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clin med III, exam 2 > GERD, esophageal cancer > Flashcards

GERD, esophageal cancer Flashcards

1
Q

what physiology is occuring in body for GERD to occur

A
  • lower esophageal sphincter TRANSIENTLY relaxes allowing back flow of stomach contents
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2
Q

what is the montreal classification of gerd

A
  • a condition that develops when the reflux of stomach contents cause troublesome symptoms or complications
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3
Q

hallmark symptom of GERD

A
  • heartburn
    • typically post-prandial
  • regurgitation
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4
Q

list the extraesophageal manifestations of GERD

A
  • bronchospasm
  • laryngitis/hoarsness
  • chronic cough
  • loss of dental enamel
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5
Q

Pt with GERD may experience what other symptoms

A
  • chest pain, may mimick angina
  • dysphagia (r/o stricture)
  • hypersalivation
  • globus sensation (lump in throat)
  • odynophagia (painful swallowing)
  • Nausea
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6
Q

What are some things that worsen GERD symptoms

A
  • obestiy
  • pregnancy
  • gravity: encourgae pts to elevate head of bed
  • medications
  • foods
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7
Q

What class of medications used for osteoporosis can injury mucosa and worsen GERD symptoms

A
  • bisphosphonates
    • need to take with full glass of water
    • don’t lay down for 30 min after taking med
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8
Q

what is a Hiatal hernia

A
  • portion of the stomach enters above the diaphragm into the chest
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9
Q

what are the two types of hiatal hernias

A
  • sliding hernia (most common)
  • paraesophageal hernia
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10
Q

symptoms of hiatal hernia

A
  • most asymptomatic
  • can cause GERD
    • ​heartburn, cough, hoarseness, CP
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11
Q

Barium swallow can not show what in the evaluation of GERD

A
  • mucosal inflammation not seen
  • can see hiatal hernia and strictures
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12
Q

what is the best diagnostic test to evaluate mucosal injury

A

EGD

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13
Q

What is the best study to confirm GERD but frequently not needed

A

ambulatory pH monitoring

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14
Q

ambulatory pH monitoring can do what is assessment of GERD

A
  • quantify reflux and allow pt to log symptoms
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15
Q

function of Esophageal manometry

A
  • measures the function of the LES and the pressures and pattern of muscle contractions (peristalsis) of the esophagus
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16
Q

how is GERD most frequently diagnosed

A
  • clinically
  • diagnostic studies and labs are not needed with classic history of GERD
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17
Q

Lifestyle and dietary modification education for pts with GERD

A
  • adjustment of bed
  • no food or drink within 3 hrs of bedtime
  • weight loss
  • food avoidance
    • chocholate
    • fried and fatty foods
    • caffeine and soda
    • red wine, alcohol
    • citrus, tomatoes, onions
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18
Q

List the 3 medication options for GERD tx

A
  • antacids :Tums
  • H2 blockers (ranitidine)
  • Proton pump inhibiters (prilosec)
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19
Q

function of antacids in tx of gerd

A
  • neutralize gastric pH
  • short lived benefit
  • do not prevent GERD
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20
Q

function of H2 blockers in tx of GERD

A
  • block action of histamine at H2 receptors of the parietal cells of the stomach
    • leads to decreased stomach acid
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21
Q

when should proton pump inhibitors be taken

A

take 30 minutes before breakfast

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22
Q

function of proton pump inhibitors in tx of gerd

A
  • reduce the amount of acid produced by the glands in the stomach
23
Q

What are some considerations to take into account with long term PPI use

A
  1. risk of infection
    • ​​acidic environment is protective
  2. Malabsorption
    • magnesium, calcium, B12, iron
24
Q

list indications for anti-reflux surgery

A
  • failed optimal medical management
  • severe esophagitis
  • noncompliance
25
Q

what is the superior option for anti-reflux surgery

A
  • Nissen fundoplication
    • passage of gastric fundus behind esophagus to encircle the distal 6 cm of the esophagus
26
Q

which type of medication should be used first for GERD? What if that fails?

