Explain the pathophysiology and radiological finding of achalasia.
- loss of Auerbach's plexus --> ↓NO which leads to loss of relaxation of LES.
- Barium xray: narrowing of GE junction and pre-narrowing dilation --> bird's beak appearance.
This is an out pouching of the pharyngoesophageal pouch. On esophagram, the contrast will collect in the diverticulum.
Zenker's diverticulum
This is a disorder of the movement of the esophagus characterized by contractions in the smooth muscle of the esophagus in a normal sequence but at an excessive amplitude or duration.
Nutcracker esophagus (hypertensive peristalsis)
What esophagram finding would you find in diffuse esophageal spasm?
"Corkscrew" appearance - due to strong, non-peristaltic contractions of the esophagus.
This condition is most commonly seen in middle-aged women and is associated with jaundice, pruritus, & fatigue. Anti-mitochondrial antibodies are classic for this disease.
Primary biliary cirrhosis
- this causes intrahepatic biliary obstruction, leading to a cholestatic pattern on LFTs (↑ALP & GGT).
This hepatic condition is associated with anti-smooth muscle antibodies and a hepatocellular damage LFT pattern.
Autoimmune hepatitis
- hepatocellular damage LFT pattern = incr. ALT & AST (often 5x upper limit); not a cholestatic pattern
A patient who presents with RUQ pain and fever is likely to be _____________.
Acute cholecystitis
(True or false) Acute cholecystitis is classically associated with jaundice.
False
What is the classic triad of acute cholangitis?
Charcot's triad:
1. RUQ pain
2. fever
3. jaundice
This is an autoimmune, progressive cholestasis, diffuse fibrosis of INTRAhepatic & EXTRAhepatic ducts. MC associated with inflammatory bowel disease (90% UC).
Primary sclerosing cholangitis
What are the common presentations of a patient with primary sclerosing cholangitis?