Achalasia Flashcards
Which of the following statements best describes achalasia?
Achalasia is a disorder of esophageal motility that is characterized by loss of inhibitory ganglion cells (i.e., inhibitory neurons), that results in the absence of peristalsis and failure of swallow-induced relaxation of the lower esophageal sphincter (LES)
Achalasia is a gastrointestinal disorder that is characterized by gastroesophageal reflux and delayed gastric emptying
Achalasia is a disorder of esophageal motility that is characterized by loss of esophageal neurons that results in gastroesophageal reflux and Barrett’s esophagus
Achalasia is a gastrointestinal disorder that is characterized by chronic nausea, weight loss, and diarrhea
Achalasia is a disorder of esophageal motility that is characterized by loss of inhibitory ganglion cells (i.e., inhibitory neurons), that results in the absence of peristalsis and failure of swallow-induced relaxation of the lower esophageal sphincter (LES)
A typical patient with achalasia can present with which of the following signs and symptoms? Weight gain Increased appetite Dysphagia with solids and liquids Constipation
Dysphagia with solids and liquids
The exact mechanism causing loss of inhibitory neurons in achalasia is unclear. Which of the following may have a contributory role? An autoimmune process Infection Trauma All of the above
All of the above
Which of the following statements about achalasia is accurate?
The majority of cases occur in children who are 2–5 years of age
The majority of cases occur in adults who are 25–60 years of age
Achalasia is associated with a significant risk of premature death
The estimated incidence of achalasia in the United States is 1 per 10,000 persons per year
The majority of cases occur in adults who are 25–60 years of age
Diagnosis of achalasia is made based on a detailed history, radiography, and esophageal motility testing. Which of the following test results is not characteristic of achalasia?
Barium swallow shows esophageal dilatation; contrast material passes slowly into the stomach as the LES opens intermittently; the distal esophagus is narrowed
Esophageal manometry test results show incomplete relaxation of the LES in response to swallowing, low resting LES pressure, and absence of esophageal peristalsis
Esophagogastroduodenoscopy rules out cancer of the gastroesophageal junction or fundus
Prolonged esophageal pH monitoring rules out gastroesophageal reflux disease (GERD)
Esophageal manometry test results show incomplete relaxation of the LES in response to swallowing, low resting LES pressure, and absence of esophageal peristalsis
Esophageal denervation is irreversible, and treatment for achalasia is palliative. The goal of therapy is to relieve signs and symptoms by reducing LES tone, relieving functional obstruction, and facilitating esophageal emptying by gravity. Which of the following statements about treatment of achalasia is accurate?
Laparoscopic Heller myotomy and partial fundoplication usually produce long-term results
Muscle relaxants are highly effective and should be used as first-line therapy in patients with achalasia
Surgical treatment should only be used in cases that fail to respond to all other treatment options
Pneumatic dilatation is associated with a success rate of 85–95%
Laparoscopic Heller myotomy and partial fundoplication usually produce long-term results
Risk factors for achalasia include previous trauma antihypertensive drugs Down syndrome a) and b) a) and c) b) and c)
a)previous trauma and c)Down syndrome
Pharmacotherapy for achalasia achieves shorter-term results than surgery or pneumatic dilatation. All except which of the following statements about treatment are correct?
Calcium channel blockers are effective in about 10% of patients
Intrasphincteric botulinum toxin therapy is associated with a 1-month response rate of < 25%
The American College of Gastroenterology recommends botulinum therapy for patients who are not a candidate for surgery or pneumatic dilatation
None of the above
Intrasphincteric botulinum toxin therapy is associated with a 1-month response rate of < 25%
The following organism has been associated with achalasia, except Varicella zoster virus Trypanosoma brucei Measles virus a) and c)
Trypanosoma brucei
The average interval between onset of manifestations and diagnosis of achalasia is 3 years, which is often due to misinterpretation of typical findings by the clinician.
True
False
False
The nurse who is providing care for a patient with achalasia should explain that it is caused by reactivation of a virus curable in most cases caused by loss of squamous cells caused by loss of neurons
caused by loss of neurons
The nurse providing care for a patient with achalasia who will be receiving a botulinum toxin (Botox) injection should explain that the results of the injection will be permanent long-term short-term none of the above
short-term
The nurse providing care for a patient who is newly diagnosed with achalasia should explain to the patient that he/she may develop chest pain headaches blurred vision hemiparalysis
chest pain
The nurse providing care for a patient who is being assessed for achalasia should be aware that the treating clinician may order which of the following diagnostic tests? CT scan Barium swallow Blood culture Sputum culture
Barium swallow
The nurse providing care for a patient who is being treated for achalasia should not be surprised when the treating clinician orders pneumatic dilatation antihypertensive medications a macrolide a low-carbohydrate diet
pneumatic dilatation
