This document provides the text of chants and prayers used in the Ethiopian Orthodox Tewahedo Church service. It includes some of the most commonly used chants in Ge'ez, Tigrinya, and English to help congregants participate. The presentation was sponsored by a foundation dedicated to preserving Ethiopian liturgical chants through modern technology and training tools.
This document contains prayers from an Ethiopian Orthodox church service. It begins with a prayer asking for the Holy Spirit to descend and bless the sacrifice. It includes blessings of God the Father, Son, and Holy Spirit. The priest asks the congregation to pray for him and the sacrifice. It concludes with a prayer praising the Holy Trinity as coequal and eternal. The document shows portions of an Ethiopian Orthodox liturgy with prayers in Ge'ez script.
This document provides information about Achalasia, including its pathophysiology, symptoms, diagnosis, and treatment options. Achalasia is caused by the loss of inhibitory neurons in the esophagus which leads to failure of the lower esophageal sphincter to relax during swallowing. Patients experience symptoms of dysphagia and regurgitation. Diagnosis involves barium swallow, esophageal manometry, and endoscopy. Treatment options include medications, balloon dilation, botulinum toxin injection, and surgical myotomy, with the goal of weakening the lower esophageal sphincter to improve swallowing.
The document contains 20 multiple choice questions about proteins and amino acids from Chapter 6 of Wardlaw's Contemporary Nutrition textbook. The questions cover topics such as: the basic building block of proteins, the chemical element found in all amino acids, properties of high quality protein, digestion of proteins in the stomach and small intestine, and the amino acid sequence of proteins.
This document provides the text of chants and prayers used in the Ethiopian Orthodox Tewahedo Church service. It includes some of the most commonly used chants in Ge'ez, Tigrinya, and English to help congregants participate. The presentation was sponsored by a foundation dedicated to preserving Ethiopian liturgical chants through modern technology and training tools.
This document contains prayers from an Ethiopian Orthodox church service. It begins with a prayer asking for the Holy Spirit to descend and bless the sacrifice. It includes blessings of God the Father, Son, and Holy Spirit. The priest asks the congregation to pray for him and the sacrifice. It concludes with a prayer praising the Holy Trinity as coequal and eternal. The document shows portions of an Ethiopian Orthodox liturgy with prayers in Ge'ez script.
This document provides information about Achalasia, including its pathophysiology, symptoms, diagnosis, and treatment options. Achalasia is caused by the loss of inhibitory neurons in the esophagus which leads to failure of the lower esophageal sphincter to relax during swallowing. Patients experience symptoms of dysphagia and regurgitation. Diagnosis involves barium swallow, esophageal manometry, and endoscopy. Treatment options include medications, balloon dilation, botulinum toxin injection, and surgical myotomy, with the goal of weakening the lower esophageal sphincter to improve swallowing.
The document contains 20 multiple choice questions about proteins and amino acids from Chapter 6 of Wardlaw's Contemporary Nutrition textbook. The questions cover topics such as: the basic building block of proteins, the chemical element found in all amino acids, properties of high quality protein, digestion of proteins in the stomach and small intestine, and the amino acid sequence of proteins.
The book of Hosea is a Narrative History and Prophetic Oracle. Hosea is the first book in the sections of Minor Prophets. They are called Minor Prophets not because their material is less important or insignificant, but because of the size of the book they wrote was shorter in length. The prophet Hosea wrote it at approximately 715 B.C. It records the events from 753-715 B.C. including the fall of the Northern Kingdom in 722. The key personalities are Hosea, Gomer, and their children.
Its purpose was to illustrate the spiritual adultery of Israel and God’s boundless love for His sinful people. Hosea brings God’s message to the wicked Northern Kingdom.
This document provides information on benign esophageal diseases including achalasia, diffuse esophageal spasm, nutcracker esophagus, esophageal diverticula, Barrett's esophagus, and caustic injury. It describes the pathogenesis, clinical features, diagnosis, and treatment options for each condition. Key points include that achalasia is characterized by failure of the LES to relax, resulting in dysphagia and regurgitation. Diffuse esophageal spasm and nutcracker esophagus are hypermotility disorders causing chest pain. Barrett's esophagus involves metaplastic changes from acid reflux and increases cancer risk. Caustic ingestion causes liquefactive necrosis and stricture formation over time.
