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GI > ACHALASIA > Flashcards

ACHALASIA Flashcards

1
Q

what type of muscle is the esophagus made up of?

A

outer longitudinal muscle layer and inner circular muscle layer

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2
Q

what do circular muscle fibers allow?

A

peristalsis

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3
Q

what is the upper 1/3 of the esophagus predominantly?

A

skeletal muscles

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4
Q

what is the lower 2/3 of the esophagus mostly?

A

smooth muscles become more dominant from the middle to the distal esophagus

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5
Q

where is the auerbach plexus located?

A

between the circular muscle layer and the longitudinal muscle layer in the lower esophagus, stomach, and intestines

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6
Q

what is the auerbach plexus responsible for?

A

responsible for the peristaltic movement of the bowels

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7
Q

can the auerbach plexus act independently from the CNS?

A

YES

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8
Q

does the auerbach plexus fail in achalasia?

A

yessss

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9
Q

what is the epidemiology of achalasia?

A

rare, neurogenic esophageal motility disorder
25-60 y/o
male=female

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10
Q

what are the 2 pathological features of achalasia?

A
  1. failed relaxation in the lower esophageal sphincter (LES) during swallowing (MAJOR)
  2. impaired peristalsis in the lower 2/3 of the esophagus (minor)
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11
Q

what are the 2 causes of achalasia?

A
  1. degeneration of myenteric plexus ganglia in the lower esophagus
  2. viral and autoimmune factors are suspected; appear there is a genetic predisposition (familial cases)
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12
Q

what are the 3 complications of achalasia?

A
  1. aspiration pneumonia
  2. megaesophagus in 10% of cases -> increase in size affects the transport of food
  3. increased risk of esophageal cancer -> food stasis, bacterial overgrowth, and chronic inflammation
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13
Q

what is the cause of primary achalasia?

A

no known cause

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14
Q

what is the cause of secondary achalasia?

A

d/t disease that causes esophageal abnormalities

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15
Q

what is the number one cause of secondary achalasia?

A

malignancy (esophageal, gastric, or other extra-esophageal cancers) by mass effect

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16
Q

what are the 4 other causes of achalasia other than malignancy?

A
  1. chagas disease
  2. infiltrative disorders: amyloidosis, sarcoidosis
  3. eosinophilic esophagitis
  4. MEN 2B
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17
Q

what is chagas disease caused by

A
  • caused by protozoan parasite (trypanosoma cruzi)
18
Q

what is the onset of achalasia?

A

insidious

19
Q

what are the big 3 sx of achalasia?

A
  1. dysphagia (progressive)
  2. nocturnal regurgitation of undigested food
  3. weight loss (Mild to mod)
20
Q

what is involved in dysphagia?

A

cant swallow solids that slowly progresses to liquids
PROGRESSIVE SX

21
Q

what can nocturnal regurgitation of undogested food lead to?

A

may cause nocturnal cough or lead to aspiration pneumonia

22
Q

what are other sx of achalasia other than the big 3?

A

heartburn (Pyrosis)
retrosternal pain -> spontaneous or with swallowing
vomitting

23
Q

what do you START WITH to dx achalasia?

A

upper endoscopy

24
Q

what is an upper endoscopy for?

A
  1. esophageal dilation
  2. r/o any obstruction or malignancy
  3. classic “pop” when the endoscope passes into stomach
25
Q

what is the gold standard test for achalasia?

A

HIGH-RESOLUTION MANOMETRY WITH ESOPHAGEAL PRESSURE TOPOGRAPHY (EPT)

26
Q

what is pressure represented by on EPT?

A

represented by color (inc. color intensity= inc. pressure)

27
Q

what 3 things does an EPT demonstrate?

A
  1. incomplete relaxation of LES after swallowing
  2. high LES resting pressure
  3. aperistalsis in lower 2/3 of esophagus
28
Q

what is a barium swallow?

A

a complementary test in equivocal manometric findings

29
Q

what can a barium swallow show?

A

the absence of progressive peristaltic contractions during swallowing

30
Q

on barium swallow, what are upper and lower esophagus doing?

A

upper esophagus is dilated, but is narrowed and “BEAK LIKE” at the LES
-PATHOGNOMONIC FOR ACHALASIA

31
Q

what happens to the emptying of barium in body?

A

delayed emptying

32
Q

what therapy will restore peristalsis?

A

none

33
Q

what is the goal of achalasia tx?

A

reduce pressure at LES and allow for passage of ingested material

34
Q

what are the 3 modalities of tx for achalasia?

A
  1. pneumatic balloon dilation of the LES
  2. surgical myotomy of the LES
  3. botulinum toxin injection
35
Q

what does a pneumatic balloon dilation of the LES do?

A

circumferential stretching

36
Q

what is a surgical myotomy of the LES ?

A

muscles of the LES are cut to allow food and liquids to pass to the stomach (relieves pressure )

37
Q

what is a complication of a surgical myotomy of the LES?

A

esophageal perforation and/or gastroesophageal reflux

38
Q

who should get the botox treatment?

A

those who aren’t surgical candidates

39
Q

what is the botulinum toxin treatment?

A

direct endoscopic injection into LES to block release of acetylcholine -> decreased LES tone

40
Q

how long does the botox treatment for achalasia last?

A

6-12 months

GI (22 decks)

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