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FUN MED SPRING 2018 COPY > 4. GERD, PUD, And Related Disorders > Flashcards

4. GERD, PUD, And Related Disorders Flashcards

1
Q

What are the 3 main parts of the mucosal defense system?

A

Mucous Gel Layer

Surface epithelial cells

Subepithelial elements

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2
Q

Composition of mucous gel layer

A

95% water and 5% mucin

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3
Q

Which part of the mucosal defense system serves as a barrier protection?

A

Mucous gel layer

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4
Q

Which part of the mucosal defense system provides cell protection and regeneration?

A

Subepithelial elements

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5
Q

Which part of the mucosal defense system produces mucus and regulates pH, and produces protective heat shock proteins that prevent protein desaturation?

A

Surface epithelial cells

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6
Q

Considered the “housekeeping elements”.

A

COX-1

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7
Q

Exacerbating factors of GERD regardless of causative factor.

A 
Abdominal obesity
Pregnancy
Gastric hypersecretory states
Delayed gastric emptying
Disruption of esophageal peristalsis
Gluttony
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8
Q

Excessive reflux of gastric contents back through the LES

A

GERD

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9
Q

The TWO most common GERD Sx. “Hallmark”

A

HEARTBURN and REGURGITATION

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10
Q

Less common GERD Sx.

A

Dysphagia

Chest Pain

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11
Q

“The great imitator”

A

Biliary colic

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12
Q

Pain associated with a bad gallbladder, can present in many ways.

A

Biliary colic

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13
Q

The DOMINANT clinical strategy for GERD

A

Lifestyle modifications + Empirical Tx with acid inhibitors

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14
Q

How long should you try the initial tx for GERD before checking on symptomatology?

A

8-12 wks

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15
Q

What are important exceptions to the GENERAL approach to tx for GERD?

A

PERSISTANT DYSPHAGIA or CHEST PAIN

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16
Q

What foods reduce LES pressure?

A 
Fatty foods
ETOH
Spearmint/Peppermint
Tomato-based foods
Coffee/tea
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17
Q

Does reducing the acidity of gastric juice prevent reflux?

A

No, just decreases sx and allows esophagitis to heal

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18
Q

The most effect GERD med

A

PPI

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19
Q

What PPI do you generally start with for GERD tx?

A

Omeprazole (20 mg QDay x 8-12 weeks)

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20
Q

When should pt’s take Omeprazole (PPI’s)?

A

30 min BEFORE FIRST MEAL

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21
Q

What pt’s may need longer term PPI use?

A

Sx return after discontinuance of PPI

Erosive disease

Barrett’s esophagus

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22
Q

What is a maintenance option for pt’s without erosive disease or Barrett’s esophagus (if effective)?

A

H2 blockers

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23
Q

What is a “PPI bridge” at night?

A

H2 Blocker

24
Q

When would you do a Nissen fundoplication?

A

Intractable GERD (must have a normal esophageal function proven with manometry)

25
Q

When would you do a Toupet partial fundoplication tx?

A

Pt’s with abnormal manometry results

26
Q

GERD complications

A

Chronic esophagitis

Bleeding

Stricture

Barrett’s Esophagus

Esophageal adenocarcinoma

27
Q

What kind of cancer can Barrett’s esophagus turn into?

A

Adenocarcinoma

28
Q

Process of Barrett’s esophagus

A

Squamous cells replaced with abnormal glandular-type epithelium

29
Q

A pt. Presents with anorexia and stomach discomfort…what is something you might consider?

A

Gastritis

30
Q

H. Pylori is a risk factor for the development of _______________

A

Gastric adenocarcinoma

31
Q

A pt. Presents with low-grade B-cell lymphoma, what would you consider testing for?

A

H. Pylori

32
Q

What should all patients with active PUD or hx of PUD or gastric cancer be tested for?

A

H. Pylori

33
Q

What is the most ideal test for H. pylori?

A

Fecal antigen immunoassay and urea breath test?

34
Q

This test demonstrates exposure of H. Pylori, but doesn’t tell us about active infection.

A

Quantitative Serologic ELISA test

35
Q

If a pt. Must stay on a PPI and you need to test for H. Pylori, what test would you use?

A

Endoscopic

36
Q

H. Pylori eradication Tx

A

Omeprazole (20mg BID) + clarighromysin 500 mg BID + amoxicillin 1 g BID x 10 days

37
Q

The most common type of PUD

A

DU

38
Q

Eating relieves this type of ulcer

A

DU

39
Q

Found in “Younger” patients (30-55)

A

DU

40
Q

What size does a break in the mucosal surface need to be to be considered an ulcer?

A

> 5mm

41
Q

Eating aggravates this type of ulcer.

A

GU

42
Q

A patient complains of waking up with stomach pain at 2 am, she says she also gets a stomach ache a few hours after every meal and is “Dependent on antacids.”

A

DU

43
Q

A patient presents with guarding, rigidity, and rebound tenderness in the stomach area?

A

Acute abdomen

44
Q

Signs of bleeding or perforation of PUD

A

Tachycardia
Orthostatic BP changes
Guarding, rigidity, rebound tenderness

45
Q

Textbook diagnostic evaluation for PUD

A

Barium swallow

46
Q

The most common complication of PUD.

A

GI bleed (15% of pt’s)

47
Q

Up to ______% of pt’s with ulcer-related hemorrhage bleed w/out any preceding warning signs or sx.

A

20

48
Q

Second most common ulcer-related complication.

A

Perforation

49
Q

When duodenal or gastric contents spill into the abdominal cavity and leads to an acute abdomen?

A

Free Perforation

50
Q

A form of perforation where the ulcer bed tunnels into an adjacent organ?

A

Penetration

51
Q

DU perforation usually goes to__________. GUs tend to perforate into the ____________

A

Pancreas

Left Hepatic Lobe

52
Q

What is the least common ulcer-related complication?

A

Gastric Outlet Obstruction

53
Q

A patient presents with new onset early satiety, nausea, vomiting, increasing postprandial abdominal pain, and with loss.

A

Gastric Outlet Obstruction as part of PUD

54
Q

Gastric outlet obstruction can be caused by ulcers and what else?

A

Fixed, mechanical obstruction secondary to scar formation in the peripyloric area (needs dilatation)

55
Q

PPIs result in over 90% healing a DU after _____weeks and 90% GU after_____ weeks when given_________

A

4
8
30 minutes before breakfast

56
Q

What else can you give to help manage PUD sx in addition to PPI?

A

Sucralfate (builds mucosal defense, give only first few days until PPI kicks in, 4x/day)

57
Q

A pt has been dealing with PUD for a long time. They’ve been very good about not taking NSAIDS and you have definitively ruled out that they DO NOT have H. Pylori, what would be a last resort option?

A

Refractory Ulcer Tx

FUN MED SPRING 2018 COPY (7 decks)

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