GI Quiz 1 - Motility Disorders Flashcards
What are 2 major Motility Disorders?
Achalasia (Cardiospasm, Eso. Aperistalsis, Megaesophagus)
Symptomatic Diffuse Eso Spasm (Spastic Pseudodiverticulosis, Rosary Bead, Corkscrew Eso.)
Describe what Achalasia is?
Neurogenic eso. motility disorder w/ impaired eso. peristalsis, lack of LES relaxation during swallowing, INC of LE resting pressure
Described what Symptomatic Diffuse Eso Spasm is?
Motility disorder w/non-propulsive contractions, hyperdynamic contractions, or INC LES pressure
What are the 3 types of Achalasia and what causes each?
Primary: Loss of ganglion cells in myenteric plexus of eos. -> denervation of eso. mm (viral?)
Secondary: Chagas Dz
Pseudo: malignancy, infiltrative disorders, Diabetes
What are SSx of Achalasia vs. Sym. Diffuse Eso. Spasm?
Achalasia:
20-60 y/o, insidious onset or gradual progression (mon-yrs),
Nocturnal regurg. of undigested food (33%) -> cough/pulm. aspiration
Chest pain (rare)
Mild-mod. wt. loss
Sym. Diffuse Eso. Spasm:
Substernal chest pain (80-90%), min-hrs, awake from sleep, <hot/cold liquids, radiates to back
Heartburn (20%)
Both:
Dysphagia solids/liquids (30-60% in spasm)
If you have pronounced weight loss in an elderly pt w/rapidly developing dysphagia SSx, what should you consider?
Achalasia 2ndary to tumor of GE junction!!
What is the workup and findings of Achalasia?
Barium Swallow: absence of progressive peristaltic contractions during swallowing, dilated eso, NARROW & BEAKLIKE AT LES
Eso. Manometry: aperistalsis, INC LES pressure, incomplete relaxation
Esophagoscopy: r/o malignancy & other DDx
What is the workup for Spasm?
Barium swallow & manometry (BEST, but spasms might not occur during test)
What is your DDx w/Achalasia?
Distal Stenosing Carcinoma
Peptic Stricture
What is the prognosis of Achalsia?
Pulmonary aspiration
Presence of CA
