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1c - GI & Liver > Anatomy, Physiology & Nomenclature > Flashcards

Anatomy, Physiology & Nomenclature Flashcards

1
Q

Name the 5 divisions of the oesophagus.

A
  1. Cervical oesophagus
  2. Upper thoracic oesophagus
  3. Middle thoracic oesophagus
  4. Lower thoracic oesophagus
  5. Abdominal oesophagus
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2
Q

How far (in cm) is the upper oesophageal sphincter from the upper central incisors?

A

15cm

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3
Q

How far (in cm) is the lower oesophageal sphincter from the upper central incisors?

A

40cm

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4
Q

Which muscle type comprises the cervical oesophagus?

A

Skeletal muscle

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5
Q

Which muscle type(s) comprises the upper thoracic oesophagus?

A

Skeletal/smooth

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6
Q

Which muscle type(s) comprises the middle thoracic oesophagus?

A

Skeletal/smooth

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7
Q

Which muscle type(s) comprises the lower thoracic oesophagus?

A

Smooth muscle

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8
Q

What junction marks the change from the lower thoracic oesophagus to the abdominal oesophagus?

A

Oesophagogastric junction

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9
Q

At what vertebral level does the oesophagus originate?

A

C5

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10
Q

At what vertebral level does the oesophagus terminate?

A

T10

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11
Q

At what vertebral level does oesophageal hiatus of the diaphragm lie?

A

T10

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12
Q

Name the 4 anatomical contributions to the lower oesophageal sphincter.

A

3-4cm distal oesophagus within abdomen

Diaphragm surrounds LOS (Lt & Rt crux)

An intact phrenoesophageal ligament

Angle of His

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13
Q

Name the 4 phases of swallowing.

A

Stage 0: Oral Phase

Stage 1: Pharyngeal Phase

Stage 2: Upper Oesophageal Ohase

Stage 3: Lower Oesophageal Phase

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14
Q

During swallowing, as the bolus travels down the oesophagus , the superior and inferior muscles have different roles.

A) State the role of the superior muscles.

B) State the role of the inferior muscles.

A

A) Contract

B) Dilate

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15
Q

Describe the oral phase (Stage 0) of swallowing.

A
  • Chewing & saliva prepare bolus
  • Both oesophageal sphincters constricted
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16
Q

Describe the pharyngeal phase (Stage 1) of swallowing.

A

Pharyngeal musculature guides food bolus towards oesophagus

UOS opens reflexly

LOS opened by Vado a gal reflex (receptive relaxation reflex)

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17
Q

Describe the upper oesophageal phase (Stage 2) of swallowing.

A

Upper sphincter closes

Superior circular muscle rings contract & inferior rings dilate

Sequential contractions of longitudinal muscle

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18
Q

Describe the lower oesophageal phase (Stage 3) of swallowing.

A

LOS closes as food passes through

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19
Q

Describe the state/actions of the oesophageal sphincters in the oral phase of swallowing.

A

Both oesophageal sphincters are constricted

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20
Q

Describe the state/actions of the oesophageal sphincters in the pharyngeal phase of swallowing.

A

UOS - opens reflexly

LOS - opened by vasovagal reflex (receptive relaxation reflex)

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21
Q

Describe the state/actions of the oesophageal sphincters in the upper oesophageal phase of swallowing.

A

UOS - closes

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22
Q

Describe the state/actions of the oesophageal sphincters in the lower oesophageal phase of swallowing.

A

LOS - closes as food passes through

23
Q

What reflex opens the lower oesophageal sphincter during the pharyngeal phase of swallowing?

A

Vasovagal reflex (receptive relaxation reflex)

24
Q

What determines oesophageal motility?

A

Pressure measurements (manometry)

25
Q

What is the average pressure of peristaltic waves?

A

~40 mmHg

26
Q

What is the average resting pressure of the lower oesophageal sphincter?

A

~ 20 mmHg

27
Q

How does the pressure of the LOS change during receptive relaxation compared to its resting pressure?

A

It’s pressure decreases from 20 mmHg to 5mmHg

28
Q

What is the pressure of the lower oesophageal sphincter during receptive relaxation?

A

Decreases to 5 mmHg

29
Q

The pressure of the lower oesophageal sphincter decreases to 5 mmHg during receptive relaxation.

What mediates this?

A

Inhibitory non-cholinergic non-adrenergic (NCNA) neurons of myenteric plexus

30
Q

What do the NCNA neurones of the myenteric plexus mediate?

