Oesophagul Disorders Flashcards
(37 cards)
What is achalasia?
Disorders of motility or peristalsis of oesophagus (assess the motor function of the UOS, LOS and oesophageal body)
What can cause GORD?
Assess cause of regurgitation (e.g. reflux of stomach acids into oesophagus); weak LOS
What is aphagia?
inability or refusal to swallow
What is meant by an oesophagul spasm?
Abnormal oesophageal contractions and food is not effectively reaching the stomach
What is diffuse oesophagul spasm?
condition characterised by chest pain coming from oesophagus (~angina)
What is the pathophysiology of Achalasia?
Findings may vary:
- Impaired LOS relaxation (spasms) -
- May be accompanied by impaired peristalsis (sphincter
spasms);
- Food + liquids don’t reach stomach; delayed LOS
opening
=> dilation of oesophageal body with distal narrowing (bird’s beak appearance) of the barium-filled oesophagus on oesophagram;
What is the effect of Achalasia?
Long period of sporadic dysphagia (difficulty swallowing);
Regurgitation of food
What is the aetiology of achalasia?
Disorders of motility or peristalsis of oesophagus (assess the motor function of the UOS, LOS and oesophageal body)
Damage to the innervation of oesophagus
Degenerative lesions to the vagus nerve and loss of myenteric plexus ganglionic cells in the oesophagus
What is the cause of achalasia?
Initiating factor unknown, but thought to be autoimmune or triggered by infection
What are the symptoms of achalasia?
Dysphagia
Vomiting
Heartburn
Retrosternal burning sensation due to oesophageal dysmotility
Retention of ingested (acidic) food;
Generation of lactic acid in the process of decomposition of retained food;
Why does heartburn occur in patients with achalasia?
Retrosternal burning sensation due to oesophageal dysmotility
Retention of ingested (acidic) food;
Generation of lactic acid in the process of decomposition of retained food;
could be due to retention of acid refluxed in oesophagus due to poor emptying and incomplete relaxation of LOS
What tests do we use to diagnose Achalasia?
Barium radiography (barium swallow): dilatation of oesophagus with beak deformity at lower end Evaluates the entire swallowing channel (mouth, pharynx, and oesophagus)
Oesophageal manometry: absent peristalsis
What considerations should you take when diagnosing Achalasia?
Patient’s self-report may suggest type of disorder responsible for complaints
=> may trigger tests required to determine/verify specific cause of complaint
Note some abnormalities of swallowing may be frequent in elderly
When is an oesophagul manometry carried out?
- To determine the cause of non-cardiac chest pain
- To evaluate the cause of reflux (regurgitation) of stomach acid and other contents back up into the oesophagus (GORD?)
- To determine the cause of difficulty with swallowing food (does UOS/LOS contract and relax properly?)
What would normal manometry results show?
Pressure of muscle contractions moving food to oesophagus = normal (15 mmHg) (when food oesophagus →stomach P = <10 mmHg)
Muscle contractions follow normal pattern down oesophagus
What would an abnormal manometry show
Muscle spasms in the oesophageal body
Weak contractions along oesophagus
*The LOS pressure is less than 10 mmHg (GORD / swallowing) – do not confuse these 2
Characterised by high LOS pressure which fails to relax after swallowing
Lack of a coordinated LOS relaxation in response to swallowing
What is reflux?
Reflux is the retrograde movement of gastric content into oesophagus, due to relaxation of the LOS;
How often does reflux normally occur?
Often brief, relatively infrequent;
Often occurs after meals in normal individuals (- transient spontaneous LOS relaxation, tsr);
Reflux usually stimulates salivation
What is the benefit of saliva?
Saliva is an effective natural antacid - dilutes and neutralises refluxed gastric contents
How does low salivation lead to GORD?
Low rate of salivation; lack of ability to swallow own saliva →prolongation of contact of refluxed material with oesophagus →GORD
What is GORD?
Gastro-oesophagul reflux disorder
retro-grade movement of gastric content into oesophagus due to relaxation of LOS;
Causes burning sensation in chest after meals – angina-like pain?
What is the difference between GORD and normal reflux?
GORD - when reflux is more frequent and troublesome
What are the causes of GORD?
Transient spontaneous LOS relaxation (tsr)
98% of normal reflux associated with (tsr) of LOS
Resting LOS pressure is too weak to resist the pressure within the stomach
Sudden relaxation of LOS not induced by swallowing
How does weak/uncoordinated oesophagul contractions contribute to GORD?
oesophageal irritation from reflux disease itself?)
prolonged duration of contact of refluxed digestive contents with oesophagus
