Achlasia Flashcards

1
Q

What is achalasia?

A

Disturbance of normal muscular activity of oesophagus (absent or uncoordinated) due to FAILURE or INCOMPLETE RELAXATION of LOS
Causes delay in passage of swallowed material into stomach

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2
Q

Describe the aetiology of achalasia?

A

Degeneration of ganglion cells of myenteric plexus in oesophagus (unknown cause)

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3
Q

Describe the epidemiology of achalasia

A
Any age (mainly 25-60 yrs)  
M = F
Annual incidence 1/100,000
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4
Q

Describe the onset of achalasia

A

INSIDIOUS onset + gradual progression of sx

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5
Q

List 6 symptoms of achalasia

A

Intermittent dysphagia of solids + liquids
Difficulty belching
Regurgitation (esp. at night)
Heartburn
Chest pain (atypical/ cramping, retrosternal)
Globus sensation

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6
Q

List 3 signs of achalasia

A

Signs of complications:
Aspiration pneumonia
Malnutrition
Weight loss (eating less)

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7
Q

What may be seen on CXR in achalasia ?

A

Dilated oesophagus with air-fluid level

Absence of normal gastric air bubble

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8
Q

What may be seen on barium swallow in achalasia?

A

Dilated oesophagus which smoothly tapers down to the sphincter (beak-shaped)

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9
Q

What investigations are performed in achalasia?

A

CXR
Barium Swallow
Endoscopy to exclude malignancy
Manometry (assess pressure at LOS)

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10
Q

What may be seen on manometry in achalasia?

A

Elevated resting LOS pressure (> 45mmHg)
Incomplete LOS relaxation
Absence of peristalsis in the smooth muscle portion of the oesophagus

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11
Q

What may you perform to exclude Chagas disease when considering achalasia?

A

Serology for antibodies against T. cruzi

Blood film to detect parasites

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12
Q

What disease presents with similar symptoms to Achalasia with achalasia and myocarditis?

A

CHAGAS DISEASE: Oesophageal infection with Trypanosoma cruzi seen in Central/ S. America

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