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ABIM-GI November 16th, 2022 > Esophagus > Flashcards

Esophagus Flashcards

1
Q

What TESTING should be done for DYSPHAGIA NOT explained by stenosis or esophagitis, CHEST PAIN not explained by heart disease or other extra-esophageal processes and PRE-OP for patients being considered for ANTI-REFLUX surgery?

A

ESOPHAGEAL MANOMETRY

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2
Q

INADEQUATE LES RELAXATION is found in what ESOPHAGEAL disorder?

A

ACHALASIA

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3
Q

UNCOORDINATED esopahgeal contractions are noted in what ESOPHAGEAL condition?

A

DIFFUSE ESOPHAGEAL SPASM

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4
Q

HYPERcontraction of the ESOPHAGUS is noted in what esophageal disorder?

A

NUTCRACKER ESOPHAGUS (also in isolated hypertensive LES)

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5
Q

HYPOcontraction of the ESOPHAGUS is found in what esophageal condition?

A

INEFFECTIVE ESOPHAGEAL MOTILITY

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6
Q

What is considered NORMAL (basal) LES (EGJ) PRESSURE?

A

10-35 mmHg

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7
Q

In which ACHALASIA TYPE do you see an IRP (EGJ releaxation pressure) >15 mm Hg, and 100% FAILED peristalsis (DCI <100 mmHg/cm/second) - should be >450 and <8,000?

A

ACHALASIA TYPE-I

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8
Q

What is considered NORMAL EGJ RELAXATION with SWALLOW (Integrated Relaxation Pressure - IRP)

A

<15 mmHg

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9
Q

Waht is considered NORMAL SPEED of PERILSTALSIS (Contractile Front Velocity - CFV) from UES to LES?

A

<9 cm/second

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10
Q

What is considered a NORMAL DISTAL WAVE AMPLITUDE (mean Distal Contractile Integral - DCI)?

A

>450 and <8,000 mmHg/cm/second (the AMPLITUDE of PERISTALSIS)

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11
Q

What is the DISTAL LATENCY in esophageal manometry?

A

The interval between the START of a SWALLOW and the Contractile Deceleration Point (CDP) - the point of transition from esophageal peristaltic clearance to esophageal emptying

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12
Q

In which ACHALASIA TYPE do you see an IRP (EGJ releaxation pressure) >15 mm Hg, and 100% FAILED peristalsis (DCI <100 mmHg/cm/second) - should be >450 and <8,000 AND PANESOPHAGEAL PRESSURIZATION with ≥20% of SWALLOWS?

A

ACHALASIA TYPE-II

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13
Q

In which ACHALASIA TYPE do you see an IRP (EGJ releaxation pressure) >15 mm Hg, and NO NORMAL peristalsis, SPASTIC CONTRACTIONS (DL <4.5 seconds) with DCI >450 mmHg/cm/second) - should be >450 and <8,000 with ≥20% of SWALLOWS?

A

ACHALSIA TYPE-III

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14
Q

NORMAL IRP, 100% FAILED peristalsis (DCI <100 mmHg/cm/second)

A

ABSENT CONTRACTILITY

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15
Q

NORMAL IRP, ≥20% PREMATURE CONTRACTIONS (DL <4.5 seconds), with DCI >450 mmHg/cm/second (some normal peristalsis mat be seen)

A

DISTAL ESOPHAGEAL SPASM

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16
Q

NORMAL IRP, ≥20% SWALLOWS with DCI >8,000 mmHg/cm/second

A

HYPERcontractile (jackhammer esophagus)

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17
Q

NORMAL IRP, ≥50% INEFFECTIVE SWALLOWS (FAILED DCI <100 or WEAK DCI <450 mmHg/cm/second)

A

INEFFECTIVE ESOPHAGEAL MOTILITY

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18
Q

NORMAL IRP, ≥50% FRAGMENTED contractions (breaks >5 cm in 20 mmHg isobaric contour) with DCI >450 mmHg/cm/second

A

FRAGMENTED PERISTALSIS

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19
Q

In this TYPE of ACHALASIA, swallowing results in NO CHANGE in the pressurization of the esophagus?

