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