Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

2025 Part Twos > Oesophagus: Motility disorters > Flashcards

Oesophagus: Motility disorters Flashcards

(86 cards)

Start Studying
1
Q

What is the literal definition of achalasia?

A

Failure to relax

Refers to the failure of the lower oesophageal sphincter to relax.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What condition is characterized by dysphagia from failure of the Lower Oesophageal Sphincter (LOS) to relax?

A

Achalasia

Associated with oesophageal dysmotility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the incidence rate of achalasia?

A

Approximately 2-4/100000

Rare condition affecting all ages, more common in women.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the presumed aetiology of achalasia?

A

Idiopathic

True pathogenesis is unclear; possible infectious neurogenic degeneration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the process involved in achalasia?

A

Inflammatory infiltrate into myenteric plexus leading to neuronal loss

Results in loss of oesophageal peristalsis and LOS relaxation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the classic triad of symptoms in achalasia?

A

Dysphagia, regurgitation, and weight loss

Other symptoms may include chest pain and nocturnal cough.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can occur if achalasia is left untreated?

A

Progressive oesophageal dilatation and wall thickening

Increased risk of cancer due to chronic inflammation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a ‘sigmoid oesophagus’?

A

Reservoir of undigested food at dilated distal oesophagus, which is regurgitated

Associated with chronic achalasia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What symptoms should prompt suspicion of achalasia?

A
  • Dysphagia to solids and liquids
  • Symptoms of reflux that don’t respond to treatment
  • Regurgitation of food

Important to differentiate from malignancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is often the first investigation for dysphagia in suspected achalasia?

A

Endoscopy

Can reveal retained food or increased resistance at LOS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the classic findings in a barium swallow for achalasia?

A

‘Bird’s beak’ at LOS with oesophageal dilatation

Severe cases may show ‘sigmoid oesophagus’ with sump formation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most important modality in the diagnosis of achalasia?

A

Manometry

Measures oesophageal and gastric pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does IRP stand for in manometry terminology?

A

Integrated Relaxation Pressure

Normal is <155mmHg; >15 indicates failure to relax.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does DCI represent in manometry terminology?

A

Distal contractile integral

Measures peristaltic strength; <100mmHg.s.cm is failed, <450 is weak, >8000 is hypercontractile.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does DL stand for in the context of achalasia diagnosis?

A

Distal latency

Speed of peristaltic wave; <4.5 s is premature and indicates spastic contraction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Type I Achalasia according to the Chicago classification?
How well does type one respond to treatment?

A

Swallow, nothing happens (no relaxation)

Minimal oesophageal body function, only a few low level oesophageal pressurisations <30mmHg. Oesophagus often dilated - ? reflection of later stage disease. Good response to treatment 80-90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What characterizes Type II Achalasia?
How common is type 2? How well does type two respond to treatment?

A

Swallow, it all gets tight

Pan-oesophageal pressurisations (partially preserved oesophageal function). Often have bird’s beak appearance on barium swallow without dilatation. Most common 50-65% of patients. Best response to treatment >90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What occurs in Type III Achalasia?
How does type three achalasia appear on barium swallow?
How well does type 3 achalasia respond to treatment?

A

Swallow, crazy uncoordinated contractions

Spastic activity of oesophagus and failure of LOS to relax (differentiates this from diffuse oesophageal spasm). Circular muscle exhibits uncoordinated rather than absent contractions. Usually affects lower 2/3 of oesophagus. Often see corkscrew appearance on barium swallow. Response to dilatation or Heller’s myotomy around 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the typical response to treatment for Type I Achalasia?

A

80-90%

Type I has minimal oesophageal body function and often presents with oesophageal dilation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the prevalence of Type II Achalasia among patients?

A

50-65%

This type features partially preserved oesophageal function and is characterized by pan-oesophageal pressurisations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What distinguishes Type III Achalasia from diffuse oesophageal spasm?

A

Failure of LOS to relax

Type III Achalasia is marked by spastic activity and uncoordinated contractions in the circular muscle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the barium swallow appearance associated with Type II Achalasia?

A

Bird’s beak appearance

This appearance occurs without dilatation of the oesophagus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the barium swallow appearance associated with Type III Achalasia?

A

Corkscrew appearance

This appearance is indicative of the uncoordinated contractions in the lower 2/3 of the oesophagus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the typical response to treatment for Type III Achalasia?

