Barrett's esophagus.
58
Surgical modalities in Surgical Treatment of GERD
1 - Nissen's fundoplication 2- Floppy Nissen's fundoplication : 3- Toupet partial fundoplication : 4 - Belsey Mark IV Cardioplasty : 5- Hill's gastropexy : 6- The Angelchik prosthesis
59
Nissen's fundoplication in Surgical modalities in Surgical Treatment of GERD
Approach Principle Advantages Disadvantages
60
Approach of Nissen's fundoplication in Surgical modalities in Surgical Treatment of GERD
* Trans-abdominal. | * Trans-thoracic approach
61
indication of Trans-abdominal approach of Nissen's fundoplication in Surgical modalities in Surgical Treatment of GERD
in the uncomplicated cases
62
indication of Trans-thoracic approach of Nissen's fundoplication in Surgical modalities in Surgical Treatment of GERD
useful in patients with peri-oesophagitis
63
Principle of Nissen's fundoplication in Surgical modalities in Surgical Treatment of GERD
The fundus of the stomach is wrapped completely 360 degree around the lower 5 cm of the esophagus.
64
Advantages of Nissen's fundoplication in Surgical modalities in Surgical Treatment of GERD
Recurrence is rare.
65
Disadvantages of Nissen's fundoplication in Surgical modalities in Surgical Treatment of GERD
* Gas-bloat syndrome | * Dysphagia.
66
Pathogenesis of Gas-bloat syndrome in Disadvantages of Nissen's fundoplication in Surgical modalities in Surgical Treatment of GERD
considerable amount of abdominal gaseous distension due to inability to eructate.
67
Principle of Floppy Nissen's fundoplication in Surgical modalities in Surgical Treatment of GERD
* The fundus of the stomach is wrapped completely 360 degree around the lower 5 cm of the oesophagus * but this is done while insertion of a Iarge 54-60 F.bougie in the oesophagus
68
Meaning of 54-60 F.bougie
F. is french bougie means candle in French Act like stent Then remove it
69
Principle of Toupet partial fundoplication in Surgical modalities in Surgical Treatment of GERD
* The fundus of the stomach is wrapped 270 degree around the lower 5 cm of the oesophagus * leaving a part of the esophagus exposed anteriorly.
70
Belsey Mark IV Cardioplasty in Surgical modalities in Surgical Treatment of GERD
Approach Principle
71
Approach of Belsey Mark IV Cardioplasty in Surgical modalities in Surgical Treatment of GERD
Only trans-thoracic
72
Principle of Belsey Mark IV Cardioplasty in Surgical modalities in Surgical Treatment of GERD
Restoration of the cardio-esophageal angle by suturing the fundus of the stomach to the distal esophagus in a 240 degree anterior wrap. The esophago-gastric junction is then sutured to the under surface of the diaphragm.
73
Principle of Hill's gastropexy in Surgical modalities in Surgical Treatment of GERD
The cardia is sutured to the median arcuate ligament of the diaphragm
74
Principle of The Angelchik prosthesis in Surgical modalities in Surgical Treatment of GERD
It is a silastic prosthetic collar placed around the lower esophagus It probably acts by decreasing the number TLOSRs.
75
Recent surgical modalities in Surgical Treatment of GERD
1- Laparoscopic Nissen's fundoplication 2- Laparoscopic Toupet fundoplication
76
Management of complications in TREATMENT of GERD
Management of A) Esophageal stricture : B) Short Esophagus : C) Adenocarcinoma
77
Management of Esophageal stricture in Management of complications in TREATMENT of GERD
1- Endoscopic dilatation. 2- Thal's fundic patch : 3- Antral patch :
78
Principle of Thal's fundic patch in Management of Esophageal stricture in Management of complications in TREATMENT of GERD
Longitudinal incision is done through the stricture which is then closed transversely by a fundic patch.
79
Principle of Antral patch in Management of Esophageal stricture in Management of complications in TREATMENT of GERD
Longitudinal incision is done through the stricture which is then closed by an antral patch.
80
Management of Short Esophagus in Management of complications in TREATMENT of GERD
Collis gastroplasty
81
Principle of Collis gastroplasty in Management of Short Esophagus in Management of complications in TREATMENT of GERD
* Lengthening of the short esophagus by dividing the fundus of the stomach as a continuation of the esophagus. * Nissen's fundoplication is then performed
82
Management of Adenocarcinoma in Management of complications in TREATMENT of GERD
* Total esophagectomy | * Stomach follow up

Surgery.(GIT 1).Esophagus (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions