MEDICAL PHYSIOLOGY
                          G.I. Conference Quiz 6A
                              January 29, 2002

1. List three symptoms of achalasia.

          Epigastric and substernal pain, dysphagia, regurgitation of food,
          weight loss

2. What features of achalasia are revealed by manometry?

          Hypertensive LES pressure, incomplete & short duration of
          relaxation of LES, simultaneous and or retrograde peristaltic
          waves in body of esophagus, or absence of peristalsis in body of
          esophagus

3. In this case, barium swallow x-ray analysis of the esophagus revealed
what structural feature of the esophagus that was inconsistent with chronic
achalasia?

          Megasophagus was not present and there was stricture at the GE
          junction

4. When diagnosing possible achalasia, what alternative cause of achalasia
symptoms was revealed in this case history?

          Obstruction due to pseudocyst (the question specifically asked
          about this case history)

5. What feature of the pseudocyst identified in this case revealed its
probable source as pancreatic?

          The high concentration of amylase







                            MEDICAL PHYSIOLOGY
                          G.I. Conference Quiz 6B
                              January 24, 2002

1. If untreated, list at least one major structural changes that will occur
in the esophagus due to achalasia?

          Megaesophagus, loss of tonus in the body of the esophagus

2. Why can calcium channel blockers be used to treat authentic achalasia?

          Calcium channel blockers prevent the increase in calcium in the
          sphincter muscle via external calcium, this lowers intramuscular
          calcium allowing the sphincter to relax

3. Why is balloon dilatation used as a treatment for achalasia?

          A small balloon is first used to enlarge the sphincter without
          tearing the muscle If that doesn't work a larger balloon is used
          to tear a wider opening of the sphincter

4. Why would obstruction at the gastroesophageal boundary cause symptoms
similar to authentic achalasia?

          Obstruction prevents proper clearing of the esophagus this would
          cause more chronic triggering of secondary peristalsis,
          irritation responses causing regurgitation and emesis, and pain

5. List at least two medical conditions that are associated with the
increased likelihood of pancreatic pseudocysts?

          Alcoholism or chronic alcohol abuse Post-cholycystectomy state
          pancreatitis