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9 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What is GERD?
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Decrease in LES tone
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Etiologies/Risk Factors
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Caffeine
Tobacco/Nicotine ETOH Fatty foods/spicy foods Medications - CCB, anticholinergic, hormones Pregnancy Obesity DM and diabetic gastroparesis |
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Subjective Findings
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"Heartburn"
"Burping" "Regurgitation" "Chest pain" "Hoarseness" "Sore throat" "Clearing throat" "worsen at night or bending over" "cough" "difficulty swallowing" dysphagia "painful swallowing" odynophagia |
Ask "any chills/fever" (r/o PNA)
Ask "cough any blood" (r/o PUD/esophageal varices) Ask "wheezing" (r/o asthma) Ask symptoms of CP (r/o MI/angina or cholelithiasis) note: RUQ pain radiate to R shoulder and subscapular = cholelithiasis/cholecystitis Ask "N/V, emesis, black tarry stool?" (r/o PUD) |
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Objective Findings
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HEENT: throat - no lesions, no erythema, no erosion of teeth, tonsils 1+
Chest/Lungs Ab - soft, NT, no HSM, -ve Murphy's sign (board-like = perforation) (Murphy's sign = RUQ deep palpation = chole) |
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Dx test
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CBC (r/o anemia if esophageal varices suspected)
EGD - 2nd line (after PPI or H2 blocker trials, or having odynophagia or dysphagia) |
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Tx (non-pharm)
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Elevate HOB
Avoid triggers Avoid recumbence 2 hrs after meals Lose weight Diary (foods/meds) |
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Tx (pharm)
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1) Antacids (PRN) - Tums (Calcium carbonate)
2) H2 blocker cimetidine = Tagamet ranitidine = Zantac famotidine = Pepcid 3) PPI esomeprazole = Nexium lansoprazole = Prevacid omeprazole = Prilosec pantoprazole = Protonix |
PPI = not PRN drugs
PPI trials = 4 weeks |
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RTC and FU
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RTC in 4 weeks after PPI trial
Check CBC Check Vitamin B12 def - long term PPI use Endoscopy and biopsy if Barrett's suspected |
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Refer if...
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CP, radiating pain, cardiac origin
hematemesis, dysphagia, GI bleeding, weight loss, anemia, abdominal mass |
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