achalasia
DESCRIPTION
microteaching for our clinical teaching subject on junior studes..TRANSCRIPT
ACHALASIA
a lack of relaxation of the LES with swallowing
A relative obstruction at the level of the sphincter is made worse by a lack of peristaltic waves in the esophagus
the condition affects primarily adolescents and adults children under the age 4 yr comprise fewer than 5% patients
Clinical Manifestations
difficulty in swallowing
regurgitation of food
cough from overflow of fluids into the trachea failure to gain weight
Diagnosis
roentgenogram and is confirmed with manometry
TreatmentTreatment
Dilating the cardio esophageal junction with a mercury bougie Transient relief of symptoms
TreatmentTreatment
Heller procedure
surgical division of muscles at the cardioesophageal junction
permanent relief of symptoms
GASTROESOPHAGEAL REFLUX
(CHALASIA)
The term chalasia describes the free reflux across a dilated sphincter
When the LES is not competent, excessive and passive reflux of gastric contents may cause significant symptoms
EtiologyEtiology
reflux may occur with increased intra abdominal pressure
The small reservoir capacity of the infant’s esophagus predisposes to vomiting
Placement of the gastrostomy tube encourages reflux
Mehtylxantines may exacerbate reflux by lowering sphincter tone
Clinical ManifestationsClinical Manifestations
signs and symptoms relate directly to the exposure of the esophageal epithelium to refluxed gastric contentsIn 85% of affected infants excessive vomiting occurs during the 1st week of life an additional 10% have symptoms by 6wk Patients with cerebral palsy, Down syndrome and other causes of developmental delay have an increase incidence of reflux
Clinical ManifestationsClinical Manifestations
delayed gastric emptying
forceful vomiting
aspiration pneumonia
chronic cough wheezing, clubbing and recurrent pneumonia
failure to grow and gain weight
hemorrhage and/or hematemesis
anorexia
DiagnosisDiagnosis
In mild cases, a careful clinical assessment may be sufficient for diagnosis
barium esophagography under fluoroscopic control
DiagnosisDiagnosis
esophagoscopy with biopsy
TreatmentTreatment
In mild uncomplicated cases In mild uncomplicated cases
keeping the child prone with head elevated at 20-30 degrees
thickening the feeding with cereal
careful attention to burping
TreatmentTreatment
In severe cases In severe cases
antacids or cimetidine given four times a day (20-40 mg/kg/24 hr )
metoclopramide (0.5 mg/kg/dose) 4 times a day
cisapride, 0.2mg/kg qid
If symptoms do not respond to a 6wk trial of intensive medical therapy, operative treatment may be indicated
TreatmentTreatment
Bougienage of strictures can provide temporary relief of dysphagia
Nissen fundoplication
TreatmentTreatment
TreatmentTreatment
occasionally, stricture formation is so extensive that colonic interposition is required to replace a portion of the esophagus
Thank You!
jgyif
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