Mayo Clinic Gastroenterology and Hepatology Board Review 4th Edition PDF
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
