GI Motility Disorders Achlasia

Question 1

GI motility is the result of what 3 neural networks?

Answer 1

• CNS
• ANS
• Enteric

Question 2

Enteric Nervous system is what:

Answer 2

Neurons located in the gut wall that comprise the intrinsic neural network called the enteric nervous system

Question 3

CNS and ANS modulates enteric nervous system activities

Answer 3

ok

Question 4

Enteric nervous system consists of two components. What are they

Answer 4

• Myenteric Plexus

- Meissner Plexus

Question 5

Myenteric Plexus is present where and is responsible mostly for what?

Answer 5

Present between the circular and myenteric muscle layers.

Responsible mostly for motility

Question 6

Meissner plexus is located where and is responsible for what?

Answer 6

Located in the submucosa and is responsible for secretion.

Question 7

Peristalsis (rhythmic contraction) results from what?

Answer 7

Pacing from the pacemaker present in ENS. Pacemaker cells are called interstitial cells of cajal.

Question 8

Are interstitial cells of cajal neural in origin?

Answer 8

Nope

Question 9

Where are interstitia cells of cajal present?

Answer 9

Throughout the GI tract

Question 10

Upper esophageal sphincter consists of what type of muscle?

Answer 10

striated muscle

Question 11

Body of the esophagus consists of what type of muscle?

Answer 11

Both smooth and striated

Question 12

Lower Esophageal sphincter relaxation is controlled by what nerve

Answer 12

Vagus Nerve.

Question 13

What does receptive relaxation of the fundus apply to?

Answer 13

This describes the way the stomach relaxes to accept new food volume

Question 14

Upper part of teh stomach handles what?

Answer 14

Liquids

Question 15

Lower part of stomach handles what?

Answer 15

Solids

Question 16

Food from the antrum empties into the duodenum when food is what size?

Answer 16

Less than 1 mm

Question 17

What are the two motility patterns of the small bowel?

Answer 17

Fed and fasting

Question 18

Fasting pattern =

Answer 18

MMC (Migratory Motor Complex)

Question 19

Whats the point of MMC

Answer 19

Housecleaning, clears anything left in Small bowel and clears any bacteria

Question 20

Function of fed pattern small bowel movements?

Answer 20

To mix food for absiorption

Question 21

Achalasia

Answer 21

Failure of the esophagus to relax and allow food to pass.

- Commonly a failure of the Lower esophageal sphincter.

Question 22

Incidence of achalasia

Answer 22

rare

Question 23

Etiology of acahalasia

Answer 23

unknowm, potentially autoimmune

Question 24

What is the pathophys of achalasia

Answer 24

Loss of post-ganglionic inhibitory neurons in the Myenteric Plexus thus shifting the balance to excitatory neurons.

Question 25

Pathology of achalasia?

Answer 25

Lymphocyte infiltration in the myenteric plexus

Question 26

Symptoms of achalasia

Answer 26

• dysphagia
• chest pain
• heart burn
• weight loss
• regurgitation of food ( globus- lump in throat)

Question 27

DX of achalasia

Answer 27

history and physical, endoscopy, barium swallow, manometry

Question 28

Characteristic finding of barrium swallow?

Answer 28

Dilated Esophagus with bird beaking of distal part

Question 29

Severe dilatation can lead to

Answer 29

sigmoid esophagus

Question 30

What the hell is manometry

Answer 30

Measurement of pressure using a special catheter.

Question 31

Esophageal, antroduodenal and anorectal manometru are the most common

Answer 31

ok

Question 32

What are the 2 manometric criteria required for dx of achalasia

Answer 32

1) LES fails to relax in response to swallow
2) Aperistalsis in the distal 2/3 of esophagus
- –

Question 33

Most common tx for achalasia

Answer 33

Heller’s Myotomy

Question 34

Complications of achalasia

Answer 34

• Malnutrition
• Aspiration
• Malignancy
• – Untreated achalasia is associated with an increased risk of squamous cell esophageal cancer

Question 35

Diseases associated with achalasia-like motility disorders

Answer 35

1) malignancy
2) Chagas Disease: secondary to trypanosoma cruzi
3) Amyloidosis
4) Sarcoidosis
5) neurofibromatosis

Question 36

Know diffuse esophageal spasm

Answer 36

Repetitive contractions in the esophagus and prolonged duration contractions.

Question 37

Nutcracker esophagus

Answer 37

Increased distal peristaltic amplitude and duration

Question 38

Nutcracker esophagus

Answer 38

Hypercontracting esophagus…increased distal peristaltic amplitude and duration