Hiatus hernia and achalasia Flashcards
Define a sliding hiatus hernia
Gastro-oesophageal junction slides up into the abdominal cavity
Define a rolling hiatus hernia
Gastro-oesophageal junction remains in place but part of the stomach herniates up into the mediastinum
Define achalasia
Failure of relaxation of the Lower oesophageal sphincter
What controls the tone of the lower oesophageal sphincter?
Excitatory transmitters such as ACh, substance P and inhibitory transmitters
What investigations would give a diagnosis of?
CXR
Barium studies
Endoscopy
Manometry
Describe manometry
A thin tube with pressure gauges is inserted into the oesophagus in order to measure pressure along the oesophagus and at the lower oesophageal sphincter as the patient swallows small sips of water. The pressure will be higher than normal in achalasia
What are the differential diagnoses for achalasia?
Oesophageal cancer
Oesophageal stricture
Gastric cancer
What symptoms do you get in achalasia?
Dysphagia Weight loss Heartburn Regurgitation of food Feeling of food sticking in throat
What are the treatments of achalasia?
Medical management
Ca2+ channel blockers and nitrates to dilate the LOS
Surgery - division of the sphincter
Botox - injected into the sphincter to cause relaxation
What are the types of surgical procedures that can be done for achalasia?
Hellers cardiomyotomy
- Cardia muscles are cut to allow for relaxation of the lower oesophageal sphincter
What is Nissen fundoplication?
Treats GORD and hiatus hernia
- The procedure involves wrapping the Gastric Fundus around the lower end of the oesophagus and stitching it in place, reinforcing the closing function of the lower oesophageal sphincter.
What would you see with the investigations in achalasia?
CXR - no air in stomach and dilated oesophagous
Barium studies - Bird’s Beak narrowing at oesophagous
Endoscopy is to rule out malignancy
Manometry - higher pressure in achalasia
