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CSI > CSI 8 - Acid Reflux (PRE-READING) > Flashcards

CSI 8 - Acid Reflux (PRE-READING) Flashcards

1
Q

What is the oesophagus?

A

Long fibromuscular tube running from pharynx to stomach

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2
Q

How long is the oesophagus, approximately?

A

25 cm

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3
Q

Where does the oesophagus start?

A

Inferior border of cricoid cartilage (C6)

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4
Q

Where does the oesophagus extend to?

A

The cardiac orifice of the stomach

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5
Q

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

A

The laryngeal part of the pharynx (laryngopharynx)

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6
Q

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

A

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

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7
Q

How does the oesophagus enter the abdomen?

A

Via the oesophageal hiatus at T10

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8
Q

What is the oesophageal hiatus?

A

Opening in the right crus of the diaphragm

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9
Q

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

A

1.25 cm long

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10
Q

What are the 4 layers of the oesophagus?

A

Adventitia, muscular layer, submucosa, mucosa

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11
Q

What is adventitia?

A

outer layer of connective tissue

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12
Q

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

A

Serosa

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13
Q

What is the muscle layer of the oesophagus composed of?

A

External longitudinal muscle layer and inner layer of circular muscle

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14
Q

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

A

Voluntary striated muscle

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15
Q

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

A

Voluntary striated and smooth muscle

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16
Q

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

A

Smooth muscle

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17
Q

What is the mucosa layer of the oesophagus?

A

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

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18
Q

How is food transported through the oesophagus?

A

Peristalsis

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19
Q

What is peristalsis?

A

Rhythmic contractions of muscles propagating down oesophagus through GI tract

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20
Q

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

A

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

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21
Q

What is dysphagia?

A

Difficulty in swallowing

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22
Q

What is the purpose of the 2 oesophageal sphincters?

A

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

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23
Q

What is the upper oesophageal sphincter?

A

Anatomical, striated muscle sphincter

24
Q

Where is the upper oesophageal sphincter?

A

At junction between pharynx and oesophagus

25
Q

What muscle produces the upper oesophageal sphincter?

A

Cricopharyngeus muscle

26
Q

What is the normal function of the upper oesophageal sphincter?

A

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

27
Q

What is the lower oesophageal sphincter?

A

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

28
Q

Where is the lower oesophageal sphincter?

A

Located in the gastro-oesophageal junction

29
Q

Where is the gastro-oesophageal junction?

A

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

30
Q

What 4 phenomena form the lower oesophageal sphincter?

A

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

31
Q

What happens to the lower oesophageal sphincter during oesophageal peristalsis?

A

Sphincter is relaxed to allow food to enter into the stomach

32
Q

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

A

To prevent reflux of acidic gastric contents into the oesophagus

33
Q

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

A

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

34
Q

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

A

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

35
Q

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

A
  • trachea
  • left recurrent laryngeal nerve
  • pericardium
36
Q

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

A
  • thoracic vertebral bodies
  • thoracic duct
  • azygous veins
  • descending aorta
37
Q

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

A
  • pleura

- terminal part of the azygous vein

38
Q

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

A
  • subclavian artery
  • aortic arch
  • thoracic duct
  • pleura
39
Q

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

A
  • left vagus nerve

- posterior surface of heart

40
Q

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

A
  • right vagus nerve

- left crus of the diaphragm

41
Q

What is Barrett’s oesophagus?

A

Metaplasia of lower oesophageal squamous epithelium to gastric columnar epithelium

42
Q

What is Barrett’s oesophagus usually caused by?

A

Chronic acid exposure - as result of malfunctioning lower oesophageal sphincter

43
Q

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

A

Long-term burning sensation of indigestion

44
Q

How can Barrett’s oesophagus be detected?

A

Via endoscopy of the oesophagus

45
Q

What percentage of malignancies in the UK care oesophageal carcinomas?

46
Q

What are the clinical features of oesophageal carcinoma?

A
  • dysphagia

- weight loss

47
Q

What are the 2 major types of oesophageal carcinoma?

A
  • squamous cell carcinoma

- adenocarcinoma

48
Q

Where does squamous cell carcinoma occur?

A

Any place in oesophagus - most common subtype of oesophagus cancer

49
Q

Where does adenocarcinoma occur?

A

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

50
Q

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

A

Systemic and portal circulation

51
Q

What are oesophageal varices?

A

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

52
Q

When are oesophageal varices normally produced?

A

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

53
Q

When does portal hypertension most commonly occur?

A

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

54
Q

What do most patient with oesophageal varices present with?

A

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

55
Q

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

A

Alcoholics

CSI (5 decks)

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