Esophagus A.docVIP

Esophagus A: Slide 16 AchalasiaInability to relax lower esophageal sphincter leads to massive esophageal dilation Condition: Chronic achalasia Museum Location: Fourth Year Tutorial Alimentary 13. Description: Chronic achalasia of the oesophagus in an elderly man. He had suffered from dysphagia for many years, but refused surgical operation, and treated himself by periodically passing bougies. Note the marked dilatation of the oesophagus and the hypertrophy of its muscle. Normal Esophagus the mucosa is composed of a nonkeratinizing stratified squamous epithelial layer that overlies a lamina propria...a small number of? specialized cell types, such as melanocytes, endocrine cells, and langerhans cells are present in the deeper portion of the epithelial layer... the submucosa consists of loose connective tissue containing blood vessels, a rich network of lymphatics, a sprinkling of leukocytes with occasional lymphoid follicles, nerve fibers (including the ganglia of Meissner plexus), and submucosal glands... ? Achalasia achalasia is characterized by three major abnormalities: (1) aperistalsis, (2) partial or incomplete relaxation of the LES with swallowing, and (3) increased resting tone of the LES... ? the pathogenesis of primary achalasia is poorly understood but is thought to involve degenerative changes in neural innervation, either intrinsic to the esophagus or in the extraesophageal vagus nerves and the dorsal motor nucleus of the vagus... ? secondary achalasia may arise in Chagas disease, in which Trypanosoma Cruzi causes destruction of the myenteric plexus of the esophagus, duodenum, colon, and ureter, with resultant dilation of these viscera... ? diseases of the dorsal motor nuclei, particularly polio or surgical ablation, can cause an achalasia-like illness, as can diabetic autonomic neuropathy, and infiltrative disorders, such as malignancy, amyloidosis, and sarcoidosis... ? birds beak... ? in most instances, however, achalasia occurs as a pr