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22 Cards in this Set

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63 y/o pt pesents to you with symptoms of GERD for several years. He has lost 15 pounds has trouble swalling. Labs show anemia. What do you do?
refer to gastroenerologist, act immediately!!!
23y/o pt presents with recent onset of GERD. He reports that his symptoms are intermittent usually after eating cetain foods and responds to OTC therapy. What do you do?
give PPI for 2-3 mo and watch
if he continues to have s/s then refer
Which is worse--Barrets
Long segment or
Short segment? Why
Long segment-related to adenocarcinoma & more complications
What is the most important factor in determining risk for esophageal CA.
DYSPLASIA
Pt presents for evaluation of GERD. Bx shows no dysplasia? What do you do?
if no dysplasia-low risk for CA, follow endoscopically 1-2 yrs
Pt presents for evaluation of GERD. Bx shows high grade dysplasia/carcinoma in situ? What do you do?
need to adress this right away- sx or photodynamic, or laser ablative tx—MUST REMOVE!!!
What type of CA is Barrets __________ (adenocarcinoma or SSC)
adenocarcinoma NOT SSC
How is H pylori related to Barrets?
Hpylori not or inversely related to Barrets!!
what is the most important mechanism in GERD
TLESR
What is TLESR?
transient lower esophagelal sphincter relaxation
TRANSIENT LES RELAXATION is characterized by 3 things.
INDEPENDENT OF SWALLOWING

NOT ACCOMPANIED BY PERISTALSIS

PERSIST LONGER THAN NORMAL SWALLOW INDUCED LES RELAXATION
TLESR associated w/ complictions complications of like _________ & _________
strictures & erosions
H-pylori infection is assoc w/ these 4 things
chronic superficial gastritis, duodenal and gastric ulcer, MALT lymphoma, and adenocarcinoma
What lab test should you do after you tx pts w/ H pylori—
Stool related H-pylori Ag
to make sure you eradicated the bug
What does Stool related H-pylori test tell us?
tells whether you have active infxn
What does the blood H-pylori tell us
tells who has been exposed NOT who has active infxn
Pt presnts with gastric ulcers. What do you do? Why?
Must biopsy! Gastric CA looks many times like gastric ulcers.Follow with US or FNA until it is gone!
Pt presnts with duodenal ulcers. What do you do?
don't worry as much duodenal ulcers are usually benign
what is the most important mechanism in GERD
TLESR
What is TLESR?
transient lower esophagelal sphincter relaxation
TRANSIENT LES RELAXATION is characterized by 3 things.
INDEPENDENT OF SWALLOWING

NOT ACCOMPANIED BY PERISTALSIS

PERSIST LONGER THAN NORMAL SWALLOW INDUCED LES RELAXATION
TLESR associated w/ complictions complications of like _________ & _________
strictures & erosions