A

TYPE-I ACHALASIA

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20
Q

In this TYPE of ACHALASIA, swallowing results in SIMULTANEOUS, LOW-AMPLITUDE PRESSURIZATION that spans the ENTIRE LENGTH of the esophagus?

A

TYPE-II ACHALASIA

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21
Q

In this TYPE of ACHALASIA, swallowing results in PREMATURE SPASTIC CONTRACTIONS of the esophagus with a DCI >450 mmHg/cm/second?

A

TYPE-III ACHALASIA

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22
Q

Modalities to treat achalasia work BEST in what TYPE of ACHALASIA (dilation, botox, POEM)?

A

TYPE-II ACHALASIA (don’t work well at all in type-III)

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23
Q

In WHICH patients should BOTOX injection be used to treat ACHALASIA rather than PNEUMATIC DILATION (30 mm - 40 mm balloon) or HELLER MYOTOMY/POEM?

A

In those who are HIGH-RISK for more INVASIVE procedures

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24
Q

Does ANY therapy available for ACHALASIA last long-term (>2 years)?

A

NO, most patients need further treatment thereafter

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25
Q

ELEVATED IRP (>15 mmHg) with NORMAL PERISTALSIS, what is that condition called?

A

EGJ OUTFLOW OBSTRUCTION (EOE, cancer, stenosis)

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26
Q

What MEDICATIONS can ELEVATE the IRP and cause HYPERcontraction (elevated DCI) and SPASM with SHORTENED DL?

A

OPIOIDS

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27
Q

Pt presents with esophageal outlet obstruction (elevated IRP) and SPASTIC contractions, what should be ruled out FIRST?

A

OPIOID use

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28
Q

Episodes of DYSPHAGIA and CHEST PAIN, TERTIARY esophageal contractions on IMAGING and PREMATURE, SPASTIC contractions on MANOMETRY?

A

Distal Esophgeal Spasm (diffuse esophageal spasm) - DES

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29
Q

The TIME from RELAXATION of the UES to the CDP (contractile deceleration point) which is the point of transition from ESOPHGEAL PERISTALTIC CLEARANCE to ESOPHAGEAL EMPTYING is known as what?

A

Distal Latency (DL) - NORMAL is >4.5 seconds

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30
Q

A condition associated with GERD, when TWO or MORE SWALLOWS (≥2) have a DCI >8,000 mmHg/cm/second

A

HYPERcontractile (jackhammer) esophagus (previusly nutcracker esophagus)

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31
Q

What condition is found in >80% of patients with SCLERODERMA (also MCTD, RA, SLE) with PREDISPOSITION to GERD in which ≥50% of SWALLOWS have a CDI <450 mmHg/cm/second?

A

Esophageal HYPOcontraction and INEFFECTIVE ESOPHAGEAL MOTILITY

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32
Q

What is considered FAILED PERISTALSIS?

A

100% of SWALLOWS have a DCI <100 mmHg/cm/second

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33
Q

What is considered INEFFECTIVE ESOPHAGEAL MOTILITY?

A

≥50% SWALLOWS have a DCI <450 mmHg/cm/second (CHICAGO classification)

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34
Q

What causes NON-CARDIAC CP in patients with GERD?

A

SENSITIZATION of the esophagus to even normal stimuli

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35
Q

If patient with NON-CARDIAC CP and WITHOUT ALARM SYMPTOMS (dysphagia, weight loss, bleeding) does NOT respond to 2 MONTHS of PPI therapy, whats the NEXT STEP?

