CSI 8 - Acid Reflux (PRE-READING)

Question 1

What is the oesophagus?

Answer 1

Long fibromuscular tube running from pharynx to stomach

Question 2

How long is the oesophagus, approximately?

Answer 2

25 cm

Question 3

Where does the oesophagus start?

Answer 3

Inferior border of cricoid cartilage (C6)

Question 4

Where does the oesophagus extend to?

Answer 4

The cardiac orifice of the stomach

Question 5

After beginning in the neck, the oesophagus is continuous superiorly with what?

Answer 5

The laryngeal part of the pharynx (laryngopharynx)

Question 6

Where does the oesophagus descend downwards into when entering the thorax?

Answer 6

Into the superior mediastinum, positioned between the trachea and the vertebral bodies of T1 to T4

Question 7

How does the oesophagus enter the abdomen?

Answer 7

Via the oesophageal hiatus at T10

Question 8

What is the oesophageal hiatus?

Answer 8

Opening in the right crus of the diaphragm

Question 9

How long approx. is the abdominal portion of the stomach at level of T11?

Answer 9

1.25 cm long

Question 10

What are the 4 layers of the oesophagus?

Answer 10

Adventitia, muscular layer, submucosa, mucosa

Question 11

What is adventitia?

Answer 11

outer layer of connective tissue

Question 12

What are the outer very distal and intraperitoneal portion of the oesophagus covered with instead of adventitia?

Answer 12

Serosa

Question 13

What is the muscle layer of the oesophagus composed of?

Answer 13

External longitudinal muscle layer and inner layer of circular muscle

Question 14

What type of external muscle is in the superior third of the oesophagus?

Answer 14

Voluntary striated muscle

Question 15

What type of external muscle is in the middle third of the oesophagus?

Answer 15

Voluntary striated and smooth muscle

Question 16

What type of external muscle is in the inferior third of the oesophagus?

Answer 16

Smooth muscle

Question 17

What is the mucosa layer of the oesophagus?

Answer 17

Non-keratinised stratified squamous epithelium (contiguous with columnar epithelium of the stomach)

Question 18

How is food transported through the oesophagus?

Answer 18

Peristalsis

Question 19

What is peristalsis?

Answer 19

Rhythmic contractions of muscles propagating down oesophagus through GI tract

Question 20

What can the hardening of the muscle layers of the oesophagus cause?

Answer 20

Can interfere with peristalsis and cause difficulty in swallowing (dysphagia)

Question 21

What is dysphagia?

Answer 21

Difficulty in swallowing

Question 22

What is the purpose of the 2 oesophageal sphincters?

Answer 22

To prevent entry of air and reflux of gastric contents into the oesophagus

Question 23

What is the upper oesophageal sphincter?

Answer 23

Anatomical, striated muscle sphincter

Question 24

Where is the upper oesophageal sphincter?

Answer 24

At junction between pharynx and oesophagus

Question 25

What muscle produces the upper oesophageal sphincter?

Answer 25

Cricopharyngeus muscle

Question 26

What is the normal function of the upper oesophageal sphincter?

Answer 26

Normally it is constricted to prevent the entrance of air into the oesophagus

Question 27

What is the lower oesophageal sphincter?

Answer 27

Physiological/functional sphincter - doesn't have any specific sphinteric muscle

Question 28

Where is the lower oesophageal sphincter?

Answer 28

Located in the gastro-oesophageal junction

Question 29

Where is the gastro-oesophageal junction?

Answer 29

Situated to the left of the T11 vertebra, marked by change from oesophageal to gastric mucosa

Question 30

What 4 phenomena form the lower oesophageal sphincter?

Answer 30

1) Oesophagus enters stomach at an acute angle 2) Walls of intra-abdominal section of oesophagus are compressed when there's a positive intra-abdominal pressure 3) Folds of mucosa aid in occluding lumen at junction 4) Right crus of diaphragm has pinch cock effect

Question 31

What happens to the lower oesophageal sphincter during oesophageal peristalsis?

Answer 31

Sphincter is relaxed to allow food to enter into the stomach

Question 32

What is the function of the lower oesophageal sphincter at rest?

Answer 32

To prevent reflux of acidic gastric contents into the oesophagus

Question 33

Where are the 4 physiological constrictions in the lumen of the oesophagus?

Answer 33

A - arch of aorta B - bronchus C - cricoid cartilage D - diaphragmatic hiatus

Question 34

What is the significance of the 4 constrictions in the oesophagus?

Answer 34

These are the areas where food or foreign objects can get stuck

Question 35

What are the anterior relations of the oesophagus in the cervical and thoracic region?

Answer 35

- trachea - left recurrent laryngeal nerve - pericardium

Question 36

What are the posterior relations of the oesophagus in the cervical and thoracic region?

Answer 36

- thoracic vertebral bodies - thoracic duct - azygous veins - descending aorta

Question 37

What are the right side relations of the oesophagus in the cervical and thoracic region?

Answer 37

- pleura | - terminal part of the azygous vein

Question 38

What are the left side relations of the oesophagus in the cervical and thoracic region?

Answer 38

- subclavian artery - aortic arch - thoracic duct - pleura

Question 39

What are the anterior relations of the oesophagus in the abdominal region?

Answer 39

- left vagus nerve | - posterior surface of heart

Question 40

What are the posterior relations of the oesophagus in the abdominal region?

Answer 40

- right vagus nerve | - left crus of the diaphragm

Question 41

What is Barrett's oesophagus?

Answer 41

Metaplasia of lower oesophageal squamous epithelium to gastric columnar epithelium

Question 42

What is Barrett's oesophagus usually caused by?

Answer 42

Chronic acid exposure - as result of malfunctioning lower oesophageal sphincter

Question 43

What is the most common symptom of Barrett's oesophagus?

Answer 43

Long-term burning sensation of indigestion

Question 44

How can Barrett's oesophagus be detected?

Answer 44

Via endoscopy of the oesophagus

Question 45

What percentage of malignancies in the UK care oesophageal carcinomas?

Answer 45

2%

Question 46

What are the clinical features of oesophageal carcinoma?

Answer 46

- dysphagia | - weight loss

Question 47

What are the 2 major types of oesophageal carcinoma?

Answer 47

- squamous cell carcinoma | - adenocarcinoma

Question 48

Where does squamous cell carcinoma occur?

Answer 48

Any place in oesophagus - most common subtype of oesophagus cancer

Question 49

Where does adenocarcinoma occur?

Answer 49

Lower third of oesophagus - associated with Barrett's oesophagus (usually originates in metaplastic epithelium)

Question 50

What 2 circulations does the abdominal oesophagus drain into, forming an anastomosis between the 2?

Answer 50

Systemic and portal circulation

Question 51

What are oesophageal varices?

Answer 51

Abnormally dilated sub-mucosal veins (in the oesophagus wall) Lie within anastomosis between systemic and portal circulation drainage from abdominal oesophagus

Question 52

When are oesophageal varices normally produced?

Answer 52

When pressure in portal system increases beyond normal (portal hypertension)

Question 53

When does portal hypertension most commonly occur?

Answer 53

Secondary to chronic liver disease, like cirrhosis or an obstruction in the portal vein

Question 54

What do most patient with oesophageal varices present with?

Answer 54

Haematemesis (vomiting of blood) - varices are predisposed to bleeding

Question 55

What group of people are at high risk of developing oesophageal varices?

Answer 55

Alcoholics