GERD Word Scramble
|
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Question | Answer |
In GERD the resting tone of the ? tends to be less than normal permitting transient relaxation 1-2 hours after eating | lower esophageal sphincter (LES) |
factors that decrease LES tone | estrogen, progesterone, glucagon, secretin, cholecystokinin, tobacco, alcohol, peppermint, chocolate, high fat/carbs food |
drugs that increase LES tone | urecholine, reglan, pentobarbital, histamine, antacids |
drugs that decrease LES tone | anticholinergics, theophylline, Demerol, calcium channel blockers |
other causes of GERD (than LES) | delayed gastric emptying, gastric or duodenal ulcers that can cause pyloric stenosis, pyloric strictures, hiatal hernia |
s/s of GERD | burning pain that radiates upward, regurgitation, dysphagia |
s/s suggestive of cancer or alarm | dysphagia, painful swallowing, noncardiac CP, hematemesis, weight loss, choking |
diagnosis: GERD | the AGA recommends diagnostic testing if pt does not respond to PPIs bid or if alarm sx are present |
drugs that improve LES tone | reglan, bethanechol; not considered for monotherapy antacids |
drugs to reduce the amount of acid | H2 blockers and PPIs |
increase esophageal healing by about 50% | H2 blockers |
increase esophageal healing by about 80% and decrease acid secretion by almost 100% | PPIs |
goals of treatment for GERD (4) | 1. reduce or eliminate the symptoms 2. heal any esophageal lesions 3. manage or prevent complications such as stricture, Barrett's esophagus, esophageal carcinoma 4. prevent relapse |
Step-up approach: | 1. lifestyle and antacids 2. H2 blockers 4-8 weeks 3. PPIs 4-8 weeks 4. Gastroenterologist |
Step-down approach: | 1. lifestyle and PPIs daily for 8 weeks 2a. if no relief, PPIs bid for 4-8 weeks 2b. if relief, step back to H2s 3. if no relief after 8 weeks PPIs, refer to gastroenterologist |
Antireflux maneuvers: | HOB elevated, avoid laying, bending, or exercising within 3 hours of meal, appropriate body weight |
Endoscopy needed if no symptom relief after ? months or sx that suggest complications | 3 |
Occurrence of GER in infants | up to 100% of 3 month olds; 4% of 6 month olds; 20% of 12 month olds 90-95% outgrown by 12-18 months |
most infants outgrow GER so aggressive management is reserved for those experiencing: | poor weight gain, feeding refusal, arcing, crying during feeding, persistent irritability, pain apnea, cyanosis |
Diagnosis of GER in infants; | H&P, caloric intake, CBC,BMP, BUN, upper GI not recommended |
most sensitive and accurate way to dx GER in infants and young children: | esophageal pH monitoring or combined multiple intraluminal impedance (MII) |
infants with suspected GER tx: | referral to pediatric gastroenterologist empirical tx with drugs is not approptiate |
older children with GERD sx: | lower CP, dysphagia, hematemesis, iron deficiency anemia, wheezing, aspiration, recurrent pheumonia, chronic cough, stridor |
older children and adolescents tx GERD: | may be empirically treated for 4 weeks with PPI(Prilosec, Nexium, or Prevacid) may use H2s in children do not recommend prokinetics (Reglan) in children |
older children dx of GERD: | if atypical or extra-esophageal sx, do not respond to initial therapy, recurrent/progressive sx refer to gastroenterologist if vomiting, difficult or painful swallowing, may require endoscopy |
older adults with H. pylori decreases acid secretion d/t the production of bacterial products and cytokines thus enhancing | the acid inhibition of H2s and PPIs, then after eradication of H.pylori the acid reducing efficacy of the drugs is diminished |
there is significant variation in older adults r/t drug clearance r/t two genotypes | slow metabolizers(more predominant in white and Asian) and extensive metabolizers |
Drugs affected by slow metabolizers in older adults: | most affected: omeprazole least affected: rabeprazole (Aciphex) moderately affected: Nexium Therefore Aciphex and Nexium may do better in older adults. |
H2s in older adults: | Pepcid generally safe, caution with renal Axid: asymptomatic VT, hepatic damage Zantac and Tagamet: confusion, toxicity,lots of drug interactions with Tagamet |
Prokinetics in older adults: | Reglan risk for CNS toxicity. Contraindicated in CHF, RF, hypokalemia |
Concerns of long-term PPI use: | development of pre-cancerous cells d/t hypochlorhydria with enterochromaffin cell-like hyperplasia changes, increase risk of hip fxs if on PPIs longer than 2 years, Vitamin B12 deficiency |
Created by:
heatherbrown2020
Popular Medical sets