Surgery(achalasia cardia)

Surgery(achalasia cardia)

• 1.
  ACHALASIA CARDIA  Primaryoesophageal motility disorder  Also called as cardiospasm –because of severe spasm of circular muscles of lower end of oesophagus.  The contracted segment doesn’t relax during swallowing as a result there is dilatation of, tortuosity and hypertrophy of the oesophagus above
• 2.
  Aetiopathogenesis  Idiopathic- itoccurs due to absence/degeneration of Auerbach’s plexus throughout the body of oesophagus, causing improper integration of parasympathetic impulse  Acquired variety- in America, caused by Trypanosoma cruzi which destroys plexus.(Chagas disease)  Stress  Emotional factors  Vitamin B1 deficiencies ganglion cells of Auerbach’s
• 3.
  Pathophysiology ACHALASIA CARDIA Imbalance ofnitric oxide and Ach Neurotransmitter inhibition is decreased (nitric oxide) Loss of inhibitory ganglionic cells in myentric plexus Myenteric plexus inflammation/damage
• 4.
  Clinical features  Womenaround 20-40 yrs. of age are commonly affected  Female:male::3:2  Progressive Dysphagia-which is more for liquids than solid food.  Regurgitation and recurrent pneumonia are common  Malnutrition and ill health  Retrosternal discomfort - pain also radiates to interscapular region  Odynophagia and weight loss
• 5.
  Dysphagia Weight lossRegurgitation Triad ofAchalasia cardia Staging I. II. Proximal dilatation <4cm Dilatation b/w 4-7 cm III. Dilatation >7cm
• 6.
  Investigations  Barium swallow- •bird beak appearance of lower oesophagus, • Dilatation of proximal oesophagus • Absence of fundic gas bubble • Sigmoid oesophagus  X-ray chest- retrocardiac air fluid level lateral view  Plain X-ray abdomen erect-fundic air bubble is absent due to stasis of fluid in oesophagus  Oesophagoscopy-dilated sac containing stagnant food and fluid due to stasis LES is closed with air insufflation, rosette apperance  Oesophageal manometry- Aperistalsis in body of oesophagus  Ultrasound- detects subepithelial tumor infiltration in 2ndy achalasia due to distal carcinama
• 7.
  Rosette appearance of LES on endoscopy X-ray
• 8.
  Treatment  Heller’s cardiomyotomy-surgical 7-10cm long incision made through lower oesophageal end and carried over to stomach ,muscles are cut till mucosa bulges out.Myotomy should be extended upto aortic arch and distally up to stomach to 1-2cm below the junction  Forceful dilatation- using pneumatic balloon under fluoroscopic control within LOS(300mmhg pressure applied for 15 sec)  Injection treatment- inj botulinum toxin is injected in LES endoscopically ,blocks Ach release  Drugs- sublingual nifedipine gives short term releif  Endoscopic myotomy
• 9.
  complications Carcinoma of midand lower oesophagus due to chronic irritation
• 10.
  THANK YOU Gitanjali Kumari 110201312