Achalasia is a motility disorder of the esophagus characterized by lack of peristalsis and failure of the lower esophageal sphincter to relax. This causes food to become obstructed at the esophagogastric junction. The cause is unknown but may involve the degeneration of inhibitory neurons in the esophageal wall. Symptoms include dysphagia, regurgitation, chest pain, weight loss and coughing when lying down. Diagnosis involves barium swallow, endoscopy and manometry. Treatment aims to reduce lower esophageal sphincter pressure and may include botulinum toxin injections, medications, surgery or dilation. Complications can include weight loss, pneumonia, esophagitis and
The document discusses different aspects of protein structure. It defines that a protein is made up of one or more polypeptide chains, and that the sequence of amino acids in the chains is called the primary structure. It also mentions that proteins can fold into precise three-dimensional shapes through chemical bonds and interactions, which is referred to as the tertiary structure. Additionally, it notes that amino acids can twist to form alpha helices in the secondary structure of proteins.
Achalasia cardia is a primary esophageal motility disorder caused by loss of inhibitory ganglionic cells in the myentric plexus, resulting in failure of the lower esophageal sphincter to relax during swallowing. This leads to dilatation of the esophagus above the sphincter and difficulty swallowing (dysphagia). Common symptoms include dysphagia that is worse for liquids, regurgitation, chest pain, weight loss and recurrent pneumonia. Diagnosis is confirmed by barium swallow showing a dilated esophagus and absence of peristalsis on manometry. Treatment options include surgical cardiomyotomy to cut the sphincter muscles, pneumatic balloon dilation, or injection of
Achalasia is a rare disorder of the esophagus that results from damaged nerves that control food movement. It causes difficulty swallowing and food getting stuck. The document discusses the causes, symptoms, tests used to diagnose (endoscopy, manometry), and treatments of achalasia. Treatments include medications to relax muscles, botox injections, balloon dilation procedures, and surgeries like Heller myotomy to cut the lower esophageal sphincter muscle.
A 47-year-old female presented with 6 months of dysphagia and difficulty swallowing solid foods, as well as 4 months of odynophagia and weight loss of 2 kg over 6 months. Examinations and investigations including endoscopy, barium swallow, esophageal manometry and CT scan revealed achalasia cardia. The patient underwent balloon dilatation and will follow up every 6 months with barium swallow tests.
Achalasia is a condition caused by the loss of inhibitory ganglion cells in the esophagus, resulting in failure of the lower esophageal sphincter (LOS) to relax. This leads to difficulty swallowing food and liquid (dysphagia), chest pain, and regurgitation. Diagnosis involves endoscopy, barium radiology, and manometry showing an non-relaxing LOS and absent esophageal peristalsis. Treatment options include pneumatic dilatation of the LOS using a balloon, Heller's myotomy to cut the LOS muscle, botulinum toxin injection into the LOS, or temporary use of calcium channel blockers or nifedipine for relief
This summary provides an overview of a clinical case study presentation about a 68-year old female patient with a history of smoking, obesity, multiple gastric surgeries, achalasia, chronic malnutrition, and recurrent aspiration pneumonia. The presentation traces the progression of the patient's diseases and treatments, highlights the nutrition care process and interventions, and explores the connections between the patient's achalasia and history of bulimia. The patient was recently admitted for acute respiratory failure from aspiration pneumonia and declined further interventions, passing away after 9 days in the hospital.
Achalasia is a motility disorder of the esophagus characterized by lack of esophageal peristalsis and failure of the lower esophageal sphincter to relax when swallowing. This causes food to get stuck in the esophagus. It is caused by degeneration of the myenteric plexus which normally coordinates relaxation of the sphincter and contractions. Symptoms include difficulty swallowing, chest pain, regurgitation of food, and weight loss. Diagnosis involves barium swallow, endoscopy and manometry. Treatment options are medications, balloon dilation of the sphincter, botulinum toxin injections, or Heller myotomy surgery.
1. Imaging such as HRCT and MRI are important for evaluating patients for cochlear implantation to identify any contraindications and guide surgery. HRCT is useful for evaluating bony anatomy while MRI can identify soft tissue anomalies.
2. Pre-operative imaging aims to evaluate factors like the size of the internal auditory meatus, status of the cochlear nerve, and presence of any neurovascular anomalies which could increase surgical risk. Anomalies of the bony and membranous labyrinth are also assessed.