A

ESOPHAGEAL MANOMETRY (if POSITIVE, treat with TCAs, Trazodone or SSRI)

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36
Q

What is the PREFERRED treatment for TYPE-III ACHALASIA (episodic chest pain, dysphagia to BOTH liquids and solids, IRP >15 mmHg, no normal peristalsis, PREMATURE CONTRACTIONS ie SPASMS with some HYPERcontractility (DCI >8,000) involving the distal 2/3rds of the esophagus)?

A

POEM (with longer tunnel)

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37
Q

What should ALWAYS be done BEFORE evaluating for ESOPHAGEAL causes of CP?

A

CARDIOLOGY EVALUATION

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38
Q

LONG-standing, INTERMITTENT, NON-PROGRESSIVE dysphagia for SOLID foods WITHOUT CP BETWEEN episodes of dysphasia suggests what diagnosis?

A

SCHATZKI RING

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39
Q

What are the TREATMENT methods for HYPERcontractile ESOPHAGUS (distal esophgeal spasm) with NORMAL IRP, DL <4.5 seconds in ≥20% of swallows?

A

PEPPERMINT OIL, SILDENAFIL, CA-Channel Blockers, NITRATES

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40
Q

How LONG is a NORMAL EGJ relaxation window (bottom of tracing before pressure increases again)?

A

~10 SECONDS

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41
Q

IRP >15 mmHg with NO PERISTALSIS is what? What if there is ANY PERISTALSIS?

A

NO PERISTALSIS - ACHALASIA

ANY PERISTALSIS - EGJ OUTFLOW OBSTRUCTION

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42
Q

What are the PREFERRED treatment modalities for the different TYPES of ACHALASIA?

A

TYPE-I: Pneumatic Dilation or HELLER

TYPE-II: Pneumatic Dilation or HELLER

TYPE-III: POEM

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43
Q

A SHORT Distal Laency (DL <4.5 seconds) indicates what type of esophageal condition?

A

ESOPHAGEAL SPASM (≥20% of swallows)

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44
Q

What is the esophageal condition in which ≥20% of contractions, the DCI >8,000 mmHg/cm/second?

A

HYPERcontractile (Jackhammer) ESOPHAGUS

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45
Q

Esophageal motility where ≥50% of swallows are with a DCI <450 mmHg/cm/s (if <100, FAILED motility)?

A

Ineffective Esophageal Motility

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46
Q

What is the MAJOR mechanism of GERD?

A

TRANSIENT LES RELAXATION (NOT preceded by a swallow) and lasting >10 seconds - this is also part of the NORMAL BELCH reflex

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47
Q

Which GABAnergic medication has been shown to DECREASE the frequency of the TLESR (transient LES relaxation) which is the predominant mechanism in GERD?

A

BACLOFEN

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48
Q

Patients with LARGE HIATAL HERNIAS almost ALWAYS also suffer from what condition?

A

GERD

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49
Q

Does Helicobacter Pylori cause GERD?

A

NO

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50
Q

This CONDITION presisposes us to GERD, BARRETT’s ESOPHAGUS, ESOPHAGEAL ADENOCARCINOMA and HIATAL HERNIA by increased intra-gastric pressure?

A

OBESITY (high BMI)

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51
Q

Patients with GERD and LA grades C&D ESOPHAGITIS, how LONG is PPI therapy needed for?

A

INDEFINITELY

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52
Q

In patients with GERD, when is an EGD indicated?

A

ALARM SYMPTOMS (dysphagia, bleeding, anemia, wt loss, recurrent vomiting)

AND

If symptoms persist AFTER 4-8 WEEKS of BID PPI therapy

53
Q

Age ≥50, MALE, WHITE, CHRONIC GERD, HIATAL HERNIA, elevated BMI are all RISK factors for this condition requiring EGD for screening?

A

BARRETT’s ESOPHAGUS and ESOPHAGEAL ADENOCARCINOMA

54
Q

What can be IMMEDIATELY diagnosed if on EGD, REFLUX ESOPHAGITIS is found?

