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Gastric Acid Disorders and GERD
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Gastric Acid Disorders and GERD
Gastric Acid Disorders and GERD
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1
Question
What condition results from increased or overactive parietal cells secreting more hydrochloric acid?
Page 1
Answer
Hyperacidity leading to Peptic Ulcer Disease (PUD) and Gastroesophageal Reflux Disease (GERD)
2
Question
What are the symptoms of Peptic Ulcer Disease caused by hyperacidity from increased parietal cells?
Page 1
Answer
Epigastric pain, heartburn, nausea, vomiting, possible GI bleeding
3
Question
How does hyperacidity from parietal cells contribute to Gastroesophageal Reflux Disease?
Page 1
Answer
High acid increases reflux into the esophagus leading to heartburn, regurgitation, and inflammation
4
Question
What conditions are associated with hyperactive parietal cells?
Page 1
Answer
Zollinger-Ellison syndrome (gastrinoma leading to high gastrin and parietal cell hyperplasia) and chronic hypergastrinemia
5
Question
What results from decreased parietal cells secreting less hydrochloric acid?
Page 1
Answer
Hypoacidity or hypochlorhydria leading to impaired digestion, vitamin B12 deficiency, and increased infection risk
6
Question
How does hypoacidity from decreased parietal cells impair digestion?
Page 1
Answer
Low acid reduces protein breakdown (pepsinogen activation to pepsin) leading to bloating, indigestion, and malabsorption
7
Question
Why does decreased parietal cells increase vitamin B12 deficiency risk?
Page 1
Answer
Parietal cells produce intrinsic factor essential for B12 absorption leading to megaloblastic anemia if deficient
8
Question
What is the hallmark of Gastroesophageal Reflux Disease?
Page 1
Answer
Reflux esophagitis with acute symptoms of esophageal inflammation from backward flow of stomach contents
9
Question
What are the main causes of Gastroesophageal Reflux Disease?
Page 1
Answer
Inappropriate relaxation or decreased tone of the lower esophageal sphincter (LES), elevated gastric volume or intra-abdominal pressure, delayed gastric emptying
10
Question
What are precipitating factors for Gastroesophageal Reflux Disease?
Page 1
Answer
Smoking, alcohol abuse, obesity
11
Question
What is the primary assessment finding in Gastroesophageal Reflux Disease?
Page 1
Answer
Heartburn or pyrosis: substernal or retrosternal burning sensation radiating to neck, jaw, or back mimicking angina or MI
12
Question
Why does GERD pain mimic angina or myocardial infarction?
Page 1
Answer
Esophagus and heart share similar nerve pathways; acid reflux causes retrosternal burning pain radiating to chest, neck, jaw, or back worsening after meals or lying down
13
Question
How does GERD differ from angina in symptom characteristics?
Page 2
Answer
GERD: burning sensation related to meals, worse lying flat or bending, relieved by antacids, not associated with exertion; Angina: pressure/tightness/crushing triggered by exertion/stress, not relieved by antacids, with diaphoresis, SOB, N/V, radiating pain
14
Question
What is regurgitation in the context of GERD?
Page 2
Answer
Warm fluid traveling up the throat with sour or bitter taste posing aspiration danger noted by crackles in lungs
15
Question
What are hypersalivation, dysphagia, and odynophagia in GERD?
Page 2
Answer
Hypersalivation is water brash; dysphagia is difficulty swallowing; odynophagia is painful swallowing
16
Question
What is Barrett’s epithelium in prolonged GERD?
Page 2
Answer
Change from normal squamous cell epithelium to columnar epithelium more resistant to acid but pre-malignant increasing cancer risk
17
Question
What progression occurs in Barrett’s esophagus?
Page 2
Answer
Epithelial metaplasia to dysplasia to adenocarcinoma
18
Question
What other manifestations occur in GERD besides classic symptoms?
Page 2
Answer
Nocturnal cough, eructation (belching), flatulence, bloating after eating, nausea and vomiting
19
Question
Why does GERD cause nocturnal cough and asthma-like symptoms?
Page 2
Answer
Weak LES allows acid reflux to pharynx when supine/asleep; reduced reflexes lead to microaspiration irritating airways
20
Question
What is the most accurate diagnostic test for GERD?
Page 2
Answer
24-hour ambulatory pH monitoring with catheter through nose to distal esophagus continuously recording pH
21
Question
What does endoscopy detect in GERD patients?
Page 2
Answer
Esophagitis, Barrett’s esophagus, strictures, ulcers; useful for complications not routine diagnosis
22
Question
What is esophageal manometry used for in GERD context?
Page 2
Answer
Motility testing measuring LES pressure and peristalsis with water-filled catheters; not specific for GERD diagnosis
23
Question
What dietary restrictions help manage GERD?
Page 2
Answer
Limit foods decreasing LES pressure (chocolate, fatty foods, caffeinated beverages, peppermints, alcohol), spicy/acidic foods (orange juice, tomatoes), carbonated beverages
24
Question
What lifestyle change minimizes nighttime GERD reflux?
Page 3
Answer
Sleep in left lateral side-lying position
25
Question
Why avoid hot drinks in GERD patients?
Page 3
Answer
Cause local vasodilation leading to LES relaxation losing barrier function allowing acid reflux worsening heartburn and esophagitis
26
Question
Why is left lateral position recommended for GERD sleep?
Page 3
Answer
Stomach's greater curvature on left; gravity keeps gastric contents in stomach reducing reflux unlike right side
27
Question
What antacids are used for GERD?
Page 3
Answer
Aluminum Hydroxide, Magnesium Hydroxide, Maalox, Mylanta neutralizing HCl and deactivating pepsin
28
Question
What do H2 receptor antagonists do in GERD treatment?
Page 3
Answer
Decrease acid production of parietal cells (Famotidine, Ranitidine/Zantac, Cimetidine/Tagamet, Nizatidine)
29
Question
What is the main treatment class for GERD and their mechanism?
Page 3
Answer
Proton Pump Inhibitors (PPIs): inhibit proton pump of parietal cell decreasing acid secretion (Omeprazole, Lansoprazole, Rabeprazole, Pantoprazole, Esomeprazole)
30
Question
What does Metoclopramide (Reglan) do for GERD?
Page 3
Answer
Increases gastric emptying