Achalasia (Ismail)

Question 1

Enteric excitatory neurons release

Answer 1

Ach and Substance P

Question 2

Enteric inhibitory neurons release

Answer 2

NO and VIP

Question 3

What controls LES relaxation?

Answer 3

vagal N (NO is the neurotransmitter)

Question 4

what part of the esophagus will polymyositis and myasthenia gravis affect?

Answer 4

proximal 1/3 (skeletal)

Question 5

What part of the esophagus will scleroderma affect?

Answer 5

distal 1/3 (smooth muscle)

Question 6

What part of the esophagus will achalasia most affect?

Answer 6

distal 1/3 (smooth muscle)

Question 7

What is Migrating Motor Complex? Function?

Answer 7

fasting pattern of contraction in the SI
it keeps the intestine “clean” of bacteria
**same as migrating myoelectric complexes = every 90 mins to clear SI of residual food/chyme

Question 8

what is the “goal” of the fed pattern of contractions in the SI?

Answer 8

mixes and propels intestinal content so that it is available for absorption

Question 9

etiology of achalasia

Answer 9

unknown. autoimmune, degenerative, or infectious

Question 10

pathophys of achalasia

Answer 10

selective loss of post gang INHIBITORY neurons (no Nitric Oxide)

Question 11

achalasia has (acute or chronic) onset

Answer 11

chronic

Question 12

symptoms of achalasia

Answer 12

non-specific: dysphagia, chest pain at xiphoid , wieght loss, globus

Question 13

a pt with achalasia may present with heart burn. how is this possible?

Answer 13

the LES cannot relax ∴ it is not the regurg gastic contents. It is actually from the food that gets stuck there. It will ferment and lactic acid will be produced → heart burn

Question 14

what is the characteristic finding on barium swallow with achalasia

Answer 14

dilated esophagus with brrd beaking and the absence of peristalsis

Question 15

what does manometery measure?

Answer 15

pressure at different parts of the GI tract

Question 16

what are the requirements for diagnosis of achalasia with manometry

Answer 16

1. incomplete LES relaxation
2. aperistalsis

(hypertensive LES is supportive not diagnostic)

Question 17

what are the best treatment options for achalasia

Answer 17

botulinum injection
ballon dilation
heller’s myotomy (surgery)

Question 18

What is heller’s myotomy?

Answer 18

laparoscopic surgury that cuts the LES to allow food to pass into the stomach **leaves only the inner muscular layer)

Question 19

what are the complications assc with not treating achalaia

Answer 19

malnutrition, aspiration, SSC

Question 20

what are 2 conditions that mimic achalasia

Answer 20

garstric carcinoma (tumor that prevents opening of LES?)
Chagas disease (2' to T. cruzi infection)

Question 21

abnormal esophageal motility disorder in which there are prolonged and repetitive contractions. What will be seen in a manometry report with this?

Answer 21

diffuse esophageal spasm

2 or 3 peristatic contraction peaks in a row

Question 22

abnormal esophageal motility disorder in which there is increased DISTAL peristaltic amplitude and duration.
What will be seen in a manometry report with this?

Answer 22

nutcracker esophagus

very high peristaltic contractions in the distal esophagus with swallowing and LES relaxes normally