Achalasia (Ismail) Flashcards
Enteric excitatory neurons release
Ach and Substance P
Enteric inhibitory neurons release
NO and VIP
What controls LES relaxation?
vagal N (NO is the neurotransmitter)
what part of the esophagus will polymyositis and myasthenia gravis affect?
proximal 1/3 (skeletal)
What part of the esophagus will scleroderma affect?
distal 1/3 (smooth muscle)
What part of the esophagus will achalasia most affect?
distal 1/3 (smooth muscle)
What is Migrating Motor Complex? Function?
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
what is the “goal” of the fed pattern of contractions in the SI?
mixes and propels intestinal content so that it is available for absorption
etiology of achalasia
unknown. autoimmune, degenerative, or infectious
pathophys of achalasia
selective loss of post gang INHIBITORY neurons (no Nitric Oxide)
achalasia has (acute or chronic) onset
chronic
symptoms of achalasia
non-specific: dysphagia, chest pain at xiphoid , wieght loss, globus
a pt with achalasia may present with heart burn. how is this possible?
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
what is the characteristic finding on barium swallow with achalasia
dilated esophagus with brrd beaking and the absence of peristalsis
what does manometery measure?
pressure at different parts of the GI tract
what are the requirements for diagnosis of achalasia with manometry
- incomplete LES relaxation
- aperistalsis
(hypertensive LES is supportive not diagnostic)
what are the best treatment options for achalasia
botulinum injection
ballon dilation
heller’s myotomy (surgery)
What is heller’s myotomy?
laparoscopic surgury that cuts the LES to allow food to pass into the stomach **leaves only the inner muscular layer)
what are the complications assc with not treating achalaia
malnutrition, aspiration, SSC
what are 2 conditions that mimic achalasia
garstric carcinoma (tumor that prevents opening of LES?) Chagas disease (2' to T. cruzi infection)
abnormal esophageal motility disorder in which there are prolonged and repetitive contractions. What will be seen in a manometry report with this?
diffuse esophageal spasm
2 or 3 peristatic contraction peaks in a row
abnormal esophageal motility disorder in which there is increased DISTAL peristaltic amplitude and duration.
What will be seen in a manometry report with this?
nutcracker esophagus
very high peristaltic contractions in the distal esophagus with swallowing and LES relaxes normally