A

GERD

55
Q

Are LIFESTYLE modifications efficacious for GERD?

A

WEAK

56
Q

What TREATMENT is recommended to patients who have MILD and INTERMITTENT GERD symptoms?

A

H2-blockers (and as an addition to those on PPI therapy who have NIGHTIME breakthrough symptoms

57
Q

Is there a ROLE for the use of SUCRALFATE in GERD?

A

NO (little)

58
Q

Best PROCEDURE to treat GERD in those NOT morbidly OBESE?

A

Modern FUNDOPLICATION

59
Q

BEST PROCEDURE to treat GERD in the MORBIDLY OBSESE?

A

Roux-en-Y Gastric Bypass

60
Q

Which BARIATRIC surgery should be AVOIDED in patients with GERD who are MORBIDLY OBESE?

A

SLEEVE GASTRECTOMY

61
Q

What is the BEST PROCEDURE for GERD, REGURGITATION and a HIATAL HERNIA <3 cm?

A

LINX procedure

62
Q

Which is the ONLY ENDOSCOPIC therapy which has shown to TREAT GERD?

A

TIF

63
Q

The presence of troublesome, RFLUX-related symptoms in the ABSENCE of endoscopically visible mucosal breakes is called what?

A

NERD (non-erosive reflux disease)

64
Q

When a patient undergoes ESOPHAGEAL pH monitoring and is found to indeed have an esophageal pH <4 for <5% of the time in a 24 hour period, they have REFLUX HYPERSENSITIVITY to even small amounts of acid and should be tested how?

A

Esophageal IMPEDANCE pH MONITORING

65
Q

Whenever a NON-GERD esopahgeal disorder causes HEARTBURN (EOE, achalasia), what is the best NEXT TEST?

A

EGD with BIOPSY and esophageal MANOMETRY

66
Q

When performing an EGD for a patient with HEARTBURN, and they have a NORMAL-appearing esophagus, what should be done and why?

A

BIOPSY esophagus for EOE (because this can cause HEARTBURN in the absence of GERD)

67
Q

Would EOE (eosinophilic esophagtitis) be present on biopsies in a patient on PPI therapy?

A

NO (must be stopped for SEVERAL WEEKS before EGD)

68
Q

In patients with NERD, what is found on esophageal BIOPSIES that can clue you in to the REFLUX etiology of their symptoms?

A

Dilated INTRACELLULAR SPACES, elongated papillae and thickened BASAL ZONE

69
Q

In esophageal pH monitoring, a Symptom Index (SI) ≥50% indicates what?

A

It indicates that >50% of symptoms are indeed associated with acid REFLUX episodes (Symptom Associated Probability SAP >95% also signifies the same thing)

70
Q

When NORMAL, PHYSIOLOGIC episodes of ACID REFLUX cause symptoms of HEARTBURN, what is this called?

A

REFLUX HYPERSENSITIVITY (functional disorder) - TCAs, SSRIs

71
Q

In patients in whom symptoms of HEARTBURN DISAPPEAR with PPI therapy, is esophageal pH monitoring necessary to establish the diagnosis of GERD?

A

NO

72
Q

In patients with PPI-resistant GERD symptoms and a POSITIVE SI on pH manometry, BESIDES SURGERY (fundoplication, Roux-en-Y) what other medication can be tried?

A

BACLOFEN (reduces TLESR events)

73
Q

As PPIs are not well known to treat LaryngoPharyngeal Reflux (LRP), when treating, what is RECOMMENDED?

A

BID PPI therapy for 8 WEEKS

74
Q

WHEN should an H2-blocker be used at NIGHT for breakthrough reflux?

A

When there is BREAKTHROUGH reflux at night while already on BID PPI therapy

75
Q

What are the EARLY mucosal changes noted in GERD?

