Case presentation

Achalasia

Supervised by : Dr.Farman Uthman

Prepared by :
Aland Haval
Avesta Sardar
Anya Farhad
Balla Bakhtyar
 • Date of admission : 9/12/2022
• Age : 68 years
• Sex : male
• Date of history and examination :
• Occupation : Retired
10/12/2022
• Address: Ranya

• Marital status : Married

• Religion: Muslim
 Chief complain

Nausea & Vomiting for 2 Weeks duration

 History of present illness
1. Beginning: On 31 October, the patient had Epigastric pain radiating to

back, Fatigue, Nausea, Vomiting and mild fever with loss of appetite for 2

days duration. Diagnosed with Gallstone by ultrasound indicating Surgery.

2. Lap-Cholecystectomy postponed until 26.11 due to high

inflammatory markers. Procedure done on patients demand

regardless of abnormal blood investigations.

3. Post-Op was fine at first but suddenly withing 2 hours, BP dropped

and admitted to Ranya ICU for 2 days.

 History of present illness

4. Pt. referred to Hawler ICU and stayed for 6 days

5. Referred back to Ranya ICU for 2 days

6. Referred to Shar Hospital, admitted to surgical wards due to

unavailable ICU beds and stayed for 3 days.

7. Referred to teaching hospital on 9th December

 Review of systems

• GIT: As mentioned in History of present illness

• Respiratory system : SOB
• Cardiovascular system : None
• Genitourinary system : None
• Central nervous system : None
• Musculoskeletal system : Back pain
• Drug history : NKDA,
Amilodipine, Metformin

• Past medical history : DM,

HTN, 1 attack of MI

• Past surgical history: Negative

• Family history :
Negative

• Social history: previous smoker

3 packs/ day quitted 15 years
ago

• No pet
• Tap water usage
 Examination
Vital signs

• Respiratory rate : 27 cycles/minute

• Pulse rate:86 beats/minute

• Blood pressure:130/70 mmHg

• Temperature: 36.4 c

• Spo2: %95
 Examination
General examination

General: middle age male, conscious, alert, oriented to time,place and

person. Cooperative, sitting on the bed comfortably with pink cannula on

his right forearm. He has no pallor, no jaundice no peripheral edema.

normal pulse rate, rhythm and volume.

 Examination
Abdominal examination

A. Inspection
• Flat abdomen symmetrically moving with respiration
• No scar
• No dilated vein
• No pigmentation
• No visible pulsation.
• Negative cough impulse.
 Examination
Abdominal examination :

B. Palpation

• soft abdomen
• slight tenderness in epigastric region on deep palpation
• no organomegaly
 Examination
Abdominal examination :

C. Percussion
• Tympanic abdomen
• No dullness
D. Auscultation
• 5 bowl sounds/ min
• no renal artery bruit.
 Preoperative
investigations

Gastroscopy
 Preoperative
investigations
Barrium swallow
Manometry
CBC
ECG

Viral screening
 Treatment

• Conservative
A. Pneumatic dilation

B. botulinum toxin

C. Drugs ( calcium channel antagonist) not very effective

 Treatment
Continued

• Surgery
Any questions?
Thank you!!!