3. Congenital anomalies identified on imaging can help determine the cause of hearing loss and surgical approach during cochlear implantation.
Achalasia cardia is the cause for dysphagia for liquids to begin with and then it will progress to dysphagia to solids as well.The cause for this problem is inadequate relaxation of lower esophageal sphincter. It is directly opposite to GERD where there will be lax lower esophageal sphincter
The document summarizes key aspects of esophageal anatomy and physiology. It describes the esophagus as a muscular tube divided into cervical, thoracic, and abdominal segments. It discusses the layers of the esophageal wall, blood supply, innervation, and functions of the upper and lower esophageal sphincters. Common esophageal disorders like GERD, diverticula, and motility disorders are also summarized.
The vestibular system in the inner ear detects motion and orientation of the head to maintain balance. It contains semicircular canals that detect rotational head movement and otolith organs that detect linear acceleration. Signals from the vestibular system are integrated with other sensory inputs in the brainstem and cerebellum to coordinate eye movements and posture. Damage to the vestibular system can cause vertigo and loss of balance.
This document provides an overview of the anatomy and embryology of the inner ear. It discusses the development of the inner ear from the otic placode and otocyst, and covers topics like the bony and membranous labyrinth, cochlea, vestibular system, inner ear fluids, blood supply, nerve supply, and surgical approaches to the inner ear. The overview is intended to inform the audience about the structure and development of this complex anatomical region.
3D printing is an additive manufacturing process that builds 3D objects by laying down successive layers of material. There are several major 3D printing technologies that differ in the materials and techniques used, such as stereolithography (SLA), fused deposition modeling (FDM), and selective laser sintering (SLS). 4D printing is an emerging technology that uses smart materials and 3D printing to create objects that can change shapes or properties when exposed to stimuli like water, heat or light. Potential applications of 4D printing include self-assembling medical devices, adaptive robotics, and shape-changing structures.
Classification of esophageal motility disordersSamir Haffar
This document discusses the classification of esophageal motility disorders based on manometric features. It describes the normal esophageal motility test and features. It then covers various motility disorders including achalasia, atypical LES relaxation disorders, diffuse esophageal spasm, hypercontraction disorders like nutcracker esophagus and isolated hypertensive LES, and ineffective esophageal motility. For each disorder, it provides the manometric criteria for diagnosis and differentiates them based on features of LES relaxation, wave progression, distal wave amplitude. It concludes by discussing the therapeutic implications of this classification system.
Interdental aids powerpoint presentationLeena Parmar
This document discusses various interdental aids used for cleaning between teeth. It begins by describing the different types of interdental spaces classified by how much of the space is occupied by gingiva. Common interdental aids discussed include dental floss, interdental brushes, wooden interdental cleaners, and water flossers. Each aid is described in terms of its material, indications for use, and proper technique. The document emphasizes that toothbrushing alone is insufficient for interdental cleaning and that the appropriate aid should be selected based on a patient's interdental anatomy and oral hygiene needs.
The document discusses the gastro-intestinal tract and esophagus. It provides details on various conditions that can affect the esophagus including diverticula, ulcers, tumors, and motility disorders. Pharyngeal/esophageal pouches and diverticula are discussed for the upper, middle, and lower third of the esophagus. Esophageal ulceration can be inflammatory from sources like reflux or viral, or neoplastic. Benign esophageal tumors are discussed along with specifics on leiomyoma features on barium swallow and CT imaging.
The book of Hosea is a Narrative History and Prophetic Oracle. Hosea is the first book in the sections of Minor Prophets. They are called Minor Prophets not because their material is less important or insignificant, but because of the size of the book they wrote was shorter in length. The prophet Hosea wrote it at approximately 715 B.C. It records the events from 753-715 B.C. including the fall of the Northern Kingdom in 722. The key personalities are Hosea, Gomer, and their children.
Its purpose was to illustrate the spiritual adultery of Israel and God’s boundless love for His sinful people. Hosea brings God’s message to the wicked Northern Kingdom.
This document provides information on benign esophageal diseases including achalasia, diffuse esophageal spasm, nutcracker esophagus, esophageal diverticula, Barrett's esophagus, and caustic injury. It describes the pathogenesis, clinical features, diagnosis, and treatment options for each condition. Key points include that achalasia is characterized by failure of the LES to relax, resulting in dysphagia and regurgitation. Diffuse esophageal spasm and nutcracker esophagus are hypermotility disorders causing chest pain. Barrett's esophagus involves metaplastic changes from acid reflux and increases cancer risk. Caustic ingestion causes liquefactive necrosis and stricture formation over time.
