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24 Cards in this Set
- Front
- Back
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Normal LESP pressure
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10-40 mmHg
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Innervation of LES
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vagal pre-ganglionic and sympathetic post-ganglionic neurons
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mucosal barrier defenses
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tight junctions
enhances mucosal bicarbonate production inc blood flow to aid repair and provide bicarbonate transmembrane pumps salivary bicarb aids to neutralize |
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Most common presentation of GERD
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"heartburn"
specific, not sensitive (lots w/ GERD don't report) usually not belly pain (dyspepsia) |
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Extra-esophageal symptoms
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hoarseness, asthma, chronic cough, sinusitis, bronchitis, bronchiectasis, erosion of dental enamel
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Common presentation
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obesity, pregnancy, smoking, collagen vasc dz, etOH use, HH
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Why don't we all get reflux?
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anti-reflex barriers
salivary glands peristalsis carries back down cells of esophagus form barrier against ion diffusion |
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5 pathophys causes of GERD
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loose LES
too many/prolonged tLESRs poor/inc peristalsis dec gastric emptying weakened epithelial resistance (too much is rare) |
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DDx w/ GERD
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CAD
esophageal CA esophageal motility costochondritis pleuritis lung ca Panic d/o Zenker's diverticulum |
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Most common complication of GERD
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erosive esophagitis
-more common w/ hiatal hernia -chronic, relapsing presents as CP, dysphagia, occ odynophagia (pain) inc chance of stricture or Barrett's |
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Pathophys of stricture formation
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circular bands of scar tissue underlying mucosa, contracts and can cause dysphagia
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Barrett's esophagus
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risk of cancer is low
occurs in app. 10% of those w/ weekly GERD does not spontaneously resolve |
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GERD complications
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loss of dental enamel
laryngeal cancer aspiration pneumonia pulm fibrosis |
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Test/tx for classic symptoms
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PPI
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Alarm symptoms for GERD; test?
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(1/10 or less) weight loss, dysphagia, anemia, early satiety, bleeding
EGD or Barium swallow |
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EGD is better to look for what?
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complications of GERD, not GERD itself
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Test for GERD
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24 hr pH probe, sits in esophagus
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Barium is best for what?
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looking for strictures (when EGD is not available)
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Conservative tx for GERD
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elevate heard of bed on 6" on blocks
stop smoking stop EtOH reduce dietary fat lose weight avoid chocolate, peppermint, caffeine, citrus, tomato-based foods |
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Mechanisms of PPI
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irreversibly block the H/K ATPase
most potent acid suppressing agents (will still reflux anatomically) |
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Surgical procedure for GERD
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Nissen fundoplication
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If complications occur, when do they occur?
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early, first 5 years
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What is characteristic esophagus finding on eosinophilic esophagitis?
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ringed esophagus
(dx made on endoscopy w/ biopsy) |
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Dx sign for pill-induced esophagitis
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kissing lesions
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