GI Pathophysiology

Question 1

patients with esophageal motility disorders often present with

Answer 1

dysphagia, heartburn, and/or chest pain

Question 2

Achalasia

Answer 2

neuromuscular disorder of the esophagus with esophageal outflow obstruction d/t inadequate relaxation of the LES and dilated hypomotile esophagus

Question 3

symptoms of achalasia

Answer 3

dysphagia, heartburn, chest pain

Question 4

diagnosis of achalasia

Answer 4

esophagram reveals “bird’s beak” appearance, EGD, esophageal manometry

Question 5

type 1 achalasia

Answer 5

minimal esophageal pressurization, better outocmes

treatment is myotomy instead of botox or dilation

Question 6

type 2 achalasia

Answer 6

pressurization of entire esophagus, best outcome regardless of treatment

Question 7

type 3 achalasia

Answer 7

esophageal spasm with premature contractions, worst outcome

Question 8

what can be used to relax the LES in achalasia?

Answer 8

calcium channel blockers

Question 9

POEM procedure

Answer 9

Per Oral Endoscopic Myotomy
take out the circular layer of the LES but leave the longitudinal muscle intact
biggest risk is pneumothorax

Question 10

distal esophageal spasm

Answer 10

diffuse esophageal spasm
autonomic nervous system dysfunction
esophagram shows corkscrew or rosary bead esophagus
pain mimics angina, responds favorably to nitroglycerin

Question 11

GERD causes

Answer 11

mucosal injury in the esophagus/extraesophageal sites

Question 12

most common symptoms of GERD are

Answer 12

heartburn, regurgitation, dysphagia, chest pain

Question 13

patho of GERD

Answer 13

LES incompetence
transient LES relaxation from gastric distension
LES hypotension
anatomic distortion of GE junction such as hiatal hernia

Question 14

reflux contents can be

Answer 14

HCl, pepsin, pancreatic enzymes, bile

Question 15

complications of GERD

Answer 15

chronic peptic esophagitis, esophagitis, strictures, ulcers, barrett’s metaplasia

Question 16

treatment of GERD

Answer 16

lifestyle modification: avoid fat, alcohol, peppermint, chocolate, acidic foods
pharmacologic treatment: PPI, H2 antagonists
surgery: Nissen fundoplication

Question 17

periop considerations for GERD

Answer 17

sodium citrate given to pregnant/morbidly obese patients, large aspiration risk (volume 25 mL, pH less than 2.5), RSI, ETT

Question 18

esophageal diverticula

Answer 18

outpouchings of the wall of the esophagus

pharyngoesophageal, midesophageal, and epiphrenic

Question 19

what do you need to avoid in someone with esophageal diverticula

Answer 19

NG tube insertion (risk of perforation)

Question 20

hiatal hernia

Answer 20

part of the stomach herniates into the thoracic cavity through the esophageal hiatus of the diaphragm
may be caused by weakening of the anchors at the GE junction to the diaphragm

Question 21

esophageal tumors

Answer 21

presents with progressive dysphagia to solid food and weight loss

Question 22

treatment of esophageal tumors

Answer 22

esophagectomy, mortality rate about 50%

complications: ARDS, RLN injury