A

Receptive relaxation of the lower oesophageal sphincter in which its pressure drops from ~20 mmHg to ~5 mmHg

31
Q

What can cause functional disorders of the oesophagus in absence of a structure?

A

Abnormal oesophageal contraction:
- Hypermotility
- Hypomotility
- Disordered coordination

Failure of protective mechanisms for reflux:
- GORD

32
Q

What is dysphagia?

A

Difficulty in swallowing

33
Q

How might you classify/characterise dysphagia?

A

Localisation - cricopharyngeal sphincter or distal

Type of dysphagia:
- For solids or fluids
- Intermittent or progressive
- Precise or vague in appreciation

34
Q

What is odynophagia?

A

Pain on swallowing

35
Q

What is regurgitation?

A

Return of oesophageal contents from above an obstruction

  • May be functional or mechanical
36
Q

What are the two broad types of regurgitation?

A
  • Functional
  • Mechanical
37
Q

What is reflux?

A

Passive return of gastroduodenal contents to the mouth

38
Q

How does the lower oesophageal sphincter usually help protect the stomach against reflux?

A

LOS is usually closed to act as a barrier against reflux

39
Q

List factors that increase lower oesophageal sphincter pressure (inhibit reflux).

A

Acetylcholine
Alpha-adrenergic agonists
Hormones
Protein-rich food
Histamines
High intra-abdominal pressure
PGF-2alpha
Etc.

40
Q

List factors that decrease lower oesophageal sphincter pressure (promote reflux).

A

VIP
Beta-adrenergic agonists
Hormones
Dopamine
NO
PGI-2
PGE-2
Chocolate
Gastric acid juice
Fat
Smoking
Etc.

41
Q

How can LOS pressure change in order to inhibit reflux?

A

Increase LOS pressure —> inhibit reflux

42
Q

How can LOS pressure change in order to promote reflux?

A

Decrease LOS pressure —> promote reflux

43
Q

Sporadic reflux is normal. Give 3 scenarios in which it might occur (not pathologically)

A
  • Pressure on full stomach
  • Swallowing
  • Transient sphincter opening
44
Q

3 protective mechanisms protect the oesophagus following reflux. What are these mechanisms?

A
  1. Volume clearance - oesophageal peristalsis reflux
  2. pH clearance - saliva
  3. Epithelium - barrier properties
45
Q

What are the main functions of the stomach? [3]

A
  • Breaks food into smaller particles (acid & pepsin)
  • Holds food, releasing it in controlled steady rate into duodenum
  • Kills parasites & certain bacteria
46
Q

In which stomach region(s) is only mucus secreted?

A
  • Cardia
  • Pylorus
47
Q

In which stomach region(s) is mucus, HCl & pepsinogen secreted?

A

Body
Fundus

48
Q

In which stomach region(s) is gastrin secreted?

A

Antrum

49
Q

Gastric secretion is regulated. There are stimulatory and inhibitory factors for its secretion.

What are the stimulatory factors of gastric secretion?

[Neural, Endocrine & Paracrine]

A

Neural:
ACh - postganglionic transmitter of vagal parasympathetic fibres

Endocrine:
Gastrin (G cells of antrum)

Paracrine:
Histamine (ECL cells & mast cells of gastric wall)

50
Q

Gastric secretion is regulated. There are stimulatory and inhibitory factors for its secretion.

What are the inhibitory factors of gastric secretion?

[Endocrine, Paracrine, Paracrine & Autocrine]

A

Endocrine:
Secretin (small intestine)

Paracrine:
Somatostatin (SIH)

Paracrine & Autocrine:
PGs (E2 & I2), TGF-a & adenosine

51
Q

To what receptors does histamine released in the stomach bind to?

A

H2-Receptors

52
Q

To what receptors does acetylcholine bind to in the gastric wall?

A

M1 Receptors

53
Q

The stomach has protective mechanisms against ulcers.

What are these main 4 mechanisms?

A
  1. Mucus film
  2. HCO3- secretion
  3. Epithelial barrier
  4. Mucosal blood perfusion
54
Q

Outline the mechanisms that repair epithelial defects of the stomach (in ulceration).

A
  1. Migration

Adjacent epithelial cells flatten to close gap via sideward migration along basement membrane

  1. Gap closed by cell growth

Stimulated by EGG, TGF-a, IGF-1, GRP & Gastrin

  1. Acute wound healing

BM destroyed - attraction of leukocytes & macrophages; phagocytosis of necrotic cells; angiogenesis; regeneration of ECM after repair of BM

Epithelial closure by restitution & cell division

1c - GI & Liver (1 decks)

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