What are the components of the antireflux mechanism in human beings? (you can choose more than one)

Which of the following can increase LES pressure?

Which test is the gold standard for the diagnosis of GERD?

30/M came in due to dysphagia. He was diagnosed with achalasia. He reports weight loss of 8kg, with occasional dysphagia. No chest pain but with occasional regurgitation. What is the Eckardt score?

This type of hiatal hernia is characterized by an upward dislocation of both the cardia and the gastric fundus

The manometric characteristics of achalasia are the following except

47/M came in due to difficulty swallowing. Barium esophagogram showed a characteristic corkscrew appearance. What is your surgical plan?

Which of the following factors preclude a patient from having surgery for esophageal cancer?

A 45-year-old male presents with progressive dysphagia for both solids and liquids, regurgitation of undigested food, and weight loss. A barium swallow reveals a “bird’s beak” narrowing at the distal esophagus. Which of the following is the most definitive treatment for this patient?

A 48M, hypertensive, Karnofsky 80%, presented with choking sensation and weight loss. EGD revealed ~1cm nodular, midthoracic esophageal mass. Chest CT and abdominopelvic CT scan did not show esophageal wall thickening, nodal nor distant metastasis. EUS showed intramucosal, N0 disease. Pathologic examination of endoscopic resection specimen revealed moderately differentiated squamous cell carcinoma, basal margin positive for tumor, G2. Nutritional support has been discussed with the patient. In consultation with MDT, what is the most appropriate next step for this patient?

A 60M, no co morbids, smoker but quit 3 months ago, ECOG 2, presented with mild dysphagia.EGD revealed ~3cm fungating mass 17cm from the incisors. Biopsy of the mass located 2 cm distal to cricopharyngeus and additional work up revealed non-metastatic poorly differentiated squamous cell carcinoma. In consultation with MDT, what is the most appropriate next step for this patient?

A 68M hypertensive, diabetic, s/p CABG 3 months prior, Karnofsky 60%, underwent EGD which revealed ~80mm erythematous, flat esophageal lesion located 30cm from incisors. Biopsy revealed squamous cell high grade dysplasia; cN0. In consultation with MDT, what is the most appropriate next step for him?

A 50M, on amlodipine 5 mg OD, SGA class A , ECOG 0, presented with symptoms of GERD. EGD revealed ~2cm ulcero-fungating lesion 33 cm from incisors, rest of esophageal, gastric mucosa normal. Biopsy was moderately differentiated adenocarcinoma, G2. No evidence of nodal nor distant metastases on CT. EUS showed dark expansion of layers 1-4 with probable penetration to muscularis propria only, no enlarged nodes. In consultation with MDT, what is the most appropriate next step for him

A 65M diabetic, presented with progressive dysphagia and weight loss, SGA class C. Endoscopy showed friable, almost circumferential, fungating mass 35 cm from incisors. Biopsy showed poorly differentiated adenocarcinoma, G3. EUS showed dark expansion beyond muscularis propria. CT showed diffuse wall thickening of distal esophagus with enlarged upper paratracheal, subcarinal, pulmonary ligament, paraesophageal nodes only. Nutritional support has been discussed with the patient. What is the most appropriate next step for him?

A 21-year-old man presents to the ER with complaints of left upper quadrant abdominal pain and melena. He had mitral valve replacement four years ago and has been on oral warfarin. On physical examination, he was pale, BP of 140/80 mmHg, a heart rate of 114/min. The left upper quadrant was tender on palpation. Hematocrit level was 17.6 %. After volume replacement and blood transfusion, the patient underwent upper GI endoscopy which revealed minimal bleeding in a mucosal tear in the distal esophagus. What is the next course of action?

A 55-year-old man is evaluated for dysphagia and chest pain. A barium esophagogram shows a 3 cm smooth, punched out filling defect in the distal end of the esophagus. What is the most likely diagnosis?

A patient arrives at the ER eight hours post-balloon dilatation of the esophagus for complaints of dysphagia and chest pain. The patient was found to be febrile, tachycardic, and normotensive. Esophagogram showed “bird’s beak” with contrast material in the left hemithorax. After fluid resuscitation and administration of antibiotics, which of the following is the most appropriate management?

A suicidal patient drank a bottle of Liquid Sosa after a break-up. You suspect esophageal perforation. As the surgeon on duty, you would approach this patient by a:

An 89-year-old man went for consult secondary to dysphagia. He already had significant weight loss because of food aversion due to persistent reflux of swallowed food. PE of the neck shows bulging, soft, nontender mass on the right anterior cervical triangle. What is the best approach for this case?