tiêu chảy của thời gian 4 năm. Sự vắng mặt của hữu cơ đáng kể thể nhận thấy rõ bệnh lý không nên nhắc một cuộc thảo luận với bệnh nhân tập trung vào một nguyên nhân tâm lý của vấn đề của mình, như một cách tiếp cận thường xuyên dẫn đến sự tha hóa của bệnh nhân. | X. Disorders of the Gastrointestinal System Answers 237 diarrhea of 4 years duration. The absence of discernible significant organic pathology should not prompt a discussion with the patient that centers on a psychogenic cause of her problem such an approach frequently leads to alienation of the patient. Instead an effort to effect safe symptomatic improvement of the diarrhea with antispasmodics is worthwhile. Psyllium to increase stool bulk is a good choice for patients with irritable bowel syndrome who complain of constipation. X-8. The answer is B. Chap. 284 Achalasia is a motor disorder of esophageal smooth muscle in which the lower esophageal sphincter LES does not relax properly in response to swallowing and normal esophageal peristalsis is replaced by abnormal contractions. Manometry reveals a normal or elevated LES pressure and reduced or absent swallow-induced relaxation. A decreased number of ganglion cells are noted in the esophageal body and LES of patients with achalasia suggesting that defective innervation of these areas is the underlying abnormality. Dysphagia chest pain and regurgitation are the predominant symptoms. The chest x-ray often reveals absence of the gastric air bubble and the barium swallow reveals a dilated esophagus. Calcium channel antagonists such as nifedipine relax smooth muscle and have been effective in treating some patients. However the mainstay of therapy remains pneumatic dilation. X-9. The answer is D. Chap. 285. Fendrick Ann Intern Med 123 260 1995. A physician has many alternatives in deciding on a therapeutic course in a patient with a radiographically or endoscopically proven duodenal ulcer. Therapy is based on neutralization of gastric acids by antacids inhibition of gastric acid secretion by antisecretory agents such as H2-receptor antagonists prostaglandins PGE1 PGE2 and proton pump inhibitors . omeprazole . Drugs such as sucralfate act locally by impeding diffusion of hydrogen ions to the base of the ulcer and by