A

T-lymphocyte predominant inflammation of the esophagus and that PROLIFERATIVE CHANGES in the SQUAMOUS epithilium PRECEDE the development of SURFACE CELL EROSIONS (happen last)

76
Q

What are HISTOLOGIC chnages seen in GERD (NOT EARLY stages)?

A

DILATED INTRACELLULAR SPACES

77
Q

In a patient in whom PPI therapy worked well for a while but no longer does, what SHOULD be performed NEXT?

A

ON PPI pH MONITORING with IMPEDANCE

78
Q

What is the BEST treatment for REGURGITATION that occurs in spite of BID PPI therapy?

A

LINX (magnets) - MUST rule out motility disorder first as DYSPHAGIA is an issue with this procedure (rule out with manometry)

79
Q

Should you ROUTINELY check for H.pylori in patient’s with GERD?

A

NO (because H.pylori causes LESS GERD by causing gastritis with less acid production)

80
Q

What are the BEST therapeuric options for Barrett’s Esophagus with DYSPLASIA?

A

RFA and EMR (if abnormalities are noted in the Barrett’s mucosa)

81
Q

What should you ALWAYS do if you find a patient to have H.pylori?

A

TREAT

82
Q

What MUST be done after Barrett’s Esophagus is ERADICATED by EMR or RFA?

A

Continue surveillance EGD every 3-6 months

83
Q

When is ENDOSCOPIC therapy for Barrett’s Esophagus not an option?

A

When dysplasia involves the SUBMUCOSA

84
Q

How OFTEN is EGD with BARRETT’s SURVEILLANCE recommended for a patient WITHOUT DYSPLASIA?

A

Every 3-5 YEARS

85
Q

How is DYSPLASIA in Barrett’s Esophagus reviewed?

A

By TWO PATHOLOGISTS, one of which has EXPERTISE in GI

86
Q

In patients with LOW-GRADE DYSPLASIA in Barrett’s Esophagus, what is the recommendation?

A

ENDOSCOPIC THERAPY vs YEARLY EGD surveillance

87
Q

How are patients with Barrett’s Esophagus treated with findigns of INDEFINITE for DYSPLASIA?

A

With REPEAT EDG and biopsy AFTER MAXIMAL PPI therapy for 3-6 MONTHS and if STILL INDEFINITE for DYSPLASIA, EGD surveillance every YEAR

88
Q

After COMPLETE ELIMINATION of INTESTINAL METAPLASIA endoscopically in patients with Barrett’s Esophagus who had HIGH-GRADE DYSLASIA or INTRA-MUCOSAL CARCINOMA, what is the recommended EGD SURVEILLANCE period?

A

Every 3 MONTHS for the 1st YEAR, then every 6 MONTHS for the 2nd YEAR then YEARLY

89
Q

After COMPLETE ELIMINATION of INTESTINAL METAPLASIA endoscopically in patients with Barrett’s Esophagus who had LOW-GRADE DYSLASIA, what is the recommended EGD SURVEILLANCE period?

A

Every 6 MONTHS for the 1st YEAR then YEARLY

90
Q

FOOD-ALLERGEN triggered, LONG histroy of DYSPHAGIA to SOLID foods with hospitalizations for esophageal food IMPACTIONS?

A

Eosinophilic Esophagitis (EOE) - asthma, atopic dermatitis, eczema, hay fever

91
Q

What is REQUIRED for the diagnosis of EOE?

A

>15 EOSINOPHILS/HPF (reflux will cause usually <10 eosinophils/hpf)

92
Q

What is the MOST COMMON food allergen that triggers EOE?

A

MILK (then wheat, eggs, soy, seafood, nuts)

93
Q

What are the ACCPETED TREATMENTS for EOE?

A

STEROIDS (fluticasone, budesonide); PPIs; Elimination DIETs

94
Q

Which infectious agents can cause ESOPHAGEAL ULCERS that require treatment of the UNDERLYING infection?

A

HSV, CMV, HIV (multiple round ulcers)

95
Q

Whenever there is a NODULAR area in BARRETT’s esophagus, waht MUST be done PRIOR to proceeding with any other invasive therapy?

