5. Esophageal Motility

Question 1

Esophagus is a hollow muscular tube that traverses cervical, thoracic and abdominal
compartments reaching _____in length and _____ in dimension

Answer 1

18-26 cm

2-3 cm expansion

Question 2

Esophageal wall structure consists of four layers:

Answer 2

mucosa, submucosa, muscularis prorpia and adventitia:

Question 3

upper quarter of the esophagus and upper
esophageal sphincter (UES) are composed of

Answer 3

striated muscle

Question 4

lower half of esophagus, along with intrinsic lower esophageal sphincter (LES) are
composed of

Answer 4

smooth muscle.

Question 5

What structure reinforces the LES

Answer 5

Crural diaphragm

Question 7

coordinated and propulsive
sequential contraction of the
esophageal muscle

Answer 7

peristalsis

Question 8

• Primary peristalsis occurs in concert with appropriately timed relaxation of

Answer 8

the upperand lower esophageal sphincters.

Question 9

How do you record peristalsis in the esophagus?

Answer 9

Primary peristalsis as recorded by an
intraluminal manometry catheter

Question 10

triggered by swallow and associated with pharyngeal contraction and
UES relaxation

Answer 10

Esophageal Primary Peristalsis

Question 11

Describe the features of secondary peristalsis

Answer 11

triggered by esophageal distention
 Contraction starts PROXIMAL to distention

Question 12

What controls the intrinsic and extrinsic peristalsis?

Answer 12

Intrinsic: Enteric neural plexus

Extrisinic: vagus

Question 13

Swallowing (a) evokes a peristaltic wave of contraction that migrates
smoothly from the striated to smooth muscle esophagus. Simultaneous
electrical activation of all______ efferent neurons produces
________ in the striated muscle esophagus, and in the smooth muscle segment a ________ is induced.

Answer 13

vagal

simultaneous contractions

peristaltic wave

Question 14

intrinsic neurons activated by vagal efferent nerve stimulation are capable of evoking a peristaltic contraction without the need for

Answer 14

centrally mediated sequencing.

Question 15

Proximal esophageal striaghted muscle peristalsis we have a motor end plate and an action potetial… what occurs in the action potential

Answer 15

Ca 2+ Release mainly from sarcoplasmic reticulum via Ttubules

Question 16

in the PROXIMAL part of the esophagus; Sequence of peristalsis is generated by the swallowing __________ of brainstem

Answer 16

“central pattern generator”

Question 17

Distal Esophageal Smooth Muscle Peristalsis is generated by:

Answer 17

varicose nerve endings and gap jnxs with Ca+ influx from outside (unlike Ttubs in the proximal esophagus)

Question 18

In distal esophageal smooth muscle, Peristalsis in smooth
muscle is physiologically regulated as

Answer 18

“a wave of inhibition followed by a wave of excitation”

Question 19

Vagal efferent synapse on excitatory adn inhibitory myenteric mortor neurosns, what is the excitatory one and what happens?

Answer 19

Excitatory motor neurons: Predominantly Acetylcholine –>
Ca2+ release –> depolarization –> second messenger pathways

(substance P)

Question 20

What the is vagal inhibitory neuron and it’s action

Answer 20

Inhibitory motor neurons:
Predominantly Nitric oxide –>cGMP dependent pathway –> inhibition of

Ca2+ entry–> hyperpolarization
• (Vasoactive intestinal peptide)

Question 21

Described as: “Sticks”,“Caught”,“hangs up”
• Most specific esophageal symptom
• Almost always organic and different from globus sensation (always a lump in throat)

Answer 21

Dysphagia

Question 22

Pain during swallow and bolus transit

Answer 22

Odynophagia

Question 23

Dysphagia in what location?

sticks or hangs up after swallow

may or may not have chest pain

Answer 23

Esophageal dysphagia

Question 24

Dysphagia when you have difficulty swallowing and cough or choke w/ nasal regurg

Answer 24

pharyngeal dysphagia

Question 25

1. Peptic stricture
2. Esophageal ring
3. Cancer

All are what kind of etiology of dysphagia

Answer 25

Mechanical

Question 26

1. Achalasia
2. Esophageal spasm
3. Dysmotility

are what etiology of dysphagia

Answer 26

neuromuscular

Question 27

Uncommon______ causes of dysphagia:

1. Scleroderma
2. Chagas disease
3. Collagen VascularDisorders

Answer 27

neuromuscular

Question 28

Uncommon_____ cause of dysphagia

1. Web
2. Diverticulum
3. Benign Tumors
4. Foreign body
5. Extrinsic (tumor)

Question 29

Person over 50 comes in with progressive dysphagia, whats most likely dx?

Answer 29

cancer

Question 30

Individual has dysphagia with Solid foods only and have chronic heartburn, cuase of dysphagia?

Answer 30

peptic stricture

Question 31

Pt comes in with intermittent dysphagia of solid foods, dx?

Answer 31

esophageal ring

Question 32

Pt has issues swallowing both solids and liquids. this is progressive and pts has heartburn adn regurg.

Answer 32

Scleroderma or Achalasia

Question 33

Pt comes in with intermittent dysphagia of solids and liquids and has chest pain. Dx?

Answer 33

esophageal spasm

Question 34

Diagnostic approach for Esophageal disorders includes?

Answer 34

Upper GI endoscopy: gets us structure info

Esophageal manometry: gives us functional info (squeeze pressure)

Radiography: Esophagram gives both

Question 35

True and false
vocal cords and Arytenoids

Answer 35

Hypopharynx

Question 36

is the technique for measurement of esophageal intra-luminal pressures
• The gold standard for diagnosis of esophagealmotor disorders

Answer 36

Esophageal manometry

Question 37

• ____ relaxes for half a second to allow bolus passage
• ______ wave produces a lumen-occluding contraction with amplitude of 30-150 mmHg
• Peristaltic duration is _____ and migrates aborally at a speed of 3-5 cm/sec
• LES relaxes for 3-8 seconds to allow _______

Answer 37

UES

Primary peristaltic

3-7 sec

bolus emptying into the stomach