GIT Cases: Achalasia Diagnosis and Treatment

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Questions and Answers

What is the primary function of the lower esophageal sphincter (LES)?

To control the release of bolus from the esophagus into the stomach. (correct)

To prevent bile reflux into the stomach.

To promote gastric acid secretion.

To facilitate the absorption of nutrients.

Which of the following factors can lower the pressure in the LES?

Use of certain medications like aspirin and NSAIDs. (correct)

High fiber diet.

Frequent physical exercise.

Increased acetylcholine secretion.

What is the primary role of peristalsis in the gastrointestinal tract?

To move food and liquid through the digestive system. (correct)

To absorb nutrients from digested food.

To digest food chemically.

To produce digestive enzymes.

What imaging procedure is most commonly used to visualize abnormalities in the esophagus?

Barium esophagography. Signup and view all the answers

What are the three phases of acid production in the gastrointestinal tract?

Cephalic, Gastric, and Intestinal. Signup and view all the answers

Which type of medication is omeprazole classified as?

Proton pump inhibitor. Signup and view all the answers

What is a common symptom of gastroesophageal reflux disease (GERD)?

Chest pain or heartburn. Signup and view all the answers

How does somatostatin affect gastric secretions?

It inhibits gastric acid and pepsinogen secretion. Signup and view all the answers

What is the most likely diagnosis for the patient in the case presented?

Achalasia Signup and view all the answers

Which structure is primarily responsible for preventing the backflow of food into the esophagus?

Lower esophageal sphincter (LES) Signup and view all the answers

What does esophageal manometry assess in the context of this case?

Esophageal motility and sphincter pressure Signup and view all the answers

Which symptom in this case is most indicative of achalasia?

Regurgitation of undigested food Signup and view all the answers

What is the primary purpose of barium esophagography in diagnosing esophageal conditions?

To identify structural abnormalities Signup and view all the answers

What mechanism allows swallowed food to move through the esophagus?

Peristalsis Signup and view all the answers

What finding would likely be seen in barium esophagography for a patient with achalasia?

Esophageal dilation Signup and view all the answers

What is a common treatment approach for achalasia?

Esophageal dilation with a balloon Signup and view all the answers

What is the primary diagnosis suggested in the case presented?

Achalasia Signup and view all the answers

Which structure helps prevent the reflux of gastric contents into the esophagus?

Lower Esophageal Sphincter Signup and view all the answers

What mechanism is responsible for the initial movement of swallowed food through the esophagus?

Primary peristalsis Signup and view all the answers

Which treatment method is used for achalasia?

Esophageal dilation Signup and view all the answers

What is the role of the oblique fibers of the stomach wall in relation to the LES?

Create a flap valve to prevent regurgitation Signup and view all the answers

What symptom was most notably observed in the achalasia case to suggest this diagnosis?

Regurgitation of undigested food Signup and view all the answers

Which type of imaging procedure is commonly used to assess esophageal conditions like achalasia?

Barium esophagography Signup and view all the answers

What initiates secondary peristaltic waves in the esophagus?

Distention of the esophagus Signup and view all the answers

Study Notes

Lab 1: GIT Cases

Topic: Gastrointestinal Tract (GIT) cases
Lecturer: Dr. Safy Salah
University: Nahda University, Beni Suef

Case 1

Patient: 75-year-old woman
Presenting complaint: Losing weight, difficulty swallowing solids and liquids, regurgitation of undigested food, feeling of fullness, chest pain, coughing, and aspiration
Physical exam: Normal
X-ray: Enlarged, fluid-filled esophagus, air-fluid interface
Barium esophagography: Esophageal dilation, loss of peristalsis, poor esophageal emptying
Endoscopic exam: Normal, no carcinoma
Esophageal manometry: Complete absence of esophageal peristalsis
Diagnosis: Achalasia
Treatment: Dilation of sphincter, incision, or botulinum toxin injection into the Lower Esophageal Sphincter (LES).

Case 1 Questions

What is the most probable diagnosis? Achalasia
Which structure limits retrograde entry of food into the esophagus? Lower Esophageal Sphincter (LES)
Explain the mechanisms of movement of swallowed food through the esophagus? Primary peristalsis and secondary peristalsis
Which symptom directed you to think about this diagnosis? Weight loss, difficulty swallowing, regurgitation of undigested food, fullness, and pain in the chest.
How to treat this condition? Dilation of sphincter, incision, or botulinum toxin injection into the LES

Case 2

Patient: 33-year-old man
Presenting complaint: Mid-epigastric pain, burning sensation in the chest, worse after eating and when lying flat, also woken up from the pain, sore throat, hoarse voice.
Relieved by: Sitting position and over-the-counter medication (Zantac)
History: aspirin and ibuprofen use
Treatment: Omeprazole (proton pump inhibitor) and reduced dose of aspirin/ibuprofen
Diagnosis: Gastroesophageal reflux disease (GERD)

Case 2 Questions

What is your possible diagnosis? Gastroesophageal Reflux Disease (GERD)
How is acid produced and controlled within the gastrointestinal tract? Acid is produced by parietal cells in the stomach. Secretions are stimulated by acetylcholine, histamine, and gastrin, and inhibited by somatostatin. Phases include cephalic, gastric, and intestinal.
Etiology of GERD? Factors affecting LES pressure, including neural control, acetylcholine, nitric oxide (NO)/VIP, other factors (like smoking, some foods, medications, or hormone gastrin).
Patient's signs/symptoms: Mid-epigastric pain, burning sensation in chest, worse after eating, lying flat, sore throat, hoarse voice, partial relief with sitting and Zantac
How do aspirin and NSAIDs affect gastroesophageal disease? Aspirin and NSAIDs promote reflux.
What class of medication is omeprazole? Proton pump inhibitor. Blocks H+ and K+ ATPase enzyme (a component of HCL production).

Case 3

Patient: 52-year-old man
Presenting complaint: Burning epigastric pain, right after eating, subsides after some time, reappears in two hours. Relieved by antacids, not NSAIDs.
History : Smoker, 5 cups coffee daily, 9 pounds weight loss without dieting
Physical exam: Epigastric tenderness on palpation
Lab findings: Positive occult blood in stool, Positive Helicobacter pylori antigen
Endoscopic findings: Ulcer confirmed by biopsy
Diagnosis: Peptic Ulcer

Case 3 Questions

What is the most probable diagnosis? Peptic ulcer.
Explain the mechanisms developing such a diagnosis in this case? Breakdown of gastric mucosal barrier, cigarette smoking, nervous.
Discuss acid secretion in the stomach. Parital cells produce HCL. Stimulation by Ach, histamine and gastrin, inhibited by somatostatin. 3 phases: Cephalic, Gastric, and Intestinal phases.
factors increasing gastric acid secretion? Histamine, acetylcholine, and gastrin
Treatment? Blockade of H2 histamine receptors (e.g., cimetidine), Inhibit H+/K+ ATPase (e.g., omeprazole), Eradication of Helicobacter pylori with antibiotics, Stop smoking and NSAIDs, Surgical removal of gastrin secreting tumors.

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Description

This quiz covers a detailed case study of a 75-year-old woman presenting with symptoms related to Achalasia, focusing on diagnosis and treatment options. Explore the gastrointestinal tract's structure and functions, and the implications of diagnosing conditions like Achalasia. Test your knowledge of relevant procedures and clinical findings.