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26 Cards in this Set
- Front
- Back
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119. When is endoscope for GERD indicated?
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a. If cancer or a complication of GERD is suspected.
b. A biopsy should also be performed to assess changes in oesophageal mucosa. |
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120. Most sensitive and specific test for GERD?
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a. 24-hour pH monitoring in the lower oesophagus.
b. It is the gold standard, but is usually unnecessary. |
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121. When is an upper GI series (barium contrast study) used for GERD?
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a. Only helpful in identifying complications of GERD (strictures/ulcerations), but cannot diagnose GERD itself.
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122. Complications of GERD?
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a. Erosive oesophagitis
b. Peptic stricture c. Oesophageal ulcer d. Barret’s oesophagus |
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123. Erosive oesophagitis?
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a. These pts are at high risk of developing complications such as stricture, ulcer, or Barret’s oesophagus.
b. They are candidates for long-term PPI therapy. |
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124. Peptic stricture secondary to GERD?
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a. Consists of fibrotic rings that narrow the lumen and obstruct the passage of food.
b. Presents w/dysphagia; may mimic oesophageal cancer c. EGD can confirm diagnosis. |
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125. Tx of Peptic stricture?
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a. Dilation.
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126. Barret’s oesophagus?
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a. Occurs in 10% of pts w/GERD
b. The normal, stratified squamous epithelium of the distal oesophagus is replaced by columnar epithelium. c. Dysplastic changes may occur, w/risk of adenocarcinoma. d. Pts who have had symptomatic GERD for at least 5 yrs (and can undergo surgery if cancer is found) should be screened for the possibility of Barrett’s. |
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127. What does GERD associated w/dysphagia suggest the development of?
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a. Peptic stricture.
b. Alternatively, a motility disorder or cancer may be present. |
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128. How should diagnosed Barret’s be monitored?
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a. If no dysplastic changes, periodic surveillance is appropriate every 3 yrs or so).
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129. Medical tx of GERD/
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a. Long-term PPIs.
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130. Recurrent pneumonia (a risk of GERD)?
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a. Due to recurrent pulmonary aspiration.
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131. What is the cytologic aspirate finding on bronchoscopy that can diagnose aspiration of gastric contents in pneumonia?!?
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a. Lipid-laden Macs (from phagocytosis of fat)!
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132. Other complications of GERD?
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a. Pitting of dental enamel (dental erosion)
b. Gingivitis c. Laryngitis, pharyngitis. |
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133. Phase I (initial tx-I of VI phases) for GERD?
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a. Behaviour modification- diet (avoid fatty foods, coffee, alcohol, orange juice, chocolate. Avoid large meals before bedtime).
b. Sleep w/trunk of body elevated c. Stop smoking d. Antacids- after meals and at bedtime. |
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134. Phase II tx of GERD?
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a. Add an h2 blocker- can be used instead of or in addition to antacids.
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135. Phase III tx of GERD?
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a. Switch to a PPI- use if above txs fail to resolve sx or in pts w/erosive oesophagitis.
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136. Phase IV tx of GERD?
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a. Add a promotility agent, such as metoclopramide (a dopamine blocker), which is most commonly used.
b. Or c. Bethanechol (a cholingergic agonist) |
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137. Phase V tx of GERD?
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a. Combination therapy:
1. H2 blocker plus promotility agent 2. PPI plus promotility agent b. Increase dose of H2 blocker or PPI |
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138. Phase VI tx of GERD?
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a. Antireflux surgery for severe or resistant cases.
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139. Indications for surgery of GERD?
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a. Intractability (failure of medical tx)
b. Respiratory problems due to reflux and aspiration of gastric contents. c. Severe oesophageal injury (ulcer, haemmorhage, stricture, Barret’s oesophagus). |
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140. Types of surgery for GERD?
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a. Nissen fundoplication (may be done open or laparoscopically)- procedure of choice for a pt w/normal oesphageal motility.
b. Partial fundoplication- when oesophageal motility is poor. |
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141. Outcomes of surgery for GERD?
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a. Excellent results have been reported.
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139. Indications for surgery of GERD?
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a. Intractability (failure of medical tx)
b. Respiratory problems due to reflux and aspiration of gastric contents. c. Severe oesophageal injury (ulcer, haemmorhage, stricture, Barret’s oesophagus). |
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140. Types of surgery for GERD?
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a. Nissen fundoplication (may be done open or laparoscopically)- procedure of choice for a pt w/normal oesphageal motility.
b. Partial fundoplication- when oesophageal motility is poor. |
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141. Outcomes of surgery for GERD?
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a. Excellent results have been reported.
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