A

Around 50%

This response is seen with dilatation or Heller’s myotomy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What factors influence the choice of treatment for achalasia?
Type of achalasia, patient fitness for surgery, local expertise ## Footnote Treatment decisions are individualized based on these considerations.
26
What is the role of pharmacological therapy in treating achalasia?
Limited due to lack of efficacy and side effect profile; can be used for non-surgical candidates ## Footnote Pharmacological options are not routinely effective.
27
What is the effect of Botox injections in achalasia treatment?
Good effect but short lasting ## Footnote Botox is primarily used for patients not suitable for surgery.
28
What are the treatment options for surgical candidates with achalasia?
Pneumatic dilations, POEM, Surgical Myotomy ## Footnote These options show comparable results.
29
What is the risk of perforation associated with pneumatic dilations?
Approximately 2-5% ## Footnote This risk is a consideration when choosing this treatment option.
30
How do outcomes compare between POEM and Heller's myotomy for Type 1 & 2 achalasia?
Similar outcomes ## Footnote Both procedures are effective for these types.
31
What is a significant concern regarding POEM and gastro-oesophageal reflux disease (GORD)?
POEM does not address the risk of GORD after myotomy ## Footnote Heller's procedure includes anti-reflux fundoplication.
32
What is the effectiveness of POEM myotomy for Type 3 achalasia?
Can extend myotomy beyond LES to lower oesophagus, treating spastic activity more effectively ## Footnote This makes it particularly beneficial for Type 3 patients.
33
What medications are used for smooth muscle relaxation at the lower oesophageal sphincter (LOS)?
Calcium channel blockers, PDE5 inhibitors ## Footnote These medications are only partially effective and have side effects.
34
What are the side effects of using calcium channel blockers and PDE5 inhibitors?
Constipation, dizziness, palpitations, tiredness, flushing, headaches ## Footnote These side effects limit their routine use.
35
What is the process of pneumatic balloon dilation?
Stretching cardia with balloons to 30-40 mmHg ## Footnote This method provides good symptom improvement but requires multiple treatments.
36
What are the pros and cons of pneumatic balloon dilation?
Pros: Equivalent results to Heller myotomy + fundo; Cons: Does not address oesophageal motility, risk of perforation 4-5% ## Footnote Dilation is effective but has limitations.
37
What is the main limitation of botulinum toxin injections in achalasia treatment?
Most patients experience recurrence of symptoms ## Footnote This limits the long-term effectiveness of botulinum toxin.
38
In which patients should botulinum toxin be limited to?
Elderly patients not suitable for PD or laparoscopic myotomy, patients with unclear diagnosis from manometry and barium studies ## Footnote Its use is carefully restricted due to complications.
39
What is POEM in the context of achalasia treatment?
PerOral Endoscopic Myotomy, a natural orifice transluminal endoscopic surgical technique ## Footnote It involves a proximal mucosal incision and dissection to perform myotomy.
40
What are the pros and cons of POEM?
Pros: Similar improvement in dysphagia symptoms to Heller's; Cons: Increased rates of reflux, often requires long-term PPI post-procedure ## Footnote These factors are critical in evaluating the overall benefit of POEM.
41
What success rate was observed in a multicentre retrospective review of POEM?
96% success rate ## Footnote This is significantly higher compared to standard treatments, which typically show around 50% success.
42
What is the gold standard treatment for achalasia?
Laparoscopic cardiomyotomy (Heller’s) + partial fundoplication ## Footnote According to the Society of American Gastrointestinal and Endoscopic Surgeons
43
What are the principles of surgical management for achalasia?
* Adequate mobilisation of oesophagus * Preservation of anterior vagal fibres * Myotomy extending 5cm up oesophagus and 2cm below LOS * Avoidance of mucosal injury * Partial fundoplication to reduce risk of reflux (usually anterior)
44
What is the initial step in the surgical procedure for achalasia?
Laparoscopic set-up as per fundoplication ## Footnote This involves dividing the phreno-oesophageal ligament and mobilising the lower oesophagus.
45
What is the extent of myotomy in achalasia surgery?
Myotomy extends 5cm above LOS and 2cm below LOS ## Footnote This ensures adequate relief of symptoms.
46
What technique is used to perform the myotomy?
Diathermy or energy device ## Footnote Care must be taken to avoid mucosal injury.
47
What is performed to ensure complete myotomy?
Endoscopic evaluation and insufflation ## Footnote This aids in identifying undivided muscle fibres.
48
What type of fundoplication is preferred in achalasia surgery?
Dor – anterior 180 fundoplication ## Footnote Nissen fundoplication is avoided due to high risk of dysphagia.
49
When should oesophagectomy be considered in achalasia patients?
* Patients with megaoesophagus * Patients with sigmoid oesophagus * Failure of >1 myotomy * Reflux stricture not amenable to dilation
50
What is the prognosis of achalasia over a 20-year period?
8% chance of carcinoma ## Footnote Most commonly squamous cell carcinoma (SCC).
51
What is recommended for surveillance in achalasia patients?
5 yearly surveillance from 15-20 years post diagnosis
52
What is GOJ/EGJ outflow obstruction similar to?
Achalasia
53
What are the diagnostic criteria for GOJ/EGJ outflow obstruction?
Raised LOS pressure (>15mmHg) with normal oesophageal contractility/peristalsis
54
How is the diagnosis of GOJ/EGJ outflow obstruction made?
Manometry
55
What are the treatment options for GOJ/EGJ outflow obstruction?
* Endoscopic * Surgical * PD for longer term symptomatic relief * Botox for temporary relief
