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Clin Med III Exam 1 > GERD > Flashcards

GERD Flashcards

1
Q

sx of GERD

A 
pyrosis (heartburn)*
regurgitation*
chest pain (mimics angina) - r/o cardiac cause
dysphagia - r/o stricture
water brash/hypersalivation
globus sensation
odynophagia
nausea

Extraesophageal sx:

  • bronchospasm
  • laryngitis/hoarsness (consider laryngoscopy)
  • chronic cough
  • loss of dental enamel
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2
Q

worsens GERD

A 
obesity
gravity (elevate HOB)
pregnancy
tobacco/ETOH (pressure to LES)
meds
foods
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3
Q

Decrease LES pressure meds (worsen GERD)

A 
anticholinergic (ditropan)
TCA (amitriptyline)
CCB
Nitrates
Narcotics

(CANNT)

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4
Q

Injure mucosa meds (worsen GERD)

A 
bisphosphonates****(Fosamax, actonel)
iron supplements
NSAIDs/ASA
potassium
Tetracycline

(by the PIN)

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5
Q

hiatal hernia: what is it?

A

portion of stomach enters above diaphragm into chest

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6
Q

Most common hiatal hernia

A

sliding

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7
Q

types of hiatal hernias

A 
sliding (most common)
paraesophageal hernia (may require surgery)
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8
Q

Sx of hiatal hernias

A

asymptomatic

GERD

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9
Q

CXR of hiatal hernia

A

incidental
seen as retrocardiac mass w/ or w/o air fluid levels

dx difficult w/o air fluid levels

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10
Q

tests for GERD

A 
barium contrast esophagram (not often used) 
EGD
Esophageal impedence testing
Esophageal pH monitoring
Esophageal manometry
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11
Q

Barium contrast esophagram

A

shows hernia and strictures; mucosal inflammation NOT seen

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12
Q

EGD

A

BEST dx study to evaluate mucosal injury

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13
Q

dx mucosal injury

A

EGD

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14
Q

esophageal impedence testing

A

observation of bolus transit: complete or incomplete

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15
Q

Esophageal pH monitoring

A

quantify reflux and allow pt to log Sxs
high sensitivity for detecting reflux

mechanism: trans nasal cath vs. wireless capsule

(find non-acidic reflux)

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16
Q

Esophageal manometry

A

measure function of LES and peristalsis- pressure and pattern of esophageal mm contractions

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17
Q

Red flags for GERD

A 
dysphagia
hematemesis/GI bleed
unexplained weight loss, fever, fatigue
anemia
inadequate response to tx**
prior anti-reflux surgery
personal hx of CA
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18
Q

dx for GERD

A

labs usually not needed w/ GERD w/o warning signs

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19
Q

Tx for GERD

A

lifestyle/diet mod (adjust bed, no food/drink 3 hrs before bed, weight loss, eliminate diet triggers)

Meds:

  • antacids (TUMS)
  • H2 blockers (ranitidine)
  • PPI (prilosec, prevacid, nexium)

anti-reflux surgery

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20
Q

tx for mild/intermittenet sx (<1-2x/week, no esophagitis)

A

STEP UP tx:
lifestyle mod
H2RA’s
+/- antacids

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21
Q

severe sx (>2/week; impairs QOL)

A

STEP DOWN tx:

  • PPI daily x 8 weeks + lifestyle mod
  • gradually decrease tx (unless maintenance necessary)
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22
Q

when to take PPI

A

30 min before breakfast - better on empty stomach

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23
Q

antacids

A

don’t prevent GERD
neutralize pH
short lived benefit

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24
Q

H2 blockers/antagonists MOA

A

block action of histamine at H2 receptors of gastric parietal cells
leads to decrease secretion of stomach acid

