1 F: The Esophagus & Deglutition (swallowing)

Question 1

Describe the gross anatomy of the esophagus

Answer 1

Flattened muscular tube of 18-26 cm from upper sphincter to lower sphincter.

Question 2

What happens between swallows?

Answer 2

The esophagus is collapsed but the lumen can distend to approx. 2 cm in the anterior-posterior dimension & up to 3 cm laterally to accommodate a swallowed BOLUS

Question 3

What does the esophagus connect?

Answer 3

Connects the pharynx to the stomach

Question 4

Where does the Esophagus begin?

Answer 4

Begins at the neck at the Pharyngoesophageal junction (C5-6 interspace of the cricoid cartilage)

Question 5

Where does the esophagus descend?

Answer 5

Descends anteriorly to the vertebral column through the superior and posterior mediastinum.

Question 6

After traversing the diaphragm at the diaphragmatic hiatus (T10 vertebral level) where does it extend?

Answer 6

It extends thru the gastroesophageal junction to end at the orifice of the cardia of the stomach (T11 vertebral level)

Question 7

Describe the histology of the esophagus

Answer 7

Non-keratinized stratified squamous

Question 8

Why is the epithelial continuity critical for function?

Answer 8

A breach in the epithelium creates an ulcer

Question 9

What does the Esophageal submucosa include? What does this help do?

Answer 9

Includes scattered esophageal glands.

**This provides mucus for lubricating the passage of food down the esophagus, augmenting that role of the salivary glands

Question 10

What is the wall of the esophagus made up of?

Answer 10

1) The mucosa
2) Submucosa
3) Muscularis

Question 11

Unlike the rest of the GI tract, the esophagus has what?

Answer 11

***Unlike the rest of the GI tract, the esophagus has NO TRUE SEROSAL OUTER LAYER, but is covered by a think & poorly defined layer of CT

Question 12

In the esophagus, the submucosal vascular plexus includes what?

Answer 12

Especially large venous spaces (that drains away from the esophagus)

Question 13

What does the Collateral of the L. Gastric Vein (a branch of the portal vein) receive venous drainage from?

Answer 13

From the mid and lower esophagus, plus from the submucosal venous plexus

Question 14

Where are most of the veins in the esophagus found?

Answer 14

In the submucosal layer

Question 15

What are Esophageal VARICES?

Answer 15

(“Varicose veins of the esophagus”)

-The submucosal venous spaces, along w/ all the other “draining” veins of the mid to lower esophagus may enlarge into esophageal varices.

Question 16

In an Endoscopic image of perhaps a Cirrhotic patient w/ (portal hypertension), what is prominent?

Answer 16

Esophageal varices w/ red wale spots on the surface

***indicates a high risk of bleeding

Question 17

In what case is Esophageal VARICES common?

Answer 17

Especially with portal hypertension (an increase in pressure in the portal vein, due to liver cirrhosis)

Question 18

What is the risk with such varices?

Answer 18

They carry a substantial risk of rupture w/ fatal bleeding into the esophageal lumen

Question 19

What does swallowing (deglutition) consist of ?

Answer 19

1) Oral or voluntary phase
2) Pharyngeal phase (involuntary)
3) Esophageal phase (involuntary)

Question 20

What is swallowing initiated by?

Answer 20

Voluntary action of collecting the oral contents on the tongue & propelling them backward to the pharynx (oral phase)

Question 21

What does the pharyngeal phase start with?

Answer 21

With a wave of involuntary contraction in the pharyngeal muscles that pushes the material into the esophagus, as the upper esophageal sphincter (UES) RELAXES and OPENS

Question 22

What is part of the reflex response ?

Answer 22

Inhibition of respiration and stimulation of glottic closure

Question 23

Why does the material tilt the epiglottis backward & down over the closed glottis ?

Answer 23

For further protection from food entering the respiratory airways

Question 24

What phase is involved once food enters the esophagus, and peristalsis takes over

Answer 24

Esophageal phase

Question 25

What does Esophageal peristalsis involve?

Answer 25

A progressive wave of ring-like smooth contractions that propels for down tot the lower esophageal sphincter (LES)

Question 26

What occurs once triggered by swallowing?

Answer 26

Esophageal peristalsis will occur whether or not food is present

***although that presence of food will intensify the contractions.

Question 27

What occurs if the primary peristaltic wave fails to move food into the stomach?

Answer 27

The persistence of the food bolus in the esophagus will set off secondary peristaltic wavies to complete the job

Question 28

The LES, like most sphincters is tonically ___________

Answer 28

contracted

Question 29

How can the tonic contraction of the LES be influenced?

Answer 29

By either relaxing (opening) or by contracting further

Question 30

What is Achalasia?

Answer 30

The failure of the LES to relax causing swallowed food difficulty passing into the stomach, and the esophagus above the LES becomes enlarged

Question 31

What can happen if LES becomes enlarged and food isn’t passed to stomach directly?

Answer 31

One or several meals may lodge in the esophagus and pass slowly into the stomach over time.

***There is danger of aspiration of esophageal contents into the lungs when person lies down

Question 32

What is Gastroesophageal reflux disease (GERD) ?

Answer 32

When various agents have been showed to decrease LES pressure, which decreases it’s closing strength.
Allowing reflux of acidic gastric contents into the esophagus

Question 33

What can also contribute to reflux ?

Answer 33

Delayed gastric emptying may contribute by increasing gastric VOLUME and PRESSURE with greater chance for reflux

Question 34

What is an example of this common condition and what can it lead to ?

Answer 34

Heartburn and esophagitis

-Leads to ulceration and structure of the esophagus due to scarring

Question 35

What does current research indicate about GERD?

Answer 35

That there may be a STRONG causal relationship between GERND & Esophageal Adenocarcinoma

Question 36

What are the agents that have been demonstrated to diminish the closing strength of the LES?

Answer 36

1) Fatty foods 2) chocolate 3) ethanol 4) caffeine 5) peppermint 6) spicy foods 7) citrus fruits and juices 8) smoking 9) steroidal based oral contraceptives

Question 37

Complications can result from persistent reflux producing a cycle of mucosal damage that causes what?

Answer 37

EDEMA and erosion of the luminal surface

Question 38

What does these complications include strictures and a conditions called_________

Answer 38

Barrett’s esophagus

Question 39

Strictures are caused by ?

Answer 39

a combination of scar tissue, spasm, and EDEMA

Question 40

What can stricutres do to the esophagus?

Answer 40

Produce narrowing of the esophagus and cause DYSPHAGIA (difficulty swallowing) when the lumen is sufficiently constricted

Question 41

What do patients with Dysphagia complain of ?

Answer 41

Choking, coughing, or an abnormal sensation of food sticking in that back of the throat or upper chest when they swallow.

Question 42

What is odynophagia?

Answer 42

Swallowing that is painful

Question 43

In a normal lower esophageal sphincter should it initially be closed or open?

Answer 43

Closed!

(With Barrett’s mucosa it can’t close properly and presents with redder pigment. Refereed to as “tongue of Barrett’s esophagus”

Question 44

What is Barrett’s esophagus characterized by?

Answer 44

A repair process in which the squamous mucosa that normally lines the esophagus is gradually replaced by COLUMNAR epithelium (METAPLASIA)

**The replacement resembles the stomach and intestines

Question 45

What is it associated with?

Answer 45

Increased risk of developing esophageal cancer