GERD, esophageal cancer Flashcards
(53 cards)
1
Q
what physiology is occuring in body for GERD to occur
A
- lower esophageal sphincter TRANSIENTLY relaxes allowing back flow of stomach contents
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
3
Q
hallmark symptom of GERD
A
-
heartburn
- typically post-prandial
- regurgitation
4
Q
list the extraesophageal manifestations of GERD
A
- bronchospasm
- laryngitis/hoarsness
- chronic cough
- loss of dental enamel
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
6
Q
What are some things that worsen GERD symptoms
A
- obestiy
- pregnancy
- gravity: encourgae pts to elevate head of bed
- medications
- foods
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
8
Q
what is a Hiatal hernia
A
- portion of the stomach enters above the diaphragm into the chest
9
Q
what are the two types of hiatal hernias
A
- sliding hernia (most common)
- paraesophageal hernia
10
Q
symptoms of hiatal hernia
A
- most asymptomatic
- can cause GERD
- heartburn, cough, hoarseness, CP
11
Q
Barium swallow can not show what in the evaluation of GERD
A
- mucosal inflammation not seen
- can see hiatal hernia and strictures
12
Q
what is the best diagnostic test to evaluate mucosal injury
A
EGD
13
Q
What is the best study to confirm GERD but frequently not needed
A
ambulatory pH monitoring
14
Q
ambulatory pH monitoring can do what is assessment of GERD
A
- quantify reflux and allow pt to log symptoms
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
16
Q
how is GERD most frequently diagnosed
A
- clinically
- diagnostic studies and labs are not needed with classic history of GERD
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
18
Q
List the 3 medication options for GERD tx
A
- antacids :Tums
- H2 blockers (ranitidine)
- Proton pump inhibiters (prilosec)
19
Q
function of antacids in tx of gerd
A
- neutralize gastric pH
- short lived benefit
- do not prevent GERD
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
21
Q
when should proton pump inhibitors be taken
A
take 30 minutes before breakfast
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
- risk of infection
- acidic environment is protective
-
Malabsorption
- magnesium, calcium, B12, iron
24
Q
list indications for anti-reflux surgery
A
- failed optimal medical management
- severe esophagitis
- noncompliance
25
what is the superior option for anti-reflux surgery
* Nissen fundoplication
* passage of gastric fundus behind esophagus to encircle the distal 6 cm of the esophagus
26
which type of medication should be used first for GERD? What if that fails?
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
what is the most common cause of esophagitis
GERD
* gastric acid, pepsin, and bile irritate the squamous epithelium
* can lead to irritation, inflammation, erosion or ulceration
28
List the 5 types of esophagitis
1. reflux esophagitis: most common
2. infectious esophagitis
3. pill esophagitis
4. eosinophilic esophagitis
5. radiation esophagitis
29
List the 3 main compications of esophagitis
1. bleeding
2. stricture
3. barrett esophagus
30
signs/symptoms of esophagitis
* similar to GERD
* heartburn
* regurgitations
* cough
* CP
31
in Barrett's esophagus, epithelium is changed from what cell type to what cell type
* **squamous epithelium** in distal esophagus replaced with **columnar epithelium**
* ****due to recurrent acid injury
32
Barrett's esophagus predisposes pt to what condition
* **adenocarcinoma** of esophagus
33
List the treatment options for Barrett's esophagus
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
What are the two types of esophageal cancer
1. squamous cell carcinoma
2. adenocarcinoma
35
squamous cell carcinoma type of esophageal cancer is most common in what patient population
* **african american men**
* **smoking**
* incidence decreasing
36
adenocarcinoma type of esophageal cancer is most common in what patient population
* **barrett's**
* **caucasian men**
* incidence increasing
37
What type of study is recommended in **all** patients with **dysphagia**
Endoscopy
38
What are some causes of infectious esophagitis
* candida
* CMV
* HSV
* TB
39
what is medication induced esophagitis
* person who has trouble swallowing pills and occasionally pill gets stuck
40
what systemic illness can cause esophagitis
* scleroderma
* CREST syndrome
41
what is eosinophilic esophagitis
* chronic, immune/antigen-mediated
* strong connection with with asthma, rhinitis, food allergies and chronic eczema
42
how is eosinophilic esophagitis diagnosed
* clinical history + EGD
* EGD shows stacked circular rings
43
tx for eosinophilic esophagitis
* diet: avoid allergins
* PPI
* topical corticosteroid
* Fluticasone inhaler: spray and **swallow**
44
What is Nutcracker esophagus
* 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
how is Nutcracker esophagus diagnosed
Manometry will show hypertensive peristalsis
46
tx of Nutcracker esophagus
* calcium channel blocker or TCA or myotomy
47
how is Achalasia diagnosed
* **Manometry** required for diagnosis
* **EGD necessary to r/o malignancy**
* Barium swallow
* Birds beak
48
what is Achalasia
* 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
tx of Achalasia
* disruption of LES muscle fibers
* pneumatic dilation
* heller myotomy
* biochemical reduction in LES pressure
* Botox, nitrates, CCB
50
What is a Mallory Weiss Tear
* mucosal laceration in distal esophagus and proximal stomach
* usually associated with repetitive vomiting, retching
51
predisposing factors to Mallory Weiss Tear
* **alcoholism**
* hiatal hernia
52
how is Mallory Weiss Tear diagnosed
EGD
53
tx of Mallory Weiss Tear
* stablize
* control bleeding: epinephrine vs electrocoagulation
* PPI