56
What surgical procedure is preferred for patients with GOJ/EGJ outflow obstruction who do not respond to endoscopic treatment?
Laparoscopic Heller’s myotomy + anterior partial fundoplication
57
What is the role of POEM in the management of achalasia?
Limited evidence currently ## Footnote POEM is peroral endoscopic myotomy.
58
What is Diffuse oesophageal spasm also known as?
Corkscrew oesophagus ## Footnote This condition presents similar symptoms to achalasia but is much less common.
59
Who is most commonly affected by Diffuse oesophageal spasm?
Female patients and those with multiple medical complaints ## Footnote This condition is particularly prevalent in these demographics.
60
What are the common symptoms of Diffuse oesophageal spasm?
Chest pain and dysphagia ## Footnote Symptoms often worsen during emotional stress.
61
What is the aetiology of Diffuse oesophageal spasm?
Not well understood ## Footnote The exact cause of this condition remains unclear.
62
What investigation is classically associated with Diffuse oesophageal spasm?
Barium swallow ## Footnote It may show a corkscrew oesophagus but is not specific or sensitive.
63
What additional investigation is needed for Diffuse oesophageal spasm?
Manometry ## Footnote It measures contractions and assesses the relaxation of the lower oesophageal sphincter.
64
What are the manometry findings indicative of Diffuse oesophageal spasm?
Simultaneous multipeaked contractions (>120mmHg amplitude) or long duration (>2.5s) ## Footnote High DCI and short Distal Latency indicate spastic contraction.
65
What is the treatment approach for Diffuse oesophageal spasm?
Treatment options include dietary modifications, acid suppression, and medications. Often only partial relief of symptoms
66
What dietary modification is recommended for Diffuse oesophageal spasm?
Avoid trigger foods ## Footnote This can help alleviate symptoms.
67
Which medications may be used for Diffuse oesophageal spasm?
Nitrates, Calcium channel blockers, anticholinergics ## Footnote Their relative efficacy is not well known.
68
What is the effectiveness of bougie dilatation for Diffuse oesophageal spasm?
Effective in 70-80%, but results are not long-lived ## Footnote This procedure may offer temporary symptomatic relief.
69
What is the potential benefit of Botox in treating Diffuse oesophageal spasm?
Some success but not sustainable ## Footnote Botox may provide temporary relief in some patients.
70
What surgical option is available for Diffuse oesophageal spasm?
Long oesophageal myotomy ## Footnote This may require thoracotomy or thoracoscopy.
71
What is POEM and its effectiveness for Diffuse oesophageal spasm?
Peroral endoscopic myotomy, early data suggests up to 90% effective ## Footnote It shows promise as a treatment option.
72
What characterizes Jackhammer oesophagus?
Excessive contractility, also known as Nutcracker oesophagus ## Footnote It features significantly elevated peristaltic contractions.
73
What are the findings on manometry for Jackhammer oesophagus?
High DCI and normal LOS relaxation (IRP) | DCI distal contractile interval, IRP integrated relaxation pressure ## Footnote This condition is exceedingly rare.
74
What are the surgical options for Jackhammer oesophagus?
Long myotomy and potentially POEM ## Footnote There is a risk of severe dilatation of the oesophagus in the future.
75
What can high resolution manometry (HRM) detect?
Non-specific findings ## Footnote Most findings are incidental and of no significance.
76
What is Secondary achalasia?
GOJ obstruction with secondary oesophageal peristalsis abnormalities ## Footnote It is not a primary motility disorder but rather mechanical.
77
What is the most common cause of Secondary achalasia?
Malignancy ## Footnote It is the most prevalent cause of this condition.
78
What disease can cause Secondary achalasia?
Chagas disease ## Footnote Caused by Trypanosoma cruzi infection from South America.
79
What surgical treatments are available for Secondary achalasia?
Serra-Doria procedure and Modified Thal procedure ## Footnote These procedures involve cardioplasty and other techniques to prevent reflux.
80
What is the term for the oesophageal motility disorder characterized by failure of the lower oesophageal sphincter to relax properly?
Achalasia ## Footnote Achalasia is a primary disorder of the esophagus where the lower esophageal sphincter fails to relax, leading to difficulty swallowing.
81
What must be excluded if achalasia is suspected in oesophageal motility disorders?
Pseudoachalasia ie malignant mechanical obstruction ## Footnote Pseudoachalasia mimics achalasia but is caused by malignancy, necessitating differentiation.
82
What condition is indicated if the lower oesophageal sphincter is not relaxing properly but peristalsis is still intact?
GOJ outflow obstruction ## Footnote GOJ stands for gastroesophageal junction, and obstruction here can affect swallowing.
83
What does premature and spastic contractility during swallowing indicate?
Distal Esophageal Spasm ## Footnote This condition causes intermittent contractions that can be painful and lead to swallowing difficulties.
84
What condition is characterized by excessive amplitude during swallowing contractions?
Nutcracker oesophagus ## Footnote Nutcracker oesophagus is characterized by high amplitude contractions, leading to chest pain and dysphagia.
85
If more than 50% of swallows are effective, what does this indicate?
Minor motility disorder ## Footnote A minor motility disorder suggests some dysfunction but not significant enough to cause severe symptoms.
86
What does it indicate if less than 50% of swallows are effective?
Normal, often seen in aging ## Footnote It is common for swallowing efficiency to decline with age, but this does not necessarily indicate a disorder.

2025 Part Twos (62 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions