GIT

Which of the following statements about achalasia is correct?

The underlying abnormality appears to be defective innervation of the esophageal body and lower gastric sphincter

Chest x-rays often reveal a large gastric air bubble

Dysphagia, chest pain, and regurgitation are the predominant symptoms

Manometry reveals a normal or elevated pressure of the lower gastric sphincter

Omeprazole is effective in controlling the symptoms in many patients

A 45-year-old man presents with sharp epigastric pain relieved by antacids and food. Barium study of the upper gastrointestinal tract reveals a crater in the proximal portion of the duodenal bulb. Which of the following statements concerning therapeutic alternatives is correct?

Atropine or related anticholinergic agents are effective in improving the symptoms

Sucralfate is effective in eradicating Helicobacter pylori colonization

Cimetidine or other H -receptor antagonists are 2 more effective than sucralfate in promoting healing

Sucralfate can significantly reduce the bioavailability of fluoroquinolone antibiotics

Omeprazole, a specific inhibitor of parietal cell H, K-ATPase, is contraindicated in routine situations because of its carcinogenic potential

Four months ago, a 36-year-old man with a peptic ulcer underwent a Billroth II anastomosis, antrectomy, vagotomy, and gastrojejunostomy. He now returns for evaluation of a stomal (anastomotic) ulcer. Fasting serum gastrin level is 350 ng/L; 5 min after the intravenous infusion of secretin the serum gastrin level is 200 ng/L. The man should be advised that the most appropriate treatment for his condition is

Total vagotomy

Total gastrectomy

Resection of the distal antrum attached to the duodenal stump

Laparotomy to search for a gastrin-producing tumor

Medical therapy with liquid antacids

A 50-year-old man without significant past medical history or recent exposure to alcohol presents with midepigastric abdominal pain, nausea, and vomiting. The physical examination is remarkable for the absence of jaundice and any other specific physical findings. Which of the following is the best strategy for screening for acute pancreatitis?

Measurement of serum amylase

Measurement of serum lipase

Measurement of both serum amylase and serum lipase

Isoamylase level analysis

Magnetic resonance imaging

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