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25
H2 blocker drugs
ranitidine (zantac) | Famotidine (pepcid)
26
PPI MOA
reduce amount of acid produced by glands in the stomach TAKE 30 MIN BEFORE 1ST MEAL OF DAY
27
PPI drugs
Omeprazole (prilosec) Lansoprazole (prevacid) Esomeprazole (nexium) Pantoprazole (protonix)
28
Risk of PPI
infection (acid is protective- C. diff, etc) | Malabsorption (Mg*, Ca, B12, Fe)
29
F/u for PPI
Mg level periodically yearly B12? bone density scan?
30
Length of medication w/o esophagitis/barett's
lowest down and shortest duration; dc meds in pts w/o sxs
31
Duration of pts w/ severe esophatitis or barett's
maintenance PPI
32
Indications for acid-reflux surgery
failed med management GERD complication (esophagitis, barrett's) noncompliance
33
Type of surgery for GERD
Nissen fundoplication- passage of gastric fundus behind esophagus to encircle the distal esophagus (open vs laparoscopic)
34
Most common cause of esophagitis
GERD- gastric acid, pepsin and bile irritate squamous epithelium
35
Types of esophagitis
``` reflux * most common infectious pill eosinophilic radiation ```
36
S/sx of esophagitis
GERD sx (heartburn, regurgitation, cough, CP)
37
Complications of esophagitis
bleeding stricture barrett's
38
Barrett's Esophagus definition
Squamous epithelium in distal esophagus is replaced w/ columnar epithelium * (due to recurrent acid injury) M>F (~55 YO)
39
Barrett's predisposed to
adenocarcinoma of esophagus (repeat EGD frequently)
40
Tx of Barrett's
- indefinite use of PPI (qd vs bid) - EGD surveillance to detect dysplasia - Endoscopic Eradication Therapy (EET) = Endoscopic ablation (EA) and/or Endoscopic resection (ER)
41
ER
remove segment of barrett mucosa -- therapeutic and provides info on involvement
42
EA (esophageal ablation)
thermal or photochemical energy to destroy barrett mucosa
43
Esophageal CA types
squamous cell carcinoma (SCC) | adenocarcinoma
44
SCC epidemiology
higher in urbanc African american men incidence decreasing
45
Risk factors of SCC
``` smoking** ETOH low fruit/veggies deficiency selenium, Sn caustic esophageal injury (hot coffee) HPV ```
46
Cause of adenocarcinoma
Barrett's ** smoking obesity
47
Epidemiology of Barrett's
Caucasians M>F (6:1) incidence increasing PREVENTION AND EARLY DETECTION
48
Prognosis of esophageal CA
50-80% have incurable, unresectable or metastatic disease palliative tx- chemo, radiation, surgery depending on stage
49
Dysphagia
GET EGD!!!! | need to prevent
50
Infectious esophagitis
DM Asthma Tb
51
Pill esophagitis
pill gets stucked
52
Systemic illness
sclerosis- poor acid clearance leads to epithelial damage
53
Eosinophilic esophatitis causes
asthma, rhinitis, food allergy, chronic eczema chronic, immune/antigen-mediated esophageal disease- EOSINOPHIL predominant inflammation
54
Sxs of eosinophilic esophagtitis
DYSPHAGIA, food impaction, CP, refractory GERD
55
Dx of eosinophilic esophagitis
Clinical + EGD (stacked circular rings, stricture)
56
Tx of eosinophilic esophagitis
diet (avoid allergens) PPI topical corticosteroids (ICS: spray and swallow, not inhale) +/- Esophageal dilation
57
Sx of esophageal motility disorders
dysphagia noncardiac CP refractory GERD
58
Major disorders of esophageal peristalsis
hypercontractile (Jackhammer) esophagus | Achalasia
59
Dx tests for motility
manometry barium swallow esophageal pH? impedence monitoring
60
Manometry results for jackhammer (hypercontractile)
``` high pressure (high amplitude) contractions in esophagus normal relaxation of esophagogastric junction mimics angina (w/ meals) ```
61
Tx of Jackhammer esophagus
CCB (diltiazem) TCA (imipramine) +/- botulinum toxin
62
Achalasia
aperistalsis on manometry: no contraction on distal 2/3 of esophagus and incomplete LES relaxation esophageal dilation BIRD'S BEAK (persistently contracted LES) Aperistalsis Poor emptying of barium
63
Cause of achalasia
progressive degeneration of esophageal neurons leading to failure of relaxation of LES and no peristalsis
64
Sx of achalasia
``` dysphagia regurg difficulty belching, CP, heartburn gradual onset 4.7 yrs til dx ```
65
Dx of achalasia
Manometry EGD necessary to r/o malignancy barium swallow: dilation of esophagus and BIRD"s BEAK
66
Tx of achalasia
disrupt LES mm fibers (pneumatic dilation, heller myotomy) Biochemical reduction in LES pressure (botulinum toxin, nitrates, CCB)
67
Mallory Weiss tear
mucosal laceration in distal esophagus and proximal stomach -- associated w/ repetitive vomiting, retching
68
Predisposing factors for mallory weiss
``` excessive alcohol consumption hiatal hernia (increased abdominal pressure) ```
69
Boerhaave's Syndrome
esophageal rupture | EMERGENCY
70
Dx of mallory weiss
EGD | clinical if issue already resolved
71
Tx of Mallor weiss
stabilize pt control bleeding - EPI or electrocoagulation address predisposing factors

Clin Med III Exam 1 (5 decks)

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