A

EGD with EMR to ensure NO SUBMUCOSAL involvement

96
Q

When RFA has been performed in a patient taking BID PPI therapy and still after several sessions, there is long-segment Barrett’s, what needs to be done NEXT?

A

Ensure patient is taking the BID PPI therapy CORRECTLY, 30 min before breakfast and 30 min before dinner PRIOR to repeating RFA - only if this too fails, proceed with fundoplication

97
Q

White exudates, linear furrows, long-standing history of solid-food dysphagia, history of asthma, >15 eosinophils/hpf allindicate EOE, what ELSE needs to be done to ESTABLISH a diagnosis of EOE?

A

Exclusion of OTHER CAUSES of EOE (vasculitis, eosinophilic gastroenteritis, Crohn’s, connective tissue disease)

98
Q

By what MECHANISM do PPIs treat EOE?

A

They INHIBIT Th2 CYTOKINE-STIMULATED SECRETION of EOTAXIN-3 by esophageal epithelial cells due to their ANTI-INFLAMMATORY effects

99
Q

What is the RECOMMENDED dose of PPI in a patient with Barrett’s esophagus?

A

ONCE DAILY (increase to twice daily if once daily is insufficient to manage acid reflux or treat GERD esophagitis)

100
Q

After an ORGAN TRANSPLANT, a patient develops FEVER, NAUSEA, VOMITING, ABDOMINAL PAIN with SEVERE ODYNOPHAGIA, whats the MOST LIKELY CAUSE?

A

INFECTIOUS ESOPHAGITIS with CMV

101
Q

Which is the ONLY stage of esophageal carcinoma that is potentially treatable ENDOSCOPICALLY?

A

T1a (NO SUBMUCOSAL INVOLVEMENT)

102
Q

Should ENDOSCOPIC ALBLATIVE THERAPY be used in Barrett’s Esophagus when there is NO DYSPLASIA?

A

NO

103
Q

What are the DIET therapies that are available and efficacious for EOE?

A

ELEMENTAL (most successful), DIRECTED ELIMINATION and EMPIRIC ELIMINATION

104
Q

What is the ONLY SYMPTOM indication for a BARIUM ESOPHAGRAM in GERD?

A

DYSPHAGIA (if ENDOSCOPY is REFUSED)

105
Q

In a patient with features of severe GERD with RAYNAUD’s, what is a test that can be done?

A

ANA

106
Q

In a patient with FREQUENT CHEST PAIN and GERD SYMPTOMS UNRESPONSIVE to MAXIMAL therapy and negative cardiac work-up, what is the NEXT STEP?

A

Ambulatory pH-IMPEDANCE testing

107
Q

In a patient with TYPICAL SYMPTOMS of UNCOMPLICATED GERD (heartburn, regurgitation, etc.) WITHOUT ALARM symptoms, what is the RECOMMENDED TREATMENT?

A

DAILY PPI (antacids and lifestyle modifications are UNLIKELY to resolve symptoms alone)

108
Q

If suspecting EOSINOPHILIC ESOPHAGITIS (EOE), where do you perform BIOPSIES from on the EGD?

A

PROXIMAL and DISTAL ESOPHAGUS (>15 eosinophils/hpf)

109
Q

If a patient with TYPICAL GERD SYMPTOMS and CONFIRMATORY EGD with REFLUX ESOPHAGITIS who does NOT respond to once daily PPI therapy BEFORE BED, what should be RECOMMENDED NEXT?

A

BID PPI, 30 min before BREAKFAST and 30 min before DINNER

110
Q

In a patient with GERD, being a WHITE MALE, having CENTRAL OBESITY and CHRONIC REFLUX SYMPTOMS (>5 years), puts him at risk for what?