Achalasia is a motility disorder of the esophagus characterized by lack of peristalsis and failure of the lower esophageal sphincter to relax. This causes food to become obstructed at the esophagogastric junction. The cause is unknown but may involve the degeneration of inhibitory neurons in the esophageal wall. Symptoms include dysphagia, regurgitation, chest pain, weight loss and coughing when lying down. Diagnosis involves barium swallow, endoscopy and manometry. Treatment aims to reduce lower esophageal sphincter pressure and may include botulinum toxin injections, medications, surgery or dilation. Complications can include weight loss, pneumonia, esophagitis and
The document discusses different aspects of protein structure. It defines that a protein is made up of one or more polypeptide chains, and that the sequence of amino acids in the chains is called the primary structure. It also mentions that proteins can fold into precise three-dimensional shapes through chemical bonds and interactions, which is referred to as the tertiary structure. Additionally, it notes that amino acids can twist to form alpha helices in the secondary structure of proteins.
Achalasia cardia is a primary esophageal motility disorder caused by loss of inhibitory ganglionic cells in the myentric plexus, resulting in failure of the lower esophageal sphincter to relax during swallowing. This leads to dilatation of the esophagus above the sphincter and difficulty swallowing (dysphagia). Common symptoms include dysphagia that is worse for liquids, regurgitation, chest pain, weight loss and recurrent pneumonia. Diagnosis is confirmed by barium swallow showing a dilated esophagus and absence of peristalsis on manometry. Treatment options include surgical cardiomyotomy to cut the sphincter muscles, pneumatic balloon dilation, or injection of
Achalasia is a rare disorder of the esophagus that results from damaged nerves that control food movement. It causes difficulty swallowing and food getting stuck. The document discusses the causes, symptoms, tests used to diagnose (endoscopy, manometry), and treatments of achalasia. Treatments include medications to relax muscles, botox injections, balloon dilation procedures, and surgeries like Heller myotomy to cut the lower esophageal sphincter muscle.
A 47-year-old female presented with 6 months of dysphagia and difficulty swallowing solid foods, as well as 4 months of odynophagia and weight loss of 2 kg over 6 months. Examinations and investigations including endoscopy, barium swallow, esophageal manometry and CT scan revealed achalasia cardia. The patient underwent balloon dilatation and will follow up every 6 months with barium swallow tests.
Achalasia is a condition caused by the loss of inhibitory ganglion cells in the esophagus, resulting in failure of the lower esophageal sphincter (LOS) to relax. This leads to difficulty swallowing food and liquid (dysphagia), chest pain, and regurgitation. Diagnosis involves endoscopy, barium radiology, and manometry showing an non-relaxing LOS and absent esophageal peristalsis. Treatment options include pneumatic dilatation of the LOS using a balloon, Heller's myotomy to cut the LOS muscle, botulinum toxin injection into the LOS, or temporary use of calcium channel blockers or nifedipine for relief
This summary provides an overview of a clinical case study presentation about a 68-year old female patient with a history of smoking, obesity, multiple gastric surgeries, achalasia, chronic malnutrition, and recurrent aspiration pneumonia. The presentation traces the progression of the patient's diseases and treatments, highlights the nutrition care process and interventions, and explores the connections between the patient's achalasia and history of bulimia. The patient was recently admitted for acute respiratory failure from aspiration pneumonia and declined further interventions, passing away after 9 days in the hospital.
Achalasia is a motility disorder of the esophagus characterized by lack of esophageal peristalsis and failure of the lower esophageal sphincter to relax when swallowing. This causes food to get stuck in the esophagus. It is caused by degeneration of the myenteric plexus which normally coordinates relaxation of the sphincter and contractions. Symptoms include difficulty swallowing, chest pain, regurgitation of food, and weight loss. Diagnosis involves barium swallow, endoscopy and manometry. Treatment options are medications, balloon dilation of the sphincter, botulinum toxin injections, or Heller myotomy surgery.
1. Imaging such as HRCT and MRI are important for evaluating patients for cochlear implantation to identify any contraindications and guide surgery. HRCT is useful for evaluating bony anatomy while MRI can identify soft tissue anomalies.