A
  1. BID dosing of H2 blocker
  2. PPI
    • start qd
    • can increase to BID with close f/u or endoscopy
  3. proceed with endoscopy first if develop any warning signs
27
Q

what is the most common cause of esophagitis

A

GERD

  • gastric acid, pepsin, and bile irritate the squamous epithelium
  • can lead to irritation, inflammation, erosion or ulceration
28
Q

List the 5 types of esophagitis

A
  1. reflux esophagitis: most common
  2. infectious esophagitis
  3. pill esophagitis
  4. eosinophilic esophagitis
  5. radiation esophagitis
29
Q

List the 3 main compications of esophagitis

A
  1. bleeding
  2. stricture
  3. barrett esophagus
30
Q

signs/symptoms of esophagitis

A
  • similar to GERD
    • heartburn
    • regurgitations
    • cough
    • CP
31
Q

in Barrett’s esophagus, epithelium is changed from what cell type to what cell type

A
  • squamous epithelium in distal esophagus replaced with columnar epithelium
    • ​due to recurrent acid injury
32
Q

Barrett’s esophagus predisposes pt to what condition

A
  • adenocarcinoma of esophagus
33
Q

List the treatment options for Barrett’s esophagus

A
  1. indefinite use of PPIs: aggressive tx may prevent ca
  2. EGD surveillance (q 6 mo - 3 yrs)
  3. Radiofrequency ablation
    • ​​low grade vs high grade dysplasia
    • long segment vs short segment
34
Q

What are the two types of esophageal cancer

A
  1. squamous cell carcinoma
  2. adenocarcinoma
35
Q

squamous cell carcinoma type of esophageal cancer is most common in what patient population

A
  • african american men
  • smoking
  • incidence decreasing
36
Q

adenocarcinoma type of esophageal cancer is most common in what patient population

A
  • barrett’s
  • caucasian men
  • incidence increasing
37
Q

What type of study is recommended in all patients with dysphagia

A

Endoscopy

38
Q

What are some causes of infectious esophagitis

A
  • candida
  • CMV
  • HSV
  • TB
39
Q

what is medication induced esophagitis

A
  • person who has trouble swallowing pills and occasionally pill gets stuck
40
Q

what systemic illness can cause esophagitis

A
  • scleroderma
    • CREST syndrome
41
Q

what is eosinophilic esophagitis

A
  • chronic, immune/antigen-mediated
  • strong connection with with asthma, rhinitis, food allergies and chronic eczema
42
Q

how is eosinophilic esophagitis diagnosed

A
  • clinical history + EGD
    • EGD shows stacked circular rings
43
Q

tx for eosinophilic esophagitis

A
  • diet: avoid allergins
  • PPI
  • topical corticosteroid
    • Fluticasone inhaler: spray and swallow
44
Q

What is Nutcracker esophagus

A
  • hypertensive peristalsis
    • due to increased response of smooth muscle in esophagus
    • contraction during meal time is so great that peristalsis is halted causing dysphagia
45
Q

how is Nutcracker esophagus diagnosed

A

Manometry will show hypertensive peristalsis

46
Q

tx of Nutcracker esophagus

A
  • calcium channel blocker or TCA or myotomy
47
Q

how is Achalasia diagnosed

A
  • Manometry required for diagnosis
  • EGD necessary to r/o malignancy
  • Barium swallow
    • Birds beak
48
Q

what is Achalasia

A
  • defect in LES relaxation and lack of peristalsis in distal 2/3 esophagus
    • will present as dysphasia
    • consider in pt who is unresponsive to PPI trial with dysphagia to solids and liquids and regurgitation
49
Q

tx of Achalasia

A
  • disruption of LES muscle fibers
    • pneumatic dilation
    • heller myotomy
  • biochemical reduction in LES pressure
    • Botox, nitrates, CCB
50
Q

What is a Mallory Weiss Tear

A
  • mucosal laceration in distal esophagus and proximal stomach
    • usually associated with repetitive vomiting, retching
51
Q

predisposing factors to Mallory Weiss Tear

A
  • alcoholism
  • hiatal hernia
52
Q

how is Mallory Weiss Tear diagnosed

A

EGD

53
Q

tx of Mallory Weiss Tear

A
  • stablize
  • control bleeding: epinephrine vs electrocoagulation
  • PPI

clin med III, exam 2 (6 decks)

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