CSI 8 Flashcards
How long is the fibromuscular tube of the Oesophagus approximately?
25cm
Describe the path of the Oesophagus from where it originates to where it ends?
Origniates from the Inferior border of the cricoid cartilage (C6)
Descends downwards into the superior mediastinum of the thorax, positioned between the trachea and the vertebral bodies of T and T4.
It then enters the abdomen via the Oesophageal hiatus (opening in the the right side of the diaphragm) at T10
Terminates by joining the cardiac oriface of the stomach at level T11.
How long is the abdominal portion of the Oesophagus approximately?
1.25cm
What are the 4 layers of the Oesophagus?
Adventitia- outer layer of connective tissue ( but very distal and intraperitoneal portions of oesophagus have a outer serosa layer instead)
Muscle Layer-external layer of longitudinal muscle and inner layer of circular muscle.
Submusosa
Mucosa -Non-keratinised stratified squamos epithelium (contiguous with columnar epithelium of the stomach)
Describe the 3 layers of the exernal longitudinal layer of muscle in the oesophagus?
Superior third -voluntary striated muscle
Middle third- voluntary striated and smooth muscle
Inferior third- smooth muscle
How is food transported dpown the Oesophagus?
Peristalsis -rhythmic muscle contractions
What is dysphagia?
difficulty swallowing
can bne caused by hardening of muscles involved in peristalsis
What is the structure/location and function of the upper oesophageal sphincter?
Structure:
- anatomical straited muscle sphincter at the junction between the pharynx and oesophagus
- produced by the cricopharyngeal muscle
Function:
-to constrict(normally like this) to prevent the entry of air into the oesophagus
Location and function of the Lower oesophageal sphincter?
Location:
-Physiological sphincter located in the gastro-oesophageal junction(junction between the stomach and oesophagus tot he left of the T11 vertebra ), it is marked by the change from oesophageal to gastric mucosa
Function:
- During Oesophageal peristalsis the sphincter is relaxed to allow food into the stomach
- At rest the sphincter prevents the reflux of acidic gastric contents up into the Oesophagus
What is the structure of the lower oesophageal sphincter?
classified as a physiological (or functional) sphincter, as it does not have any specific sphincteric muscle. Instead, the sphincter is formed from four phenomena:
- The oesophagus enters the stomach at an acute angle.
- The walls of the intra-abdominal section of the oesophagus are compressed when there is a positive intra-abdominal pressure.
- The folds of mucosa present aid in obstructing the lumen at the gastro-oesophageal junction.
- The right crus of the diaphragm has a “pinch-cock” effect.
Where is food most likely to get stuck in the Oesophagus?
The anatomical relations of the Oesophagus which has given rise to 4 physiological constriction remembered as ABCD:
- Arch of the Aorta
- Bronchus
- Cricoid cartilage
- Diaphragmatic hiatus
What is Barretts Oesophagus?
What causes it?
- Metaplasia of lower oesophageal squamous epithelium to gastric/intestinal columnar epithelium.
- usually caused by chronic acid exposure due to malfunctioning lower oesophageal sphincter. The acid irritates the oesophageal epithelium, leading to a metaplastic change.
How can you detect barrets?
Endoscopy of the Oesophagus
What proportion of malignancies in the UK are oesophageal carcinomas?
2%
What are the clinical features of Oesophageal carcinomas?
Dysphagia- difficulty swallowing, becomes worse as tumour increase in size =restricts passage of food
Weight loss
What are the 2 major types of Oesophageal cancer?
Squamos cell carcinoma- most common type(occurs at any level of the oesphagus)
Adenocarcinoma- occurs in inferior third of the oesophagus.. It usually originates in the metaplastic epithelium of Barretts
What are oesophageal varices?
What is the problem with them?
- Normally the abdominal oesophagus drains into systemic and portal vein circulation to form an anastomosis
- varices are weird mini sub mucosal veins in the wall of the oesophagus that lies within the anastomosis
- Usually made when portal hypertension happens ot their is blockage of the portal vein as the blood will then travel via the varices instead which is dangerous as these veins are weak can can burst.
- Patients tend to present with haematemsis(vomiting blood).
What causes Oesophageal varices?
Who is at high risk of getting them ?
Causes- portal hypertension which is caused by chronic liver diseases such as cirrhosis
Alcoholics are at high risk
What is heartburn?
burning sensation in the chest because of acid reflux (stomah acid goes up oesophagus and into the mouth)
What is another term for reflux?
Gastro-oesophageal relux disease (GORD)
What is some treatmetn for reflux?
- Proton Pump Inhibitor (PPI) for 4-8 weeks
- H2 blocker(offered if PPI doesnt work)
What is the treatment for severe Oesophagitis?
Oesophagitis=severe inflammation
- PPI for 8 weeks
- If symptoms come back after you’ve stopped using PPI you should be given a higher dose or treatmetn with a different PPI. You may have to take treament for a long time
- if it doesnt work your symptoms and lifestyle will be reviewed by GP and they may give a different PPI or get some specialist adivice e.g. a gastroenterologist
When is surgery for reflux and Oesophagitis appropriate?
What is the most common surgery for reflux and describe?
-For people who dont want to take medicine long term it have unpleasant side effects from medication
Laparoscopic fundoplication- A keyhole surgery technique, in which the surgeon stitches and folds the top of the stomach, just below where the oesophagus meets the stomach, to create a smaller opening. The aim is to reduce the amount of stomach contents re-entering the oesophagus.
What does the term dyspepsia encompass?
- recurrent epigastric pain
- heartburn
- symptoms of acid regurgitation(with or without bloating)
- nausea and vomitting
- indigestion
- tummy-ache
- reflux