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Clinical Medicine III > GERD & Esophageal D/O > Flashcards

GERD & Esophageal D/O Flashcards

1
Q

GERD can facilitate the transition of normal squamous epithelial cells to intestinal columnar cells. This is called ____plasia, and leads to what esophageal condition?

A

Metaplasia

Barrett’s Esophagus

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2
Q

Barrett’s esophagus puts patients at 30x increased risk for what?

A

adenocarcinoma

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3
Q

On CXR you notice an air-fluid level above the diaphragm… what does this indicate?

A

hiatal hernia

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4
Q

what are three conditions that increase risk of GERD?

A

hiatal hernia
scleroderma
ZES

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5
Q

Pt. p/w:

  • retrosternal CP
  • regurgitation
  • Burning sensation/pyrosis
  • nocturnal asthma/cough/SOB

What GI condition is this concerning for?

A

GERD

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6
Q

The below are the 9 alarm sxs for GERD/Esophageal d/os that necessitate what study?

Dys/odynophagia
GI bleed sxs
wt. loss
anemia
poor tx response
new onset dyspepsia > 60
prior surg intervention
CA hx
A

EGD

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7
Q

Describe how GERD is typically diagnosed…

A

clincal diagnosis (pyrosis, cough, better upright, relief with antacids)

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8
Q

What body position can help alleviate GERD? What about while sleeping

A

upright after meals

elevate head of the bed 30 degrees (using blocks, don’t bend at the waist)

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9
Q

What approach to GERD therapy if mild sxs with 1-2 episodes a week?

A

Step up:

Lifestyle + H2RA

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10
Q

What approach to GERD therapy if mod/severe sxs and 2+ episodes a week?

A

Step Down:

lifestyle + PPI x 8 weeks

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11
Q

What dosing instructions should be given to patients taking a PPI?

A

take 30 minutes before 1st meal

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12
Q

What are 2 complications of PPIs?

A 
increased infx (c. diff risk)
Malabsorption
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13
Q

What 4 nutrients may be malabsorbed while taking PPIs, requiring you to monitor?

A

Mg, B12 (IF), Ca, Vit. D

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14
Q

After 8 weeks of PPI tx, sxs have resolved. How to you get the patient off the drug?

A

gradually

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15
Q

A patient’s GERD sxs have resolved after an 8 week course of a PPI, but they had severe sxs +/- Barrett’s Esophagus… what can be done next?

A

QD maintenance dose PPI

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16
Q

After 8 week trial of PPI, sxs haven’t improved. What diagnostics should be administered initially?

A

24 hr pH study + EGD/Bx

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17
Q

What are four indications for Nissen Fundoplication after EGD surveillance of GERD complications?

A

non-response to meds
esophagitis
Barrett’s
non-compliance w. meds

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18
Q

What are three complications of GERD?

A

Esophagitis (Barrett’s & Erosive)

Esophageal strictures

Esophageal CA (Adenocarcinoma, squamous cell carcinoma)

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19
Q

A pt. p/w the below… what can these be concerning for/included on your DDx?

laryngitis/hoarseness
loss of dental enamel
angina-like CP
dysphagia
water brash
Globus
A

GERD

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20
Q

The below 5 meds worsen GERD sxs by what mechanism?

TCAs
CCBs
Nitrates
Narcotics
Anticholinergics/histamines
A

decreasing LES pressure

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21
Q

The below 5 meds worsen GERD sxs by what mechanism?

Bisphosphonates
Fe
NSAIDs
K+
Tetracycline
A

injuring mucosa

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22
Q

What are the 5 risk factors for GERD development?

A

Obesity/fat rich diet
caffeine intake
EtOH, TOBB

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23
Q

A patient p/w GERD sxs + dysphagia or odynophagia should be concerning for…

A

esophagitis

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24
Q

What are the 5 types of esophagitis?

A 
Pill induced
Infectious
Eosinophilic
Caustic
GERD induced
25
Q

What are three complications of esophagitis?

A

bleed, stricture, barrett’s esophagus

26
Q

A patient p/w GERD sxs + dysphagia or odynophagia … What diagnostics could be ordered? which is best?

A

EGD + barium esophagram

EGD best

27
Q

Most cases of esophagitis necessitate tx with…

A

PPIs

28
Q

This condition is caused by a recurrent acid injury to the esophagus

A

Barrett’s esophagus

GERD –> Squamous Damage –> columnar replacement –> metaplasia

29
Q

How is barrett’s esophagus treated?

A

indifinite PPI +/- endoscopic resection or ablation

30
Q

How is barrett’s esophagus monitored?