2. Pre-operative imaging aims to evaluate factors like the size of the internal auditory meatus, status of the cochlear nerve, and presence of any neurovascular anomalies which could increase surgical risk. Anomalies of the bony and membranous labyrinth are also assessed.
3. Congenital anomalies identified on imaging can help determine the cause of hearing loss and surgical approach during cochlear implantation.
Achalasia cardia is the cause for dysphagia for liquids to begin with and then it will progress to dysphagia to solids as well.The cause for this problem is inadequate relaxation of lower esophageal sphincter. It is directly opposite to GERD where there will be lax lower esophageal sphincter
The document summarizes key aspects of esophageal anatomy and physiology. It describes the esophagus as a muscular tube divided into cervical, thoracic, and abdominal segments. It discusses the layers of the esophageal wall, blood supply, innervation, and functions of the upper and lower esophageal sphincters. Common esophageal disorders like GERD, diverticula, and motility disorders are also summarized.
The vestibular system in the inner ear detects motion and orientation of the head to maintain balance. It contains semicircular canals that detect rotational head movement and otolith organs that detect linear acceleration. Signals from the vestibular system are integrated with other sensory inputs in the brainstem and cerebellum to coordinate eye movements and posture. Damage to the vestibular system can cause vertigo and loss of balance.
This document provides an overview of the anatomy and embryology of the inner ear. It discusses the development of the inner ear from the otic placode and otocyst, and covers topics like the bony and membranous labyrinth, cochlea, vestibular system, inner ear fluids, blood supply, nerve supply, and surgical approaches to the inner ear. The overview is intended to inform the audience about the structure and development of this complex anatomical region.
3D printing is an additive manufacturing process that builds 3D objects by laying down successive layers of material. There are several major 3D printing technologies that differ in the materials and techniques used, such as stereolithography (SLA), fused deposition modeling (FDM), and selective laser sintering (SLS). 4D printing is an emerging technology that uses smart materials and 3D printing to create objects that can change shapes or properties when exposed to stimuli like water, heat or light. Potential applications of 4D printing include self-assembling medical devices, adaptive robotics, and shape-changing structures.
Classification of esophageal motility disordersSamir Haffar
This document discusses the classification of esophageal motility disorders based on manometric features. It describes the normal esophageal motility test and features. It then covers various motility disorders including achalasia, atypical LES relaxation disorders, diffuse esophageal spasm, hypercontraction disorders like nutcracker esophagus and isolated hypertensive LES, and ineffective esophageal motility. For each disorder, it provides the manometric criteria for diagnosis and differentiates them based on features of LES relaxation, wave progression, distal wave amplitude. It concludes by discussing the therapeutic implications of this classification system.
Interdental aids powerpoint presentationLeena Parmar
This document discusses various interdental aids used for cleaning between teeth. It begins by describing the different types of interdental spaces classified by how much of the space is occupied by gingiva. Common interdental aids discussed include dental floss, interdental brushes, wooden interdental cleaners, and water flossers. Each aid is described in terms of its material, indications for use, and proper technique. The document emphasizes that toothbrushing alone is insufficient for interdental cleaning and that the appropriate aid should be selected based on a patient's interdental anatomy and oral hygiene needs.
The document discusses the gastro-intestinal tract and esophagus. It provides details on various conditions that can affect the esophagus including diverticula, ulcers, tumors, and motility disorders. Pharyngeal/esophageal pouches and diverticula are discussed for the upper, middle, and lower third of the esophagus. Esophageal ulceration can be inflammatory from sources like reflux or viral, or neoplastic. Benign esophageal tumors are discussed along with specifics on leiomyoma features on barium swallow and CT imaging.
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Tanjore Painting: Rich Heritage and Intricate Craftsmanship | Cottage9Cottage9 Enterprises
Explore the exquisite art of Tanjore Painting, known for its vibrant colors, gold foil work, and traditional themes. Discover its cultural significance today!
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Editor's Notes
The tubular esophagus is a muscular organ, approximately 25 cm in length, and has specialized sphincters at proximal and distal ends. The upper esophageal sphincter (UES) is composed of several striated muscles, mainly cricopharyngeus, creating a tonically closed valve and preventing air from entering into the gastrointestinal tract. The lower esophageal sphincter (LES) is composed entirely of smooth muscle and maintains a steady baseline tone to prevent gastric reflux into the esophagus.
