GERD Flashcards
(22 cards)
What is the LES?
What is its function?
- lower esophageal sphincter
- tonically contracted smooth muscle (maintained by Ach)
- main function is to protect the esophagus from noxious stomach contents
How is the esophagus protected from stomach acid in a healthy patient?
- peristalsis of esophagus (to push contents back down)
- saliva contains bicarbonate to neutralize acid
What is the function of the pyloric sphincter?
to control the emptying of stomach contents into the duodenum
What do parietal cells do?
secrete HCl and intrinsic factor (B12)
intrinsic factor helps to absorb B12
B12 helps to make RBCs
What do G cells do?
secrete gastrin
What do enterochromaffin-like cells (ECL) do?
secrete histamine
What do chief cells do?
secrete pepsinogen
What is pepsinogen?
- the inactive form of pepsin
- pepsin is needed to break down protein
- activated in low pH
- will inactivate at higher pH when in duodenum, so we don’t digest ourselves
What are the 3 producers of gastric acid?
stimulated by vagus nerve…
- Acetylcholine
- sight, smell, taste of food
- stomach distension - Gastrin
- Histamine
Explain the H+/K+ ATPase proton pump.
- located on parietal cell
- exchanges H+ (cytsol) for K+ (canaliculi) using energy from ATP
- K+ and Cl- move passively into the canaliculus
- when H+ are transported out, they combine with Cl- to from HCl
What is the definition of GERD?
a chronic disorder related to the retrograde flow of gastro-duodenal contents into esophagus and/or adjacent organs resulting in a spectrum of symptoms, with or without tissue damage.
What are the signs and symptoms of GERD?
CHEST
- heartburn
- regurgitation
- chest pain
- dysphagia/odynophagia (hard to swallow/pain swallowing)
- belching
PULMONARY
- non-allergic asthma
- cough
- aspiration
- hoarseness
ORAL
- tooth decay
- gingivitis
THROAT
- globus sensation
- hoarseness
- laryngitis
EAR
- earache
When does symptoms of GERD usually occur?
What are they aggravated by?
- after a meal
- aggravated by bending over
How do you tell the difference between GERD and MI?
- when did it start?
- if pain gets worse after meals = GERD
- if pain gets worse after exertion = MI
What are the 3 dysfunctions associated with LESP?
- spontaneous LES relaxation not associated with swallowing = TLESR
- most common cause - increases in intra-abdominal pressure
- eating, straining, coughing - sphincter is atonic
What happens when there is impaired acid clearance?
- decreased peristalsis
- decreases salivation
- increased frequency of reflux
How does delayed gastric emptying contribute to GERD?
- increase in gastric volume = increase frequency and volume to be refluxed
- fatty meals and smoking contribute
How do you diagnose GERD?
- endoscopy
- 24 hour pH monitoring
- proton pump administering
- manometry (measures pressures differences)
- MOST IMPORTANT is a clinical history
What are some complications of GERD?
- esophagitis
- bleeding
- esophageal erosions and ulcers
- stricture formation
- Barrett’s esophagus
- adenocarcinoma of the esophagus
What factors trigger GERD?
- Food
- large meals induce TLESRs
- don’t eat meals 2-3 hrs before bed - Obesity
- Pregnancy
- Meds
- Smoking
- Hiatial Hernia
What is a hiatial hernia?
- When the proximal stomach is dislocated through the hiatus of the diaphragm into the chest
- the diaphragm becomes separated from the LES
What are some treatment options for GERD?
- lifestyle modifications
- Antacids
- Alginic acids
- H2 receptor agonists
- Proton pump inhibitors
- superior treatment - Prokinetics
- will cause diarrhea - Mucosal protectants
- doesn’t allow acid to penetrate foods
- digestion will suck really bad
