1.4. Oesophageal Disease - Achalasia Flashcards
Is Achalasia more common in Males or Females?
Neither, it is an even split
At what age is Achalasia most likely to occur?
Those who are Middle-Aged
What causes Achalasia?
A Degeneration of the Inhibitory Neurons (Ganglion Cells) of the Myenteric Plexus, in the Distal Oesophagus
What does the Degeneration of Inhibitory Neurons (Ganglion Cells) of the Myenteric Plexus result in?
The Distal Oesophageal Muscularis Externa not being able to Relax
What does the inability of the Distal Oesophageal Muscle to relax, result in?
- A high pressure at the Lower Oesophageal Sphincter
2. The Absence of Peristaltic Waves in that area
What is the Normal Pressure experienced at the Lower Oesophageal Sphincter?
10mmHg
What Pressure is exerted on the Lower Oesophageal Sphincter in Achalasia?
45mmHg
the normal is 10mmHg
What is the ultimate result of Achalasia?
Functional Distal Obstruction of the Oesophagus
What are the Clinical Signs of Achalasia?
- Weight Loss / Anorexia
- Aspiration Pneumonia
- Lower Oesophageal Relaxation Failure
- A High Pressure in the Oesophagus
Why does Weight Loss / Anorexia occur?
Due to the inability to get food into the Stomach
Why might Aspiration Pneumonia occur?
Due to the backup of foodstuff in the Oesophagus potentially entering into the lungs
What symptoms would a patient with Achalasia present with?
- Progressive Dysphagia
- Regurgitation
- Chest Pain
Why would Progressive Dysphagia occur?
Due to the problem getting food into the Stomach
Why would Regurgitation occur?
Due to the problem getting food into the Stomach
Why would Chest Pain occur?
Due to the build up of pressure exerted by the foodstuff
What investigations are needed for Achalasia?
- Manometry
- Barium Swallow
- CT Scan
What does Manometry measure?
The Pressure in the Distal Oesophagus
What is the purpose of a Barium Swallow / CT Scan?
To see the obstruction in the Distal Oesophagus
What will the Distal Oesophagus look like in a patient with Achalasia?
A Rats Tail
What are the Treatments of Achalasia?
- Nitrates
- Calcium Channel Blockers
- Endoscopic Botulinium Toxin Inection
- Endoscopic Pneumatic Balloon Dilation
- Myotomy
What are the 2 Pharmacological Treatments of Achalasia?
- Nitrates
2. Calcium Channel Blockers
What is the Mechanism of Action of Nitrates?
These cause the Relaxation of the Smooth Muscle around the Distal Oesophageal Sphincter
What is the Mechanism of Action of Calcium Channel Blockers?
These cause the Relaxation of the Smooth Muscle around the Distal Oesophageal Sphincter
What are the 2 Endoscopic Treatments of Achalasia?
- Endoscopic Botulinium Toxin Inection
2. Endoscopic Pneumatic Balloon Dilation
What is the Mechanism of Action of Endoscopic Botulinium Toxin Inection?
This paralyses the Exitatory Neurons of the Distal Oesophagus, causing relaxation
What is the Mechanism of Action of Endoscopic Pneumatic Balloon Dilation?
- A deflated balloon is lowered into the Distal Oesophgus by an Endoscope
- The Balloon is the inflated to the point where it tears the Contracted Smooth Muscle
- This tearing relieves the Symptoms
What is the Surgical Treatment of Achalasia?
A Myotomy
What is the Mechanism of Action of a Myotomy?
The Lower Oesophageal Sphincter Muscles are cut, allowing the passage of Food / Liquid
What can the treatment of Achalasia potentially lead to?
Gastro-Oesophageal Reflux Disease