A

That BARRETT’S ESOPHAGUS will be found on EGD

111
Q

What is the RECOMMENDATION for ENDOSCOPIC MANAGEMENT of a patient with LONG-SEGMENT BARRETT’S ESOPHAGUS WITHOUT DYSPLASIA?

A

EGD with SURVEILLANCE BIOPSIES in 1 YEAR (then, if no dysplasia is found, EGD every 3-5 years)

112
Q

What is the PPI DOSAGE GOAL in patients with REFLUX and BARRETT’s ESOPHAGUS?

A

SYMPTOM CONTROL (do NOT increase dosage or frequency if asymptomatic on current regimen)

113
Q

Is ENDOSCOPIC ABLATIVE THERAPY recommended in patients with BARRETT’s ESOPHAGUS WITHOUT DYSPLASIA (i.e. long-segment)?

A

NO

114
Q

What is the RECOMMENDATION for treatment of a patient with BARRETT’s ESOPHAGUS noted to have a NODULAR LESION with DYSPLASIA?

A

ENDOSCOPIC MUCOSAL RESECTION (superior to biopsy alone)

115
Q

What should be done when a BIOPSY of a patient with BARRETT’s ESOPHAGUS comes back as LOW-GRADE DYSPLASIA?

A

CONFIRMED by an EXPERT GI PATHOLOGIST followed by a REPEAT EGD with 4-QUADRANT BIOPSIES every 2 cm within 6 MONTHS

116
Q

What is the RECOMMENDED TREATMENT of NON-METASTATIC CANCER of the ESOPHAGUS post-staging?

A

NEOADJUVANT CHEMOTHERAPY followed by SURGERY

117
Q

In the ABSENCE of HIGH-GRADE DYSPLASIA, what is the RECOMENDED tratment for a patient with LONG-SEGMENT BARRETT’s ESOPAHGUS with GI PATHOLOGIST CONFIRMED LOW-GRADE DYSPLASIA?

A

REPEAT EGD in 1 YEAR

118
Q

What is the MAIN INHIBITORY NEUROPEPTIDE for RELAXATION of the LES?

A

NITRIC OXIDE

119
Q

What type of NEUROPEPTIDES are SUBSTANCE P and ACETYLCHOLINE?

A

EXCITATORY

120
Q

ISOBARIC PRESSURIZATIONS in response to SWALLOWS?

A

ACHALASIA TYPE-II

121
Q

NO DISCERNABLE PRESSURIZATIONS in response to SWALLOWS?

A

ACHALASIA TYPE-I

122
Q

SPONTANEOUS and REPETATIVE PRESSURIZATIONS in response to SWALLOWS (spastic)?

A

ACHALASIA TYPE-III

123
Q

PROLONGED PRESSURIZATIONS in response to SWALLOWS is found where?

A

DIFFUSE ESOPHAGEAL SPASM, ACHALASIA TYPE-III and NUTCRACKER ESOPHAGUS

124
Q

For the DIAGNOSIS of ACHALASIA, which MANOMETRIC FINDING is the MOST SENSITIVE?

A

ELEVATED INTEGRATED RESIDUAL PRESSURE (IRP) - this measures BOTH LES pressure and relaxation

125
Q

ELEVATED PHARYNGEAL PRESSURES with DEGLUTITION can result in what pathology?

A

ZENCKER’s DIVERTICULUM

126
Q

WHAT is the TREATMENT of CHOICE for a SMALL ZENCKER’s DIVERTICULUM?

A

CRICOPHARYNGEAL MYOTOMY

127
Q

What effect do ACHALASIA, SCLERODERMA and AMYLOIDOSIS have on the ESOPHAGUS?

A

COMPLETE SMOOTH MUSCLE DYSFUNCTION

128
Q

Does DERMATOMYOSITIS cause COMPLETE SMOOTH MUSCLE DYSFUNCTION of the ESOPHAGUS?

A

NO (only affects striated muscle)

ABIM-GI November 16th, 2022 (8 decks)

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