Motor disorders of the oesophagus Flashcards
What is meant by oesophageal reception
Sensation from the entire oesophagus is carried through the vagus nerve
Which neuron nuclei are involved in swallowing
Trigeminal
Facial
Hypoglossal
Explain the initiaton of primary, secondary and tertiary peristalsis
Primary peristalsis is initiated by swallowing
Secondary peristalsis:
- Progressive contraction
- Induced by stimulation of sensory receptors in the oesophageal body
Tertiary peristalsis
- Local smooth muscle activity
Explain when the upper oesophageal sphincter is discharged
At rest it is tonically closed - neural stimuation keeps it closed
Discharge increases with:
- Inspiration
- Slow distention
- Acid in u/o
- Vasalva manoeuvre
- Gagging
Why are CCB effective in Achalasia
The myogenic component of the Lower oesophageal sphincter is calcium dependant
Explain the two motility groups of the oesophagus
Hypo motility group: which has decreased amplitude of contractions with low resting pressure
Hyper motility group: swallow induced waves are of high amplitude, prolonged and repetitive
How is achalasia dysphagia alleviated
By manoevres that increase oesophageal pressure:
- Straigtening the back
- Raising the arms above the head
What are the diagnostic tests for motility disorders
Radiologic and radionuclide imaging
Transnasal or transoral videoendoscopy
Manometery
Which conditions cause oropharyngeal dysphagia
Neurological:
- Cerebrovascular accidents
- Parkinson’s disease
Striated muscle disorders
- Inflammatory myopathies
- Muscular dystrophies
- Myasthenia gravis
What is achalasia
It is a hyper motility disorder where the lower oesophageal sphincter fails to relax
What are the types of achalasia
Type 1: Classic achalasia
Type 2: Intermittent pan-oesophageal pressurization
Type 3: Premature distal oesophageal spasm
What is the pathophysiology of achalasia
Achalasia results from progressive degeneration of ganglion cells in the myenteric plexus in the esophageal wall, leading to failure of relaxation of the lower esophageal sphincter (LES), accompanied by a loss of peristalsis in the distal esophagus
Circular muscle of the lower oesophagus is thickened: Type 1+2
Preserved inhibitory ganglions: Type 3
How is achalasia diagnosed
CXR - no gastric bubble and dilated oesophagus
Endoscopy - Used to rule out achalsia mimics
Mannometry - Will confirm or rule out achalasia features: sequentially propagated waves are absent
What is treatment for Achalasia
Balloon dilatation
Esophagomyotomy
Pharmacological
Botulin toxin injection
What are the clinical manifestations of Achalasia 2&3
Chest pain occurs in 80-90% not associated with dysphagia. Retrosternal
Dysphagia only in 30-60%
LOW
