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35 Cards in this Set

  • Front
  • Back
What is GERD?
reflux of gastric contents into the esophagus resulting in symptoms and/or inflammatory changes of esophageal epithelium; retrograde movement of gastric content through LES to esophagus
If a patient presents with odynophagia and dysphagia, what could you suspect?
GERD
What are causes of GERD?
temporary increases in intra-abdominal pressure; prolonged intra-abdominal pressure; protracted LES relaxation; hiatal hernia; scleroderma; diabetes; decreased salivation, decreased peristalsis; increased sensitivity of esophagus to reflux
What can cause temporary increase in intra-abdominal pressure?
overeating and carbonated drinks
What can cause prolonged increase in intra-abdominal pressure?
pregnancy and obesity
What can cause protracted LES relaxation?
alcohol, cigarettes, drugs (NSAIDs, anti-cholinergics, opioids, tricyclic anti-depressents)
70% of patients with GERD also have?
scleroderma
What is an important mechanism for reflux?
transient LES relaxation (TLESR); part of the normal belch reflex
An increase in intra-abdominal pressure is accompanied by
an increase in LES pressure
What is the etiology for GERD?
hiatal hernia, esophageal peristaltic dysfunction, defect in epithelium, gastric abnormalities
What is generally the chief complaint of a patient suffering from GERD?
burning sensation in the epigastric area that may radiate to the neck or throat and is usually accompanied by regurgitation
What is water brash?
regurgitation of an XS accumulation of saliva from lower part of esophagus with some acid
You see a patient with pyrosis exacerbated by bending over and often after meals who complains of frequent indigestion but finds relief with antiacids or sitting, what should you suspect?
GERD
What are some key S/S of GERD?
pyrosis; indigestion; bitter taste in back of mouth; dysphagia; odynophagia; epigastric pain; chest pain
A patient that complains of heartburn 2 or more times per week most likely suffer from?
GERD
What is the GOLD STANDARD for diagnosing a patient with GERD?
ambulatory 24 hr pH recording
In a patient with GERD, how would you rule out ischemic disease?
EKG/stress test
What is the study of choice for persistent heartburn and odynophagia?
upper endoscopy
What is the acid perfusion test/Bernstein test?
determine whether chest pain is caused by GERD; chest pain caused by GERD induced by acidic liquid
What is a key difference in symptoms between GERD and Ischemic Heart Disease?
IHD is EXERCISED-INDUCED
What are some DDX related to GERD?
ischemic heart disease, noncardiac chest pain, infectious esophagitis, medication induced esophagitis, peptic ulcer disease, esophageal carcinoma, biliary tract disease
What is the most important complication related to GERD?
Barrett's esophagitis
What occurs mainly in distal esophagus in 7 - 23% of patients with untreated GERD?
peptic esophageal strictures
What is the main symptom of peptic esophageal stricture?
dysphagia that may cause food impaction and pulmonary aspiration
What are the goals in treating GERD, a chronic, lifelong condition?
relieve symptoms, remain symptom free; heal esophagitis; prevent relapse
What is the STEP UP plan for GERD?
more conservative treatment; diet/lifestyle modifications, OTC meds, add more complex therapies until symptom control is achieved
What is the STEP DOWN plan for GERD?
for more severe symptoms; start with most powerful meds to bring symptoms under control
What are some lifestyle changes that can aid in treatment of GERD?
elevate head while sleeping, reduce weight, avoid large meals, avoid food that exacerbate symptoms, stop smoking, stay upright two hours after meals, use of OTC products
What are foods that can exacerbate the symptoms of GERD?
fat, chocolate, alcohol, carbonated beverages, citrus
What meds are used to treat mild to moderate GERD?
H2RA and PPI (if symptoms continue)
What drugs are H2RAs?
ranitidine (zantac), famotidine (pepcid), cimetidine (tagamet), nizatidine (axid)
What drugs are PPIs?
omeprazole (prilosec), iansoprazole (prevacid)
What is the most effective drug for inhibiting gastric secretions?
PPIs
What are the indications for surgical treatment of GERD (3)?
medical failure, low patient's compliance for medical treatment, young age below 45
What are the surgical interventions for GERD?
laparoscopic or open NISSEN FUNDOPLICATION