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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
What is the average pressure of peristaltic waves?
~40 mmHg
26
What is the average resting pressure of the lower oesophageal sphincter?
~ 20 mmHg
27
How does the pressure of the LOS change during receptive relaxation compared to its resting pressure?
It’s pressure decreases from 20 mmHg to 5mmHg
28
What is the pressure of the lower oesophageal sphincter during receptive relaxation?
Decreases to 5 mmHg
29
The pressure of the lower oesophageal sphincter decreases to 5 mmHg during receptive relaxation. What mediates this?
Inhibitory non-cholinergic non-adrenergic (NCNA) neurons of myenteric plexus
30
What do the NCNA neurones of the myenteric plexus mediate?
Receptive relaxation of the lower oesophageal sphincter in which its pressure drops from ~20 mmHg to ~5 mmHg
31
What can cause functional disorders of the oesophagus in absence of a structure?
Abnormal oesophageal contraction: - Hypermotility - Hypomotility - Disordered coordination Failure of protective mechanisms for reflux: - GORD
32
What is dysphagia?
Difficulty in swallowing
33
How might you classify/characterise dysphagia?
Localisation - cricopharyngeal sphincter or distal Type of dysphagia: - For solids or fluids - Intermittent or progressive - Precise or vague in appreciation
34
What is odynophagia?
Pain on swallowing
35
What is regurgitation?
Return of oesophageal contents from above an obstruction - May be functional or mechanical
36
What are the two broad types of regurgitation?
- Functional - Mechanical
37
What is reflux?
Passive return of gastroduodenal contents to the mouth
38
How does the lower oesophageal sphincter usually help protect the stomach against reflux?
LOS is usually closed to act as a barrier against reflux
39
List factors that increase lower oesophageal sphincter pressure (inhibit reflux).
Acetylcholine Alpha-adrenergic agonists Hormones Protein-rich food Histamines High intra-abdominal pressure PGF-2alpha Etc.
40
List factors that decrease lower oesophageal sphincter pressure (promote reflux).
VIP Beta-adrenergic agonists Hormones Dopamine NO PGI-2 PGE-2 Chocolate Gastric acid juice Fat Smoking Etc.
41
How can LOS pressure change in order to inhibit reflux?
Increase LOS pressure —> inhibit reflux
42
How can LOS pressure change in order to promote reflux?
Decrease LOS pressure —> promote reflux
43
Sporadic reflux is normal. Give 3 scenarios in which it might occur (not pathologically)
- Pressure on full stomach - Swallowing - Transient sphincter opening
44
3 protective mechanisms protect the oesophagus following reflux. What are these mechanisms?
1. Volume clearance - oesophageal peristalsis reflux 2. pH clearance - saliva 3. Epithelium - barrier properties
45
What are the main functions of the stomach? [3]
- Breaks food into smaller particles (acid & pepsin) - Holds food, releasing it in controlled steady rate into duodenum - Kills parasites & certain bacteria
46
In which stomach region(s) is only mucus secreted?
- Cardia - Pylorus
47
In which stomach region(s) is mucus, HCl & pepsinogen secreted?
Body Fundus
48
In which stomach region(s) is gastrin secreted?
Antrum
49
Gastric secretion is regulated. There are stimulatory and inhibitory factors for its secretion. What are the stimulatory factors of gastric secretion? [Neural, Endocrine & Paracrine]
Neural: ACh - postganglionic transmitter of vagal parasympathetic fibres Endocrine: Gastrin (G cells of antrum) Paracrine: Histamine (ECL cells & mast cells of gastric wall)
50
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]
Endocrine: Secretin (small intestine) Paracrine: Somatostatin (SIH) Paracrine & Autocrine: PGs (E2 & I2), TGF-a & adenosine
51
To what receptors does histamine released in the stomach bind to?
H2-Receptors
52
To what receptors does acetylcholine bind to in the gastric wall?
M1 Receptors
53
The stomach has protective mechanisms against ulcers. What are these main 4 mechanisms?
1. Mucus film 2. HCO3- secretion 3. Epithelial barrier 4. Mucosal blood perfusion
54
Outline the mechanisms that repair epithelial defects of the stomach (in ulceration).
1. Migration Adjacent epithelial cells flatten to close gap via sideward migration along basement membrane 2. Gap closed by cell growth Stimulated by EGG, TGF-a, IGF-1, GRP & Gastrin 3. 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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