Week 1

Question 1

What is achalasia?

Answer 1

The lower esophageal sphincter (LES) cannot relax.

Also involves aperistalsis of lower esophagus

Question 2

What is Achalasia

Answer 2

Lower esophageal (LAS) cannot relax.

Question 3

What are the causes/risk factors for Achalasia?

Answer 3

1. Nerve degeneration of inhibitory neurons.
2. Esophageal dilation due to accumulation of food and fluid,
   3, Hypertrophy.
3. An unknown cause

Question 4

How would you describe the effect of Achalasia in relation to GERD?

Answer 4

Achalasia is the opposite of GERD. In achalasia the esophagus is contracted, with GERD it is relaxed.

Question 5

What are the clinical manifestations of Achalasia?

Answer 5

1. Substernal chest pain( similar to angina) that occurs during or immediately after a meal.
2. Inability to belch (eructate).
3. Dysphagia.
4. Coughing.
5. Regurgitation of food.
6. Weight loss.
7. Weakness.
8. Poor skin turgor.

Question 6

What is dysphagia?

Answer 6

Dysphagia is trouble swallowing.

Question 7

When we have chest pain, what cause do we always rule out first?

Answer 7

Whenever we have chest pain we would always rule out a cardiac problem first.

Question 8

What are the potential complications of Achalasia?

Answer 8

1. Megaesophagus.
2. GERD
3. Chest Pain
4. Nocturnal regurgitation
5. Aspiration
6. Halitosis

Question 9

What is megaesophagus?

Answer 9

Megaesophagus, also known as ME, is a condition in which peristalsis fails to occur properly and the esophagus is enlarged.

Question 10

What are the diagnostic tests used to diagnose Achalasia?

Answer 10

1. Upper GI barium x-rays
2. Esophageal manometry
3. Esophagogastroduodenoscopy (EGD)

Question 11

What is Esophageal manometry?

Answer 11

Esophageal manometry is a test to measure the function of the LES. Tests the pressure of the LES.

Question 12

What is Esophagogastroduodenoscopy?

Answer 12

EGD , an upper endoscopy, is a procedure used to examine the lining of the esophagus, stomach, and upper part of the small intestine (duodenum). The patient is positioned on his left side and a camera is inserted down the throat.

Question 13

What are some nursing implications for a patient who undergoes an EGD?

Answer 13

Patient will be NPO 8 hours prior to test.
Invasive procedure. Patient must sign a consent form.
Conscious sedation- person can converse to comment on pain, etc., but will not remember the procedure.
Ensure patient is medicated adequately for pain.
Following the procedure check for the return of gag reflex.

Question 14

Describe patient education for a patient with Achalasia?

Answer 14

Recommended dietary adjustments such as soft foods, several small meals rather than 3 large meals. Medications can be used to help manage it. It can also be helpful to elevate the head of the bed after eating and at night
Medications used to manage condition include smooth muscle relaxants before meals such as nitrates ( isosorbide dinitrate- [Isordil], and calcium channel blockers ( nifedipine [ Procardia}. Patients would also need explanations of any procedures to be performed.

Question 15

What is the treatment for Achalasia?

Answer 15

Medications used include smooth muscle relaxants such as nitrates, calcium channel blockers. Also, botulism injections can be given into the LES.
Invasive treatments include dilation of the cardiac sphincter, surgery such a Heller myotomy, or POEM (peroral endoscopic myotomy)