Icm Winter 2 Gerd

Front 1

63 yo female presents with 5 yr hx of epigastric and substernal burning/discomfort. usually after meals but frequently wakes her from sleep. choking in throat and sour taste, sx releived by rolaids

wahts the dx

Back 1

GERD

ASA, EtOH, acid, coffee, cigars, make it worse

Front 2

63 YOWM physician presents c a 5 year Hx of burning epigastric and substernal discomfort usually occurring after meals but frequently awakening him from sleep with horrible burning and choking in his throat and a very sour taste. Symptoms are usually quickly relieved by Rolaids.
Because of an increase in the frequency and severity of Sx, he sees a friend, a gastroenterologist.
PMH: Illnesses: psoriasis; Surg: cholecystectomy 1987; Meds: ASA, Vit D, Rolaids.
SH: married; 6-8 cups of coffee/day; 2 glasses of wine/night; late night snacks +; smokes cigars
FH: Father 90 c CAD; mother 88 very healthy; 2 children in excellent health although younger daughter had cholecystectomy age 28
Exam: overweight; few psoriatic plaques c nail changes including hyperkeratosis and pitting. Ab: well healed RUQ scar.
Lab tests all nl. A procedure is done

wht procedure

Back 2

esophago-gastro-duadeno-oscopy

GERD

Front 3

37 YOAAF with systemic sclerosis. Seen in 1977 at The University of Pittsburgh. She had Raynauds and rapidly progressive skin disease but her major complaint is frequent and very severe heartburn. Her rheumatology fellow recommended elevation of the head of the bed, no food or liquid after 6 PM and Antacids 1 hour PC and HS. Her Sx improve slightly but after about a year, she develops difficulty swallowing bread, meat and lettuce. They stick in the lower chest. Liquids are no problem. She has lost 15lbs. Exam shows only marked sclerodactyly with telangiectasias. A procedure is done

what is the procedure
what does her medical conditions have to do with presenting sx

Back 3

SS- skin turns to leather and you get contractures

upper GI series, SS ahve esophageal impairment often. No peristalisis and loss of mm tone

in SS you get mat like telangectasias, see red spots

Front 4

whats CREST

Back 4

seen in scleroderma

Calcinosis
Raynaud's syndrome
Esophageal dysmotility
Sclerodactyly
Telangiectasia

Front 5

what can cause an esophageal stricture

Back 5

GERD

**less common now bc of PPI

Front 6

58 YO Chinese-Am gastroenterologist with a 5 year Hx of frequent severe epigastric and substernal burning. This was worse after meals and frequently awakened him at night. Tums provide some relief. In the last 3 months, he has had trouble swallowing meat and coarse bread. They stick in the lower chest. He has had no trouble with liquids. He has lost 5 lbs. in the past month. He is seen by another gastroenterologist and has a procedure the next day.

what is the procedure

Back 6

endoscope,

adenocarcinoma of lower esophagous. this is the more serious complication of GERD (the less serios is structure)

weight loss, food gets stuck

Front 7

what are 2 common complications of GERD

Back 7

1. stricture
2. adenocarcinoma of lower esophagous

Front 8

what is CRITICAL for GERD dx

Back 8

History- like always!

there isnt really a good set of dx criteria

Front 9

whats NERD

Back 9

is benign GERD, can be heart burn +/- dysphagia

Front 10

what are 3 complications of GERD1

Back 10

1. barrets
2. adenocarcinoma
3. stricture (also common in scleroderma)

Front 11

what is benign GERD with or w/o dysphagia

Back 11

NERD

Front 12

as far as disease frequency what has been the trend for the following GI complaints

1. H pylori
2. GERD
3. gastric adenocarcinoma
4. barrets
5. esophageal carcinoma

Back 12

decrease in the stomach: h pylori and gastric adenocarcinoma adn a shift to esophageal disroders like GERD which can lead to barrets and eventually adenocarcinoma of esophagous

Front 13

when do you see substernal burn
nd or regurg with GERD

what makes it worse
what makes it better

Back 13

night
after meals

worse when lying down or change in position
better with antacid

Front 14

classic gerd is substernal heart pain that is better with antacid and worse at night, when lying down or after a meal

what are some atypical presentation

Back 14

layngitis
hoarsness
globus- feeling something stuck in your throat
throat clearing
chronic cough
asthma
sleep apnea

Front 15

what does the body do to protect against GERD

Back 15

1. clear the esophagus- peristalsis, bicarb
2. mucosa
3. LES competence (prevent regurg)
4. gastric emptying

Front 16

why does SS get esophageal stricture often

Back 16

decreased pressure in LES, so acid can back up easier

Front 17

what are some things that can cause GERD

Back 17

1. low LES tone- SS
2. Increased Gastric VOlume- delayed gastric empty
3. inadequate esophageal clearance- decreased salivation, decreased peristalsis
4.

hiatial hernia
impaired mocosal integrity

Front 18

are hiatal hernias always assoicated with GERD

Back 18

nope, but they can

Front 19

what are the dx tests for GERD

Back 19

1. barium swallow- low S/S
2. Endoscopy- Ro barrets, adenocarcinoma, stricture
3. esophageal manometry- only for surgical pts
4. 24 hr pH monitoring

**these arent really all that great, remeber we said hx is iportant. in a person with londstanding untreated be sure to endoscope to ro complication

Front 20

is it important to work up and tx GERD

Back 20

ya can have cancer as complication

Front 21

can GERD cause ulcer

Back 21

you bet

Front 22

whats the progression of GERD into adenocarcinoma

Back 22

GERD
barrett esophagous
barret with high grade dysplasia
adenocarcimona

Front 23

what are some alarm signs in your pt with GERD

Back 23

1 old
2. anemia, rectal occult blood
3. dysphagia
4. respiratory sx
5. early satiety
6. weight loss
7 sx despite tx

Front 24

what is the etiology of sq cell esophageal cancer

adenocarcinoma

Back 24

Sq cell: EtOH, TOB, women, proximal/mid esophagous

Adenocarcinoma: assoicated with Barrets, white male, distal esophagous, increasing frequency

Front 25

tx for GERD

phase 1-4

Back 25

1. lifestyle- stop smoke, loose weight, elevate head of bed, no food/liquids after 6 pm

2. H2 receptor antagonist

3. PPI

4. Surgery- nissen fundo plication

Front 26

62 yo male with heartburn after meals for 7 years. no Other sx. tums and OTC H2 blocker. what do you do

1. esophageal pH monitor and manometry
2. endoscope
3. nissen fundo plication
4. opeprazole and see him in 6 mo
5. quite complaining

Back 26

endoscope bc untx for 7 years, look for complications