Esophageal_Motility_Disorders-1

Esophageal_Motility_Disorders-1 - Esophageal Motility...

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Esophageal Motility Disorders Vic V. Vernenkar, D.O. St. Barnabas Hospital Dept. of Surgery
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Anatomy Active muscular organ with a complex neuromuscular structure and integration. The sequential muscular contractions push food from above and clear acid and bile reflux from below. Specialized sphincter at each end. UES and LES
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Anatomy UES contracts during inspiration preventing air from entering into the GI tract, while the LES maintains a steady baseline tone to prevent gastric juice from refluxing into the esophagus. LES also contracts during periods of increased intraabdominal pressure, preventing reflux due to pressure in the abdomen. Inner circular layer, outer longitudinal layer of muscle. (ring occlusions and shortens)=> peristalsis.
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Peristalsis Sequential, coordinated contraction wave that travels along the whole length of the esophagus, propelling intraluminal contents downstream. Primary wave strips from proximal to distal, triggered by swallowing center, 2cm/sec. Secondary wave induced by distension of bolus, acts to clear esophagus of retained food. Tertiary contractions are dysfunctional and have no role.
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Motility Disorders Achalasia Primary spastic motility disorders, including DES, nutcracker esophagus, hypertensive LES Secondary esophageal motility disorders related to DM, scleroderma, alcohol, psychiatric disorders, etc.
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Achalasia Loss of ganglion cells from the wall of the esophagus, starting at the LES and going proximally. Loss of inhibitory nerves at LES. Circular muscle layer thickened at LES but microscopically cells appear normal.
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Achalasia
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Achalasia Loss of the inhibitory nerves at the LES causes failure of the LES to completely relax, and a hypertensive LES pressure over 40mmHg in 60% of patients. Loss of nerves along the body of esophagus causes aperistalsis, stasis, dilatation.
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Achalasia Non-peristaltic isolated contractions or low- amplitude simultaneous contractions occur. If high-amplitude (>60mmHg) simult contractions occur it is called Vigorous Achalasia.
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Edrophonium (acet cholesterase inhib) increases LES pressure. Atropine reduces the LES pressure in
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Esophageal_Motility_Disorders-1 - Esophageal Motility...

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