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  1. Name four diseases of the esophagus.
    • Heartburn
    • Aphagia-> Foreign body/food impaction
    • Dysphagia-> Difficult swallowing ->(Oropharyngeal dysphagia or Esophageal dysphagia)
    • Odynophagia-> Painful swallowing-> (Sharp, substernal pain with swallowing and Reflects severe erosive dz, infectious esophagitis)
  2. What is an upper endoscopy useful for?
    • Direct visualization
    • Capable of biopsy
    • Study of choice for persistent heartburn, odynophagia, and abnormalities noted on barium studies
  3. What study differentiates between mechanical and motility disorders and is the study of choice to evaluate dysphagia?
    Barium esophagography
  4. What does an esophageal pH recording do?
    • Records pH
    • Correlates to patient's symptoms
  5. What study is:
    -Used to assess esophageal motility
    -Determines the location of the lower esophageal sphincter for pH probe placement
    -Establishes etiology of dysphagia, esp. achalasia (after Barium esophagram)
    -Pre-operative prior to Nissen fundoplication
    Esophageal Manometry
  6. What are the 4 layers of the GI wall?
    • Mucosa
    • Submucosa
    • Muscularis
    • Serosa
  7. True or false: The mucosa contains blood vessels, nerves, and lymphatics
    False. The submucosa contains blood vessels, nerves, and lymphatics. The mucosa contains epithelium.
  8. True or false: The muscularis is usually two layers of smooth muscle -> the outer longitudinal and inner circular.
  9. What makes up the serosa?
    Simple squamous epithelium and connective tissue.
  10. What percentage of adults have weekly symptoms of GERD? What percentage have daily symptoms?
    • Weekly: 20%
    • Daily: 10%
  11. What are the factors contributing to GERD?
    • Incompetent lower esophageal sphincter
    • Hiatal hernia
    • Irritant effects of reflux -> (Acidic gastric fluid w/pH < 4.0) -> Alkaline pancreatic secretions
    • Abnormal esophageal clearance: diminished peristalsis-> acid stays in esophagus
    • Delayed gastric emptying: Gastroparesis or partial gastric outlet syndrome
  12. Causes of GERD: What are contributing causes to decreased pressure of lower esophageal spincter?
    • High fat foods
    • Nicotine
    • Ethanol
    • Caffiene
    • Medicines (Nitrates, calcium channel blockers, anticholinergics, progesterone, estrogen
    • Pregnancy
  13. Causes of GERD: What are contributing causes to decreased esophageal motility?
    • Achalasia
    • Scleroderma
    • Presbyesophagus
    • Diabetes
    • Medicines (nitrates, calcium channel blockers, anticholinergics, progesterone, estrogen)
    • Pregnancy
  14. Causes of GERD: What are contributing factors to prolonged gastric motility?
    • Medicines (nitrates, calcium channel blockers, anticholinergics, progesterone, estrogen)
    • Outlet obstruction
    • Diabetic gastroparesis
    • High fat food
    • Pregnancy
  15. Barrett's esophagus is a complication of GERD. What are some of the features of this complication?
    • Squamous epithelium replaced by metaplastic columnar epithelium: Can lead to adenocarcinoma
    • Occurs in 10% of patients c chronic reflux
    • Diagnosed by endoscopy
    • Treatment is long-term PPI
    • Recommendation of endoscopy in patients with > 5 yr history of GERD symptoms
    • Q 3-5 yrs with known Barrett's
    • Dysplasia (low grade -> annual endoscopy) (high grade -> esophagectomy)
  16. Stricture is a complication from GERD. What are some of the features of Stricture?
    • Occurs in 10% of patients with esophagitis
    • Gradual development of solid food dysphagia
    • Must have endoscopy to R/O malignancy
    • Treatment: Dilation, then long term PPI
  17. What are the treatment goals for GERD?
    • Provide symptomatic relief
    • Heal esophagitis
    • Prevent complications
    • Most patients will have empirical diagnosis and treatment
  18. What lifestyle modifications should be made for patients with GERD?
    • Avoid lying down within 3 hours after meals
    • Elevate head of bed 6"
    • Avoid acidic foods (tomato, citrus, spicy, coffee)
    • Avoid pepperment, chocolate, ETOH, smoking
    • Lose weight

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2013-10-23 15:58:31

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