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  #1  
Old 04-07-2012
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GIT Esophagus histology in this patient?

A 49-year-old female presents with increasing problems swallowing food (progressive dysphagia). X-ray studies with contrast reveal that she has a markedly dilated esophagus above the level of the lower esophageal sphincter (LES). No lesions are seen within the lumen of the esophagus. Which of the following is the most likely cause of this patient’s symptoms
A. Decreased LES resting pressure
B. Absence of myenteric plexus in the body of esophagus
C. Absence of myenteric plexus at the LES
D. Absence of submucosal plexus in the body of esophagus
E. Absence of submucosal plexus at the LES


Answer after 24 hours...
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  #2  
Old 04-07-2012
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B. Achalasia.
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  #3  
Old 04-07-2012
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LOL @ "answer after 24 hrs"
C-achalasia cardia
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Old 04-07-2012
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C) Absence of myenteric plexus at LES ... Achlasia

Easy way to remember the function of the plexuses -

Myenteric plexus = Motility
Submucosal plexus = Secretions
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Old 04-08-2012
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Oh yeah, I misread the answer choices. Agree that it's C.
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Old 04-08-2012
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Yep totally C lol I actually remember that question to be in an NBME i took a couple of months ago
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Old 04-08-2012
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Default The answer is B.....!!!!

Achalasia, which means “un-relaxation,” is a term that describes the absence of normal lower esophageal sphincter (LES) relaxation. This condition results from decreased or absent ganglion cells in the myenteric plexus in the body of the esophagus. The etiology of this neuronal loss is unknown in many cases; however, some cases are secondary to other diseases, such as diabetes mellitus, amyloidosis, sarcoidosis, and Chagas’ disease, which is caused by Trypanosoma cruzi. Because of the increased LES pressure and the absence of peristaltic waves in the lower esophagus, the esophagus in these patients is dilated and tortuous above the level of the LES. Barium x-ray studies reveal this dilation. The distal esophagus has a characteristic “beaklike” appearance. Patients with achalasia have an increased risk of developing aspiration pneumonia and squamous cell carcinoma.

As explained in goljan- the incomplete relaxation of LES is due to the destruction of NO(nirtic oxide) synthase producing neurons and the aperistalsis seen in the proximal portion(the body) of esophagus is due to loss of myenteric plexus. This correlates with the barium meal picture of esophagus- dilated proximal esophagus with beak like tapering of distal end(LES).....
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Gastrointestinal-Tract-, Histology-, Pathology-, Step-1-Questions

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