Mayo Clinic Gastroenterology and Hepatology Board Review 4th Edition PDF

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Mayo Clinic Gastroenterology and Hepatology Board Review 4th Edition PDF

Mayo Clinic Gastroenterology and Hepatology Board Review

Book Name : Mayo Clinic Gastroenterology and Hepatology Board Review

Edition : 4th Edition | | ISBN :0199827613

Author Name : Stephen Hauser;

Category : BOARD REVIEW

Format / Pages : PDF – 480 Pages

Mayo Clinic Gastroenterology and Hepatology Board Review 4th Edition PDF
 Due to idiopathic dysfunction of distal esophageal neural structures leading to impaired relaxation of distal esophageal sphincter (LES) during swallowing
 20-40 years old; males=females
 dysphagia for both solids and liquids
 weight loss
 nocturnal cough, recurrent aspiration, bronchitis, pneumonia
 X-ray (not needed)  air-fluid level in the distal esophagus
 Initial test  barium swallow showing dilated esophagus which tapers as a “bird’s beak” at the LES
 Next step  esophagoscopy with biopsies to rule out secondary causes of achalasia (cancer, Chagas’ disease)
 Most accurate test  esophageal manometry showing:
1. Increased LES pressure
2. Impaired relaxation of LES with swallowing
3. Absence of normal peristaltic activity throughout the esophagus
 Initial therapeutic measure  pneumatic dilation

Mayo Clinic Gastroenterology and Hepatology Board Review
 If ineffectvie or patient refusal to undergo pneumatic dilation  botulinum toxin injection (everyone needs  reinjectionafter some time)
 If both ineffective then proceed to Heller myotomy (usually done laparoscopically with a risk of post-op reflux development)
Diffuse Esophageal Spasm
 Intermittent chest pain relieved by nitroglycerin thus simulating myocardial infarction but unrelated to exertion or eating (ruling out myocardial infarction and odynophagia, respectively)
 Pain may be precipitated by drinking extremely cold or hot liquids
 Dysphagia, especially for liquids
 If can not differentiate clinically between Esophageal Spasm and MI proceed to EKG
 Initial test  barium swallow showing a “corkscrew” appearance
 Most accurate test  Mayo Clinic Gastroenterology and Hepatology Board Review manometry showing:
1. high amplitude, repetitive, simultaneous contractions
2. nutcracker esophagus  high amplitude, prolonged contractions
 management  Ca+ channel blockers (nifedipine, etc.) or nitrates
 If severe and resistant to all forms of therapy proceed to longitudinal esophageal myotomy.

Mayo Clinic Gastroenterology and Hepatology Board Review

Mayo Clinic Gastroenterology and Hepatology Board Review has been designed to provide a review of core essential knowledge in gastroenterology, hepatology, and relevant related areas of radiology, pathology, endoscopy and nutrition to physicians, trainees and other persons caring for patients,




gastroenterology fellows in training, medical residents, medical students, gastrointestinal assistants, nurses, and allied health care personnels.

Mayo Clinic Gastroenterology and Hepatology Board Review