The body of the esophagus is similarly composed of 2 muscle types. The proximal esophagus is predominantly striated muscle, while the distal esophagus and the remainder of the GI tract contain smooth muscle. The mid esophagus contains a graded transition of striated and smooth muscle types. The muscle is oriented in 2 perpendicular opposing layers: an inner circular layer and an outer longitudinal layer, known collectively as the muscularis propria. The longitudinal muscle is responsible for shortening the esophagus, while the circular muscle forms lumen-occluding ring contractions.
Esophageal peristalsis
The muscle layers contract simultaneously and produces peristalsis. Peristalsis is a sequential, coordinated contraction wave that travels the entire length of the esophagus, propelling intraluminal contents distally to the stomach. The LES relaxes during swallows and stays opened until the peristaltic wave travels through the LES, then contracts and redevelops resting basal tone.
Primary peristalsis is the peristaltic wave triggered by the swallowing center. The peristaltic contraction wave travels at a speed of 2 cm/s and correlates with manometry-recorded contractions. The secondary peristaltic wave is induced by esophageal distension from the retained bolus, refluxed material, or swallowed air. The primary role is to clear the esophagus of retained food or any gastroesophageal refluxate. Tertiary contractions are simultaneous, isolated, dysfunctional contractions. These contractions are nonperistaltic, have no known physiologic role, and are observed with increased frequency in elderly people. Radiographic description of this phenomenon has been called presbyesophagus.
Esophageal motility disorders are not uncommon in gastroenterology. These disorders may be primary esophageal motility disorders, where the cause is unknown or may occur as manifestations of systemic diseases, referred to as secondary motility disorders.
Primary esophageal motility disorders, include diffuse esophageal spasm (DES), nutcracker esophagus, and hypertensive LES Nonspecific esophageal motility disorder (inefficient esophageal motility disorder)
Secondary esophageal motility disorders related to scleroderma, diabetes mellitus, alcohol consumption and psychiatric disorders.
The predominant neuropathologic process of achalasia involves the loss of ganglion cells of the myenteric plexus of Aurbach’s from the wall of the esophagus, starting at the LES and developing proximally. These mediate the relaxation of the of LES. Because the postganglionic cholinergic neurons are spared, there is unopposed cholinergic stimulation, which increases the LES resting pressure and decreases the LES relaxation.
In the peristaltic esophageal body, achalasia is characterized by a loss of intrinsic acetylcholine-containing nerves. Extrinsic nerves may also be affected, characterized by Wallerian degeneration of the axoplasm and myelin sheaths within the vagus nerve and dorsal motor nucleus. The physiologic process of achalasia is correlated most directly to the loss of the inhibitory nerves at the sphincter, resulting in failure of the LES to completely relax and causing relative obstruction.
Two theories exist:
A degenerative disease of the neurones, and
Infections of the neurons by a virus (eg. Herpes zoster)
Idiopathic achalasia is an inflammatory disease of unknown etiology characterized by esophageal aperistalsis and failure of LES relaxation due to loss of inhibitory nitrinergic neurons in the esophageal myenteric plexus. Proposed causes of achalasia include gastroesophageal junction obstruction, neuronal degeneration, viral infection, genetic inheritance, and autoimmune disease. Current evidence suggests that the initial insult to the esophagus, perhaps a viral infection or some other environmental factor, results in myenteric plexus inflammation. The inflammation then leads to an autoimmune response in a susceptible population who may be genetically predisposed. Subsequently, chronic inflammation leads to destruction of the inhibitory myenteric ganglion cells resulting in the clinical syndrome of idiopathic achalasia. Further studies are needed to better understand the etiology and pathogenesis of achalasia-such an understanding will be important in developing safe, effective, and possibly curative therapy for achalasia.
The myotomy is carried cephalad for at about 6 cm and through the longitudinal and circular muscle fibers down to the esophageal submucosa and extended 2 cm in the caudal direction from the GEJ on the anterior stomach to ensure complete division of the sling fibers, making the total length of the myotomy about 8 cm.
Fig: A completed 8-cm myotomy is shown. Arrow 1 points to the anterior vagus nerve. Arrow 2 points to the left edge of the myotomy. Arrow 3 points to the exposed esophageal submucosa.