A

EGD to detect meta/dysplasia

31
Q

Infectious esophagitis can be caused by fungal overgrowth… what three populations are at risk?

A

immunocompromised
inhaled CS users
recent abx users

32
Q

Describe how systemic illness can lead to esophagitis

A

systemic sclerosis –> poor acid clearing –> esophagitis

33
Q

this is a chronic, immune mediated cause of esophagitis…

A

eosinophilic

34
Q

A patient with food allergy, rhinitis, asthma, atopic derm is at increased risk for what esophageal d/o?

A

eosinophilic esophagitis

35
Q

A patient p/w the following, concerning for…

Dysphagia
food impaction
CP
refractory GERD
UGI Pain
Atopic hx
A

eosinophilic esophagitis

36
Q

You suspect eosinophilic esophagitis for a pt. w. GERD + esophagitis + atopic hx. What diagnostics should be ordered and what findings should support your Dx?

A

Hx + EGD showing stacked circular rings +/- stricture

37
Q

How is eosinophilic esophagitis treated?

A

diet mods, PPI, topical CCS +/- esophageal dilation

38
Q

Dysphagia, non-cardiac CP, refractory GERD are suggestive of what class of disorders?

A

esophageal motility d/o

39
Q

A patient p/w progressive dysphagia (solids –> liquids) non-cardiac CP, refractory GERD necessitates what diagnostic and why?

A

EGD to r/o structural abnormality

40
Q

If EGD is WNL for a patient w. dysphagia and motility d/o sxs, what treatment should be tried?

A

QD or BID PPI

41
Q

A pt. w. dysphagia and motility d/o sxs has failed PPI tx… what diagnostics are indicated for refrectory sxs?

A

Manometry, barium esophagram + pH and impedence monitoring

42
Q

Manometry for a patient w. refractory GERD and dysphagia shows:

increased pressure contractions in esophagus

normal esophagogastric junction relaxation

What does this suggest?

A

Hypercontractile/jackhammer esophagus

OR

distal esophageal spasm

43
Q

increased pressure contractions in esophagus and normal esophagogastric junction relaxation in DES and jackhammer esophagus causes what sxs and when?

A

angina sxs during meals

44
Q

What are two mechanisms/goals of medical tx of DES/jackhammer esophagus?

A

control GERD

Relax muscles

45
Q

How is GERD controlled in tx of DES/jackhammer esophagus?

A

PPI

46
Q

how is esophageal muscle relaxed in DES/jackhammer esophagus?

A

Diltiazem (CCB) or Imipramine (TCA) +/- botox

Peppermint oil b4 meals if no GERD

47
Q

What combo therapy should be initiated for DES/jackhammer esophagus?

A

PPI + Diltiazem (CCB) or Imipramine (TCA) +/- botox

48
Q

A patient p/w the below, concerning for…

dismotility sxs (non-cardiac CP, refractory GERD)

+ Gradual onset of (4 years or so):
Dysphagia
regurgitation
difficulty belching

A

Achalasia

49
Q

You suspect achalasia on a patient w. gradual onset dysmotility sxs, dysphagia. What diagnostics should be ordered?

A

EGD (r/o malignancy/structural d/o)

Manometry + Barium Esophagram

50
Q

What two signs on barium esophagram can indicate achalasia?

A

bird’s beak sign

aperistalsis

51
Q

What two signs on manomentry can indicate achalasia?

A

aperistalsis in distal 2/3

incomplete LES relaxation

52
Q

Which diagnostic for achalaisa is required for diagnosis?

A

manometry

53
Q

Tx for achalasia is either mechanical or biochemical. They both try to disrupt the LES… What are two mechanical txs for achalasia?

A 
pneumatic dilation
Heller Myotomy (surg. release of LES)
54
Q

Tx for achalasia is either mechanical or biochemical. They both try to disrupt the LES… What is the progression of biochemical treatments?

A

botox –> nitrates –> CCBs

55
Q

This d/o is a mucosal laceration in distal esophagus or proximal stomach.

A

mallory-weiss syndrome

56
Q

What are three disorders that can cause mallory-weiss syndrome?

A

EtOH abuse, hiatal hernia, bulemia

57
Q

What physiological process is the cause of a mallory-weiss syndrome (not disorders that lead to it, what physical action)

A

repetitive vomiting/retching

58
Q

How is mallory-weiss syndrome diagnosed and treated?

A

dx: EGD
tx: electrocoag, band ligation or epi

Clinical Medicine III (21 decks)

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