Motility

Question 1

pressure in the esophagus is (higher/lower) than in the stomach

Answer 1

lower

Question 2

lack of peristalsis in the esophageal body and no relaxation of LES

Answer 2

achalasia

Question 3

only known etiology of achalasia

Answer 3

chagas dz

Question 4

inflammatory infiltrate in myenteric plexus leads to?

Answer 4

ganglionic drop-out

Question 5

achalasia presentation

Answer 5

dysphagia with solids and liquids, chest pain, heartburn, reflux?

Question 6

complications of achalasia

Answer 6

malnutrition, pulmonary aspiration, SSC

Question 7

barium swallow shows a “bird beak” – dx?

Answer 7

achalasia

Question 8

name 3 tx for achalasia

Answer 8

botox injection every 6 months (prevents muscle contraction by blocking ACh release), balloon dilation of LES, esophageal myotomy

Question 9

repetitive, simultaneous, abnormally long contractions of esophagus in response to swallowing

Answer 9

esophageal spasm

Question 10

presentation of esophageal spasm

Answer 10

chest pain, dysphagia

Question 11

“corkscrew esophagus” on imaging: dx?

Answer 11

esophageal spasm

Question 12

tx for esophageal spasm

Answer 12

similar to angina – SM antagonists (ca channel blockers, nitrates), can do myotomy but NOT standard

Question 13

weakened peristalsis often associated with reflux dz

Answer 13

peristaltic dysfunction or ineffective esophageal motility

Question 14

autoimmune disorder causing diffuse fibrosis, inflammation, vasculopathy, affects skin and organs

Answer 14

scleroderma

Question 15

calcinosis and Raynaud’s can be sx of?

Answer 15

scleroderma

Question 16

complications of scleroderma

Answer 16

renal crisis, pulmonary HTN, interstitial lung dz

Question 17

in the GI tract, scleroderma results in replacement of _____ with collagen, leading to?

Answer 17

muscle; myopathy

Question 18

esophageal sx of scleroderma

Answer 18

reflux, dysphagia (decreased LES pressure and peristalsis)

Question 19

gastric sx of scleroderma

Answer 19

stasis leads to N/V

Question 20

small bowel sx of scleroderma

Answer 20

impaired motility leads to bloating, nausea, and often bacterial overgrowth (malabsorption, steatorrhea)

Question 21

colonic sx of scleroderma

Answer 21

constipation

Question 22

vomiting is a coordinated event mediated by the ____ and triggered by?

Answer 22

CNS; toxins/noxious stimuli

Question 23

ddx for acute N/V

Answer 23

infection, toxin, obstruction, trauma, pregnancy

Question 24

ddx for chronic N/V

Answer 24

motility disorder, medications, endocrine, obstruction, brain-stem lesion

Question 25

most common cause of gastroparesis

Answer 25

diabetes

Question 26

sx of gastroparesis

Answer 26

N/V, bloating, epigastric pain, weight loss

Question 27

physical findings of gastroparesis

Answer 27

hypovolemia, succussion splash

Question 28

dx of gastroparesis

Answer 28

endoscopy to r/o obstruction, gatric emptying study

Question 29

intrinsic causes of bowel obstruction

Answer 29

neoplasm, ulcer, stenosis, foreign body

Question 30

extrinsic causes of bowel obstruction

Answer 30

adhesions, pancreatitis, neoplasms, endometriosis, fibroid, etc.

Question 31

what does H-I-V stand for?

Answer 31

hernias, intususception, volvulus

Question 32

dx of obstruction is through?

Answer 32

encoscopy, imaging (can tell location based on what is dilated on xray)

Question 33

for intussusception in adults, it is important to?

Answer 33

identify the lead point, rule out malignancies