Achalasia

By. Groups 1
Ranti Agustini 21117098)
Ridia Lokarina (21117100)
Rizky Amrin Sidiq (21117102)
Selvi Suci Hayati (21117104)
Sheli Sulistia Ningsih (21117106)
Shindy Prima Utami (21117108)
Sici Safitri (21117111)
A. Understanding

 Achalasia is a rare motility disorder where the relative obstruction of the

gastroesophageal junction becomes worse due to the absence of
peristaltic waves in the esophagus. Acalacia is the loss of esophageal
peristalsis and failure of relaxation of the lower esophageal sphincter. The
failure to relax the smooth muscle fibers of the gastrointestinal tract at the
intersection of one part with another in particular the failure of the
esofagogaster sphincter to relax at swallowing due to degeneration of
ganglion cells in the organ (Dorland pocket medical dictionary, 2007).
 Anatomical Physiology
 Mouth

The mouth or oral cavity is the entrance to the digestive system and contains an accessory
organ that functions in the initial process of digestion.

 Pharynx

Pharynx Is a link between the oral cavity and esophagus.

 Eshophagus

The esophagus functions to carry food, fluid, secretions from the pharynx to the stomach
through a process of swallowing, where there will be a formation of bolus food with soft size and
consistency, the process of swallowing consists
Epidemiology

 Achalasia is rare compared to other diseases. Most

cases occur in middle age with almost the same sex
ratio, more common in adults even though it can occur
in childhood or baby. This disease is also not inherited
and usually takes years to cause symptoms. In the United
States there are around 2000 cases of achalasia every
year, most of them at the age of 25-60 years and few in
children.
 Etiology
Based on the theory, the causes of achalasia include:
1. Genetic theory
Achalasia can be reduced in the range of 1% -2% of the population with achalasia.
2. Infection theory
Akalasia is caused by:
a. Bacteria (diphtheria pertussis, dostridia, tuberculosis, syphilis)
b. Virus (herpes, varicella zooster)
c. Toxic substance (gas kombat)
3. Autoimmune theory
Akalasia is caused by an inflammatory response in the esophageal myenteric plexus
dominated by T lymphocytes which play a role in autoimmune diseases.
4. Degenerative theory
Achalasia is associated with the aging process with neurological status or psychological
illnesses such as Parkinson's or depression.
 Pathophysiology
1. Neuropathology
Among others :
 Abnormalities in Extrinsic Conservation
 Abnormalities in Intrinsic Innervation
 Plain esophageal muscle abnormalities
 Abnormalities in the esophageal mucosa.
 Skeletal Muscle Abnormalities
2. Neurophysiological abnormalities

In a healthy esophagus, extracellular cholinergic neurons release acetylcholine causing

muscle contractions and increasing LES tone, where inhibition of NO / VIP neurons mediates
inhibition thereby inhibiting the response of swallowing along the esophagus, which results in
LES peristalsis and relaxation. The key to the abnormality of achalasia is damage from the
postganglionic neuron inhibitor of the LES cyclic muscle.
 Classification
Based on etiology, achalasia can be divided into 2, namely:
1. Primary
It is the most common case of achalasia found in the United States. In this type, the
cause of achalasia is unknown, but it is thought to be caused by a neurotropic virus
which results in lesions of the dorsal vagus nucleus in the brain stem and misenteric
ganglia of the esophagus.
2. Secondary
Akalasia is caused by other diseases, including:
Infection (Chagas disease)
Gastric carcinoma that invades the esophagus through radiation, toxins or certain
drugs.
Intraluminer tumors, such as cardia tumors or extra luminous pushing like pancreatic
pseudocysts.
Anti-cholinergic drugs or post vagotomy.
Clinical Manifestations

There are main signs of achalasia disease, namely:

1. Dysphagia (difficult to swallow)
2. Regurgitation
3. Weight loss
4. Symptoms that accompany the main symptoms, such
as pain in the chest.
Diagnostic Check

