5. Esophageal Motility Flashcards

1
Q

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

A

18-26 cm

2-3 cm expansion

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2
Q

Esophageal wall structure consists of four layers:

A

mucosa, submucosa, muscularis prorpia and adventitia:

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3
Q
upper quarter of the esophagus and upper
esophageal sphincter (UES) are composed of
A

striated muscle

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4
Q

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

A

smooth muscle.

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5
Q

What structure reinforces the LES

A

Crural diaphragm

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6
Q
A
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7
Q

coordinated and propulsive
sequential contraction of the
esophageal muscle

A

peristalsis

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8
Q

• Primary peristalsis occurs in concert with appropriately timed relaxation of

A

the upperand lower esophageal sphincters.

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9
Q

How do you record peristalsis in the esophagus?

A

Primary peristalsis as recorded by an
intraluminal manometry catheter

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10
Q

triggered by swallow and associated with pharyngeal contraction and
UES relaxation

A

Esophageal Primary Peristalsis

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11
Q

Describe the features of secondary peristalsis

A

triggered by esophageal distention
 Contraction starts PROXIMAL to distention

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12
Q

What controls the intrinsic and extrinsic peristalsis?

A

Intrinsic: Enteric neural plexus

Extrisinic: vagus

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13
Q

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.

A

vagal

simultaneous contractions

peristaltic wave

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14
Q

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

A

centrally mediated sequencing.

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15
Q

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

A

Ca 2+ Release mainly from sarcoplasmic reticulum via Ttubules

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16
Q

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

A

“central pattern generator”

17
Q

Distal Esophageal Smooth Muscle Peristalsis is generated by:

A

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

18
Q

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

A

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

19
Q

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

A

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

(substance P)

20
Q

What the is vagal inhibitory neuron and it’s action

A

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

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

21
Q

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

A

Dysphagia

22
Q

Pain during swallow and bolus transit

A

Odynophagia

23
Q

Dysphagia in what location?

sticks or hangs up after swallow

may or may not have chest pain

A

Esophageal dysphagia

24
Q

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

A

pharyngeal dysphagia

25
Q
  1. Peptic stricture
  2. Esophageal ring
  3. Cancer

All are what kind of etiology of dysphagia

A

Mechanical

26
Q
  1. Achalasia
  2. Esophageal spasm
  3. Dysmotility

are what etiology of dysphagia

A

neuromuscular

27
Q

Uncommon______ causes of dysphagia:

  1. Scleroderma
  2. Chagas disease
  3. Collagen VascularDisorders
A

neuromuscular

28
Q

Uncommon_____ cause of dysphagia

  1. Web
  2. Diverticulum
  3. Benign Tumors
  4. Foreign body
  5. Extrinsic (tumor)
A
29
Q

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

A

cancer

30
Q

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

A

peptic stricture

31
Q

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

A

esophageal ring

32
Q

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

A

Scleroderma or Achalasia

33
Q

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

A

esophageal spasm

34
Q

Diagnostic approach for Esophageal disorders includes?

A

Upper GI endoscopy: gets us structure info

Esophageal manometry: gives us functional info (squeeze pressure)

Radiography: Esophagram gives both

35
Q

True and false
vocal cords and Arytenoids

A

Hypopharynx

36
Q

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

A

Esophageal manometry

37
Q
  • ____ 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 _______
A

UES

Primary peristaltic

3-7 sec

bolus emptying into the stomach

38
Q
A