ACHALASIA

Question 0

S + S

Answer 0

Dysphagja to solids and liquids
Regurgitation if substances retained
Chest pain dt oesophageal spasm
Wt loss

Question 1

Pathogenesis?

Answer 1

Autoimmune
Myenteric dysfunction
peristalsis + increased LOS tone

Question 2

What is Hirschsprung’s?

Answer 2

Achalasia of the rectum

Question 3

Ix?

Answer 3

Endoscopy (not diagnostic) -> tumour (pseudoachalasia)

Barium swallow or oesophageal manometry is diagnostic

Question 4

Management for achalasia?

Answer 4

Endoscopic injection of botulinum toxin -> decreases ACh -> decreased LOS tone

Pneumatic dilation -> weakens LOS by tearing it’s muscle fibres
Heller myotomy -> cut muscles of cardia (LES) allowing foods through

Question 5

Complications of achalasia?

Answer 5

Aspiration (bronchitis, pneumonia, lung abscess)

Oesophagitis from stasis-> oesophageal carcinoma