GERD and PUD CIS - Tieman Flashcards Preview

Year2 GI Exam II > GERD and PUD CIS - Tieman > Flashcards

Flashcards in GERD and PUD CIS - Tieman Deck (66)
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1

Case 37yo M, waking up coughing at night, bitter liquid in mouth, after eating large meal before bed, sharp substernal chest pain, radiates to back

mild HTN
pain in knees
obesity
NSAID use

takes PPIs - it helps

returns 6 months with recurrence

scope - erosive esophagitis - no intestinal metaplasia

GERD

DDx - PUD, asthma, COPD, atypical angina

after recurrence - scope - because has alarm symptoms - difficult and painful swallowing**

increase effectiveness of PPI - take H2RA

2

GERD and obesity

with increased abdominal pressure

-pushes acid through the LES

-bending over, pregnancy, obesity

3

alcohol and GERD

relaxes the LES

4

diagnosis of GERD

trial of PPIs - if goes away

80% specific if response in 2 or 3 weeks

5

sx of GERD

heartburn - epigastric
-post prandial - after eating

water brash - salivary secretions in mouth

effortless regurg of gastric contents

**dysphagia
**odynophagia
-these are alarm symptoms

6

goal of GERD tx

relieve symptoms to prevent esophagitis and complications in cost-effective manner

lifestyle modifications - elevate head of bed, avoid spicy food, weight loss, stop smoking, avoid esophagitic drugs

7

scope with GERD

painful or difficulty swallowing
-alarm symptoms

8

barium swallow and EGD

done together

barium swallow - anatomical info and physio information (reflux)

EGD - visualize mucosa and allow biopsy

9

EGD

indicated in alarm symptoms

high specificity for esophagitis, barrets esophagus, cancer

10

barrets esophagitis

columnar epitheilum extends up into the esophagus

metaplasia and increased goblet cells**
-intestinal metaplasia

11

PPI

take 1 hour before meal

12

how to enhance PPI

combine with H2RA

take it

13

prokinetics

bethanecol
metaclopramide

side effects

14

gaviscon

antacid

15

H2RA

delayed onset but effective if used long period (12 weeks)

with PPIs - suppress nocturnal acid reflux

increased drug concentration if metabolized by cytochrome P-450 enzyme - warfarin

16

suppress nocturnal acid reflux

PPI with H2RA

17

PPI

given before meals

10-14 hours of action

esomeprazole - most effective

18

interfere with diazepam and warfarin metabolism

PPIs

19

pH monitoring

placed distal esophagus

records time and pH when patient hits button with symptoms

abnormal pH < 4 more than 5% of time

useful in establishing GERD

20

esophageal manometry

measure amplitude of peristaltic wave down esophagus

for motility disorders

21

surgery for GERD

laparoscopic nissen fundoplication

in good risk patients who respond well to medical therapy - but need a long-term maintenance**

if not cured with maintenance - no surgery**

90-95% successful - but 60% return to meds within 10-15 years

22

barrets esophagus

esophageal adenocarcinoma

23

extra-esophageal GERD manifestations

asthma

indication for GERD surgery

24

Case 45yo M - pain pit of stomach, intermittent epigastric radiates to back

-worse with eating and getting up
-pain levels vary 3-6/10
-pain worse after ethanol
-NSAID use for muscle aches
-increased stress
-stool weakly guiac positive

gastric ulcer

is urgent - check CBC
-microcytic hypochromic anemia

next - EGD

biopsy - h pylori

tx - triple threapy
-six weeks later - similar symptoms
-scope again - look for cancer

25

gastric ulcer

worse with eating

26

duodenal ulcer

better with eating

bc neutralize acid

27

stress

can increase acid production

28

peptic ulcer disease

duodenal - 2-3 hours after eating, relieved by food

gastric - right after eating, worse with food

chronic low grade bleeding - iron deficiency anemia

29

PUD diagnosis

barium swallow

EGD - higher sensitivity and specificity - allows biopsy - for h pylori

30

etiology of PUD

h pylori
acid secretory testing
NSAID