1. Radiological examination
2. Esophagoscopic examination
3. Manometric Examination
4. Barium swallowing or esophago gastro duodenoscopy
(EGD); ± monitoring of esophageal pH or manometer.
5. Motility checks
Complications

Some complications and achalasia as a result of food retention in the

esophagus are as follows:
1. Obstruction of the respiratory tract
2. Bronchitis
3. Aspiration pneumonia
4. Lung abscess
5. Meckel diverticulum
6. Esophageal perforation
7. Small cell carcinoma
8. Sudden death
Nursing Care

A. Assessment
1. Client Identity
Name, age, gender, occupation, entry date, address, MR number, etc.
2. Health History
a. Previous Medical History
Usually clients have experienced upper gastrointestinal disease.
b. Current Health History
Usually the client experiences dysphagia, regurgitation, pain behind the
sternum, anorexia and decreased body weight.
c. Family Health History
The presence or absence of family members who suffer from the same
disease as the client.
Next....
3. Physical Examination
a. Head and Neck
Usually the hygiene of the head is maintained and the neck usually does not have
enlarged lymph nodes
b. Eye
Usually the conjunctiva is not anemic, the sclera is not jaundiced and the palpebra
is not edema
c. Nose
Usually no abnormalities are found
d. Mouth
Usually oral and dental hygiene is maintained and the lips mucosa is dry
e. Ear
Usually abnormalities are not found
f. Chest / Thorax
g. Abdomen
Lungs
I: usually not ascites, concave
I: usually symmetrical left and right
Q: Usually liver and spleen are not palpable
P: usually fremitus left and right
P: usually Tympani
P: usually sonor
A: usually vesicular, no ronchi, no wheezing A: usually a normal BU

Heart h. Genitourinary

I: Ictus is usually not visible There are usually no abnormalities and

P: Usually Ictus is felt by 1 finger LMCS RIC V complaints
P: usually the heart is within normal limits i. Extremity
A: usually regular rhythms Usually there is no edema
4. Daily activities
a. Nutrition
Anorexia, nausea, vomiting, bad stomach, weight loss.
b. Rest / sleep
Weakness, fatigue, heavy activity arises shortness of breath, difficulty
sleeping
c. Elimination
Usually clients do not experience interference
d. Personal hygiene
Usually the client's cleanliness is maintained
B. Focus of Intervention
a. Disorders of nutrition fulfillment are less than the body's needs b / d inadequate intakes
are characterized by nausea vomiting.
Objective: Nutritional needs are met with the results criteria: BB within normal limits
Intervention:
• Assess client's nutritional needs
• Give clients a small but frequent meal
• Give food warm
• Give clients motivation to want to spend food
Rational :
• By knowing the nutritional needs of the client can be assessed the extent of the client's
nutritional deficiencies and determine the next step
• To reduce gastric fulfillment and facilitate absorption
• Warm food is expected to reduce nausea / vomiting
• Clients feel cared for and try to spend their food
b. Activity intolerance b / d physical weakness
Objective: Clients can carry out activities according to the level of tolerance
with the results criteria: Clients can carry out daily activities according to their
level of ability.
Intervention:
• Assess the cause of fatigue
• Help clients meet basic needs
• Provide a calm environment and uninterrupted resting period
• Provide a safe environment
Rational :
• To find out the factors that decrease activity tolerance
• Maximizing the fulfillment of the client's basic needs
• Save energy for activities
• Avoid injuries from accidents
C. Implementation

It is the application of an action plan that has been prepared with

priority problems and this activity is carried out by nurses to help meet
client needs and achieve expected goals.

D. Evaluation

It is the final stage of the nursing process to determine the expected

outcome of the actions taken and the extent to which the client's
problem is resolved. The nurse carries out a review to determine the
next action if the goal is not achieved.
Thank You.....