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17 Cards in this Set
- Front
- Back
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The upper 1/3 of the esophagus is made up of ____ muscle, while the lower 2/3rds are made up of ____ muscle.
How many sphincters are there? Which, along with the crux of diaphragm and the angle of His forms a pinch-cock to avoid reflux? |
striated, smooth
2, UES & LES LES |
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What is primary peristalsis?
What innervates the LES? |
peristalsis associated with a swallow
vagal preganglionic and sympathetic post-ganglionic neurons |
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Does saliva help neutralize the pH in the terminal parts of the esophagus?
Is it abnormal for normal people to reflux? |
Yes.
No, but they quickly clear it. |
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What is the definition of GERD?
Are regurgitation, belching, or dysphagia often common sx? |
Cephalad displacement of gastric contents into esophagus causing either tissue damage or symptoms
yes. |
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GERD:
- does it increase w/ age? - gender predominance? State whether or not the following are risk factors for GERD: obesity, pregnancy, smoking, collagen vascular dz, EtOH, hiatal hernia |
- yes
- more common in males - all are |
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Is increased potency of stomach acid often the cause of GERD?
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No.
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How can a hiatal hernia contribute to GERD?
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When the LES is up in thoracic cavity abnormally, inspiration opens the LES with negative thoracic pressure
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The following describe which complication of GERD:
Occurs in 10-40% of those with reflux symptoms Secondary to high amounts of acid, pepsin, and perhaps duodenal contents (bile) refluxing More common in those with a hiatal hernia Chronic, relapsing condition Presents as chest pain, dysphagia, occ. odynophagia Does this complication increase the chance of stricture or Barrett's esophagus? |
Erosive Esophagitis
yes. |
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What is a stricture, and how does it form?
- presenting sx? - tx? |
Occurs secondary to severe circumferential mucosal damage
Composed of circular bands of scar tissue underlying mucosa - dysphagia - often amenable to dilatation |
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What is Barrett's esophagus?
- for which neoplasm is it considered a precursor? + is this a high risk? - does it spontaneously resolve? - is it more or less symptomatic than normal mucosa? - occurs in what % of GERD pts? |
Metaplastic change of mucosa from squamous to specialized columnar
- adenoCA of esophagus + no, low risk of cancer. - no - less - 10% |
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For pts with classic GERD sx, should we try empiric therapy?
What are some alarm sx? Effect re: tx? |
yes, and a good response can mean we don't have to do further testing.
Weight loss, dysphagia, anemia, early satiety, bleeding - require early investigation w/ EGD or barium swallow; not empiric tx. |
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Is EGD good at finding GERD itself? NERD? How about complications of GERD?
What is the best dx test for GERD? Can barium swallow dx GERD? What is it good for? |
No, no. Yes, it's excellent for finding complications; it misses the dz itself b/c people can have reflux and not have damage.
24hr pH probe. no. investigating dysphagia, if EGD isn't available. |
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What type of GERD tx should be tried first?
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conservative
- elevated head - stop smoking - stop EtOH - reduce fat - lose weight - avoid chocolate, peppermint, caffeine, citrus, and tomatoes |
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For occasional, mild, non-erosive GERD, what is the tx?
more severe dz? Erosive esophagitis, and the worst dz? |
PRN OTC antacids; H2 blockers
H2 blockers @ 3x recommended dose PPIs |
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What is a Nissen procedure? When is it used?
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loop stomach around the esophagus laproscopically
Used in those refractory to therapy, those regurgitating food, and those unable/unwilling to take longterm, high dose PPI |
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If complications occur i/ pts w/ GERD, when do they usually happen?
What is the prog if cancer is developed? |
Early on in "reflux life"
dismal. |
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Candida
Herpes CMV Radiation HIV Pill-Induced ... can any of these cause esophagitis? |
yes, all can.
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