Master the Boards USMLE Step 2CK - Gastroenterology

Master the Boards USMLE Step 2CK - Gastroenterology Essential feature of the majority of esophageal disorders - answerDysphagia Difficulty swallowing - answerDysphagia Proper term for pain while swallowing - answerOdynophagia Both dysphagia & odynophagia can lead to? - answerWeight loss When severe, some forms of esophageal disorder will also give rise to what? - answer- Anemia - Heme+ stool What should be done when gastrointestinal alarm symptoms are present? - answerEndoscopy Alarm symptoms indicating endoscopy - answer- Weight loss - Blood in stool - Anemia Inability of the lower esophageal sphincter (LES) to relax (aperistalsis of the esophageal body) due to a loss of the nerve plexus within the lower esophagus - answerAchalasia Etiology of achalasia - answerNot clear Presentation of achalasia - answer- Young patient 50 y/o - Progressive dysphagia to both solids & liquids at the same time - No association w/ alcohol & tobacco use Findings on barium esophagram associated w/ achalasia - answer"Bird's beak" as the esophagus comes down to a point Most accurate diagnostic test used to diagnose achalasia - answerManometry Findings on manometry associated w/ achalasia - answerFailure of the lower esophageal sphincter to relax CXR findings associated w/ achalasia - answerAbnormal widening of the esophagus How useful is a CXR in the diagnosis of achalasia? - answerNot very useful as it is neither very sensitive nor very specific Mucosal findings associated w/ achalasia on upper endoscopy - answerNormal mucosa When is endoscopy useful in the setting of achalasia? - answerTo exclude malignancy in some patients With regards to the esophagus, what studies are acceptable to do first in most patients? - answerBarium studies With regards to the esophagus,, what studies ALWAYS lack the specificity of endoscopic procedures? - answerRadiologic tests Can the normal function of the missing neurological control of the esophagus associated w/ achalasia be restored/"cured"? - answerNo, all treatment is based on mechanical dilation of the esophagus Treatment of achalasia - answer1. Pneumatic dilation 2. Surgical sectioning or myotomy 3. Botulinum toxin injection Procedure where an endscope w/ the ability to inflate a device that will enlarge the esophagus is placed - answerPneumatic dilation Effectiveness of pneumatic dilation in the treatment of achalasia - answer8