Achalasia and Mallory Weiss Tear Flashcards
What is achalasia?
When the oesophageal sphincter spasms/fails to open during swallowing leading to functional oesophageal stricture
How does achalasia present?
Dysphagia (typically solids more than liquids) Regurgitation of digested food Aspiration pneumonia Substernal cramps Weight loss
How do you investigate achalasia?
Barium swallow
Manometry
What is the characteristic appearance of achalasia when doing a barium swallow?
Birds beak with narrowing of the oesophagus
How is manometry useful in investigating achalasia?
Shows high resting pressure in LOS and incomplete relaxation on swallowing and absent peristalsis
What is manometry?
Pressure sensitive tube that can be used to monitor a sphincter
How do you manage Achalasia
CCBs
Surgery then PPI
Botox in sphincter
What are the surgical options for treating achalasia?
Oesophageal balloon dialtion
Heller’s Cardiomytomy Slit down oesophagus (muscles of the cardia cut)
What re the issues of botox treatment for achalasia?
Body rejection (antigens) Needs to be repeated often
What causes a Mallory-Weiss Tear?
Repeated forceful vomiting causing a tear in the oesophagus
How does a mallory-weiss tear present?
Haematemesis following retching
Often after significant alcohol intake
After a really bad cough, e.g. pertussis
How do you investigate a Mallory-Weiss tear?
Endoscopy - OGD
An OGD visualises from from the oesophagus to the ________
2nd part of the duodenum
How do you manage Mallory-Weiss tears?
Conservatively
