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Chapter 20. Esophagus & Diaphragm

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Esophageal achalasia is characterized by

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A. Absence of esophageal peristalsis

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B. Heartburn in more than 50% of patients

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C. Low intraluminal pH due to GERD

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D. All of the above

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A. Absence of esophageal peristalsis. Esophageal manometry is the gold standard for establishing the diagnosis of esophageal achalasia. The classic manometric findings are: (1) absence of esophageal peristalsis and (2) hypertensive LES (in about 50% of patients) that relaxes only partially in response to swallowing. Dysphagia for both solid and liquid food is the most common symptom, experienced by virtually every patient. Heartburn is present in about 40% of patients. As the low intraluminal pH, it is not due to GER, but rather to stasis and fermentation of undigested food in the distal esophagus.

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Which of the following sentences about Zenker diverticulum is wrong?

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A. It is the most common diverticulum of the esophagus.

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B. It is a consequence of an underlying esophageal motility disorder.

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C. Aspiration of diverticular contents is frequent.

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D. The surgical treatment consists of LES myotomy, resection of the diverticulum or its suspension.

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D. The surgical treatment consists of LES myotomy, resection of the diverticulum or its suspension. Although rare, Zenker diverticulum is more common than the epiphrenic diverticulum. It is a protrusion of pharyngeal mucosa through a weak zone in the Killian’s triangle, secondary to abnormalities of the UES sphincter. Dysphagia occurs very frequently. As the pouch enlarges, its contents can be inhaled into the respiratory tree causing chronic cough and pneumonia. Finally, the established treatment consists of eliminating the functional obstruction performing a UES myotomy, associated with resection or suspension of the diverticulum.

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A 54-year-old patient has heartburn. The correct workup includes

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A. Esophageal manometry, 24-hour pH monitoring and upper endoscopy.

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B. Upper endoscopy and 24-hour pH monitoring.

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C. Nothing, the patient has gastro-esophageal reflux and needs surgery.

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D. Nothing; the patient has gastro-esophageal reflux and needs treatment with proton pump inhibitors.

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A. Esophageal manometry, 24-hour pH monitoring and upper endoscopy. Heartburn, along with regurgitation and dysphagia is considered a typical symptom of gastroesophageal reflux (GERD). However, a clinical diagnosis of GERD based on these symptoms is correct in only 70% of patients (when compared with the results of pH monitoring). Heartburn ...

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