Achalasia Flashcards
def
oesophageal motility disorder
characterized by loss of peristalsis & failure of relaxation of lower oesophageal sphincter
aetiology
ganglion cells in the myenteric plexus of the oesophagus degenerate (unknown cause)
oesophageal infection with trypanosoma cruzi produces a similar disorder (Chagas’ disease)
epi
commonly elderly
history
insidious onset:
- intermittent dysphagia (solids & liquids)
- regurgitation (especially at night)
- heartburn
- chest pain (retrosternal)
- weight loss
examination
may reveal signs of complications
investigations
1 CXR
-widened mediastinum
-double right heart border (due to dilated oesphagus)
2 barium swallow
-dilated oesophagus which smoothly tapers down to LOS
3 endoscopy
-exclude malignancy
4 manometry
-high resting LOS pressure (>45mmhg)
-incomplete LOS relaxation
-absence of peristalsis in distal (SM portion) of oesophagus)
when would you perform serology testing
serology for antibodies against T. cruzi if Chagas disease is suggested by travel to central/south america
def of myotomy
when muscle is cut
aetiology of achalasia
inflammatory destruction of inhibitory nitrinergic neurons in the oesophageal myenteric plexus
what is another name for the oesophageal myenteric plexus
auerbach plexus
what is a risk factor for achalasia
allgrove syndrome
what is allgrove syndrome
3As
achalasia
alacrima
adrenal insufficiency
how may people with achalasia eat
in strange postures to aid swallowing
what are important investigations in achalasia
UGI endoscopy (mucosa with frothy appearance) barium swallow (dilated oesophagus which smoothy tapers down like a bird beak) oesophageal manometry
what is pseudoachalasia
malignancy mimicking achalasia
