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30 Cards in this Set
- Front
- Back
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What type of reflux is GERD
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Physiologic reflux
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When does GERD s/sx usually occur
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mainly after meals
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What is GERD
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reflux of gastric acid into the esophagus usually due to an incompetent LES
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What is the classic s/sx of GERD
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heartburn(pyrosis)
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What age group and sex is most likely to present with GERD
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all ages and sexes are equal but men are 10x more likely to develop Barrett's esophagitis a complication of GERD
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What Risk factors should you teach a patient to avoid to help prevent GERD
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avoid carbonated drinks, overeating, tight clothing, obesity, Smoking, ETOH, Drugs
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What physiologic problems can increase chance of developing GERD
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pregnancy, Hiatal Hernia, Scleroderma, Diabetes
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What is the primary barrier to reflux of gastric contents into esophagus
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Lower Esophageal Spinchter LES
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What is a hiatal hernia
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where part of the stomach bulges out above the diaphragm
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Why would you run an ECG on a patient complaining of heartburn possible due to GERD
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r/o cardiac ischemic disease especially in patients presenting with cardiac risk factors
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What might you find on physical exam of patient with GERD in there mouth
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loss of tooth enamel
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If patient is having trouble controlling their GERD what further dx test would you order
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endoscopy with biopsy to test for barrett's esophagus. Upper GI series barium swallow, 24 ambulatory PH monitor, Esophageal manometry (test LES)
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You suspect your patient has GERD they complain of Odynophagia so you order an endoscopic exam on exam you not white cheesy exudate and diffuse esophagitis what is likely causing the patients problems
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Infectious Esophagitis not GERD. Patient is likely immunosuppressed because infectious esophagitis is rare most common cause of it is Candida
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What medications are likely causes of Esophagitis
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NSAIDS, tetracyclines, KCL supplements, Steroids, Fosamax
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What will you likely see on endoscopy of patient suffering from medication induced esophagitis
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deep isolated ulcerations proximally
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What comorbid condition often accompanies GERD
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Peptid Ulcer Disease PUD
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If patient has duodenal peptic ulcer during your history what would you expect patient to say makes it feel better
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eating generally relieves pain fo PUD in duodenal area
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What is the most important complication of GERD and why is it so important
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Barrett's Esophagus where normal squamous epithelial tissue is replaced my metaplastic columnar tissue this increase a pts risk of esophageal carcinoma
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You have been treating a patient for GERD they present at your office complaining of dysphagia and recently developed aspiration pneumonia what complication have they likely developed with their GERD
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Peptic Esophageal Stricture- may cause fodd impaction and pulmonary aspiration
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What is the diagnostic study of choice for evaluating PERSISTENT heart burn and odynophagia
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Upper Endoscopy allows you to dilate strictures, biopsy tissues, visualize mucosa
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What is the GOLD STANDARD functional diagnosis test for GERD
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ambulatory 24-h pH recording- lets you see when patients have reflux and how often. Must be done prior to surgery
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What test will you order that is not useful for diagnosing GERD but will help you see how the LES is functioning also helps r/o achalasia, must be done prior to surgery
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Manometry
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What test will help you distinguish between mechanical and motility disorders
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Barium Esophagography
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You are a primary care prac and patient presents complaining of heartburn w/ GI bleeding, dysphagia, Odynophagia what should you do
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Refer Patient because of the GI bleeding also do a cardiac workup to r/o ischemic heart disease
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If patient has complained of GERD symptoms for over 5 years what should you do for them when they come to your office
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order a consult for endoscopy to check for Barrett's esophagitis
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What should be your first goal in tx GERD
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lifestyle modification with the patient and alleviating symptoms with OTC meds to avoid further damage to esophagus
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If life style modifications are not sufficient to control GERD what medication should be added next
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H2 receptor antagoinist (tidine drugs IE ranitidine, famotidine, cimetidine, nizatidine
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After adding H2 blockers your patient is still suffering s/sx of GERD what should you add to their tx
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Proton Pump Inihibtor (prazole's, omeprazole, lansoprazole, raberprazole, esomeprazole) Help healing from esophagitis prevent complications such as barrett's esophagitis
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If medications fail to control Patients GERD what tx option is left
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Surgery, laproscopic open nissen fundopiication
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If your patient has Barrett's esophagitis as a complication from their GERD what should be done for them
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they should have surveillance endoscopy with biopsy every 2yrs or less
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