Hello!
This post is about the pathophysiology of achalasia!
In achalasia, there is loss of NO and VIP releasing inhibitory neurons. Thus, the loss of the inhibitory innervation in achalasia results in the manometric consequence of failure of LES relaxation as well as loss of esophageal peristalsis.
Mnemonic: In achalasia, the LES allows NO entry of VIP food particles :D
Anticholinergic medications decrease the LES pressure, while cholinergic medications increase it confirming that the cholinergic neurons in achalasia are preserved. This is the same mechanism through which botulinum toxin reduces the LES pressure and is shown to be efficacious in treating achalasia.
Revision: Botulinum toxin is a protease that cleaves the SNARE protein to prevent fusion and release of Ach containing vesicles.
CCK test: CCK has a dual effect on the lower esophageal sphincter (LES): it stimulates smooth muscle contraction and the release of inhibitory neurotransmitters. Administration of CCK normally causes the LES pressure to fall because the effect on inhibitory neurotransmitters is greater. In patients with achalasia, CCK causes the lower esophageal sphincter pressure to rise. (Confirming the loss of inhibitory neurons theory!)
That's all!
-IkaN
Related post: Achalasia surgery mnemonic
This post is about the pathophysiology of achalasia!
In achalasia, there is loss of NO and VIP releasing inhibitory neurons. Thus, the loss of the inhibitory innervation in achalasia results in the manometric consequence of failure of LES relaxation as well as loss of esophageal peristalsis.
Mnemonic: In achalasia, the LES allows NO entry of VIP food particles :D
Anticholinergic medications decrease the LES pressure, while cholinergic medications increase it confirming that the cholinergic neurons in achalasia are preserved. This is the same mechanism through which botulinum toxin reduces the LES pressure and is shown to be efficacious in treating achalasia.
Revision: Botulinum toxin is a protease that cleaves the SNARE protein to prevent fusion and release of Ach containing vesicles.
CCK test: CCK has a dual effect on the lower esophageal sphincter (LES): it stimulates smooth muscle contraction and the release of inhibitory neurotransmitters. Administration of CCK normally causes the LES pressure to fall because the effect on inhibitory neurotransmitters is greater. In patients with achalasia, CCK causes the lower esophageal sphincter pressure to rise. (Confirming the loss of inhibitory neurons theory!)
That's all!
-IkaN
Related post: Achalasia surgery mnemonic
No comments:
Post a Comment
This is express yourself space. Where you type create something beautiful! <3
Wondering what do I write? Well...
Tell us something you know better. You are a brilliant mind. Yes, you are! ^__^
Ask about something you don't understand @_@?
Compliment... Say something nice! =D
Be a good critic and correct us if something went wrong :|
Go ahead. Comment all you like here! (:
PS: We have moderated comments to reduce spam. ALL comments that are not spam will be published on the website.