Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI/Nutrition > Diseases of the Esophagus > Flashcards

Diseases of the Esophagus Flashcards

1
Q

What is the main physiological function of the digestive tract?

A

To process acquired food and water to meet the nutritional needs of the multi cellular organism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the single task of the esophagus?

A

To transport the bolus (food/water) from pharynx into the gastric reservoir (sometimes to transport things out)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is swallowing both voluntary AND involuntary?

A

The initial phase is voluntary, but as the bolus is pushed backwards by the tongue to the hypopharynx the involuntary phase of the swallow reflex is triggered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How many muscles are required for swallowing

A

More than 50 (oral, pharyngeal, laryngeal, esophageal, and diaphragmatic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What compartments of the body does the esophagus traverse?

A

Cervical, Thoracic, and Abdominal (It is 18-26 cm in length)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What four layers make up the wall of the esophagus? How thick is each layer?

A

Mucosa, submucosa, muscularis propria, and adventitia; They each reach 2-4 mm in thickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What outward motion signifies the start of the involuntary phase of swallowing?

A

Upward movement of the “adam’s apple”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the difference between the inner and outer muscular layer of the esophagus?

A

Inner layer is circular Outer layer is longitudinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which layer of the esophagus is not fixed, and slides over the other layers?

A

Mucosa layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the muscular differences between the upper esophageal sphincter (UES) and the lower esophageal sphincter (LES)?

A

The upper quarter of the esophagus and UES are composed of striated muscle The lower half of the esophagus along with the LES are composed of smooth muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which layer of muscle thickens near the LES?

A

Inner circular layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the crural diaphragm?

A

Part of the diaphragm around the LES that contributes to the resting tone (also called the external esophageal sphincter)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is peristalsis?

A

Coordinated and propulsive sequential contraction of the esophageal muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What mechanism allows primary peristalsis to occur?

A

Appropriately timed relaxation of the upper and lower esophageal sphincters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the two subtypes of peristalsis?

A
  • Primary - triggered by swallow (associated with pharyngeal contraction and UES relaxation)
  • Secondary - Triggered by esophageal distention (contraction starts proximal to distention)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What two nervous processes contribute to peristalsis?

A

Intrinsic: Enteric neural plexus

Extrinsic: Vagus nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is proximal esophageal striated muscle peristalsis controlled?

A

Action potential involves calcium release mainly from sarcoplasmic reticulum via T-tubules The peristalsis is generated by the swallowing “central pattern generator” of the brainstem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is distal esophageal smooth muscle peristalsis controlled?

A

Calcium influx from outside and latency gradiant with “dual peripheral innervation” Peristalsis is physiologically regulated as “a wave of inhibition followed by a wave of excitation”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Vagal efferents synapse both on _______ and ______ myenteric neurons

A

inhibitory; excitatory

20
Q

How do vagal efferents affect excitatory motor neurons?

A

Predominantly acetylcholine (some substance P) leads to calcium release and depolarization and second messenger pathways

21
Q

How do vagal efferents affect inhibitory motor neurons?

A

Predominantly NO leads to a cGMP dependent pathway which inhibits calcium entry and leads to hyperpolarization (Can also be triggered by vasoactive intestinal peptide)

22
Q

Do layers of the esophageal muscles contract separately or together?

A

Together - they move in a coordinated fashion to propel the bolus

23
Q

What is the most specific esophageal symptom in esophageal disorders?

A

Dysphagia (difficulty swallowing)

24
Q

What kinds of food can lead to dysphagia? Which causes dyphagia first?

A

Solid AND liquid (Solid food is more dependent on peristalsis and will present first with dysphagia)

25
Q

What other symptoms often present with dysphagia and can be used to aid in diagnosis?

A
  • Heartburn
  • Regurgitation (effortless)
  • Odynophagia (pain during swallow and bolus transit)
  • Chest pain (Non exertional and non cardiac)
26
Q

How long after swallowing should pain occur for dysphagia diagnosis?

A

less than 10 seconds

27
Q

What are the differences in dysphagia symptoms based on location?

A
  • Esophageal - Sticks or hangs up after swallow; may have chest pain when stuck
  • Pharyngeal - Difficulty initating swallow; coughing, choking and nasal regurgitation
28
Q

What are the common etiologies of dysphagia? (Mechanical vs. Neuromuscular)

A
  • Mechanical:
    • Peptic stricture (caused by acid reflux)
    • Esophageal ring (acquired or congenital)
    • Cancer
  • Neuromuscular:
    • Achalasia (most important)
    • Esophageal spasm; dysmotility (non-specific)
29
Q

What are some uncommon etiologies of dysphagia? (mechanical vs. neuromuscular)

A
  • Mechanical: Web, diverticulum, tumors, foreign body
  • Neuromuscular: Sclerodoerma; Chagas disease; Collagen Vascular disorders
30
Q

What signs of solid food dysphagia are indicative of cancer? peptic stricture? esophageal rings?

A
  • Cancer: Progressive and age > 50
  • Peptic stricture: Chronic heartburn
  • Esophageal Ring: Intermittent
31
Q

What signs of solid OR liquid food dysphagia are indicative of scleroderma/achalasia? spasm?

A
  • Liquid food dysphagia is often neuromuscular
    • Scleroderma/Achalasia: Progressive with heartburn/regurgitation
    • Spasm: Intermittent and chest pain
32
Q

What can be done diagnostically to identify esophageal disorders?

A
  • Upper GI endoscopy (structural information
  • Esophageal manometry (functional information)
  • Radiography: esophagram (structural and functional)
33
Q

What can you look for during an endoscopy?

A
  • Hypopharynx (observe true and false vocal cords and arytenoids
  • LES open or closed?
  • Obstruction?
  • Is Z line visible?
34
Q

What is esophageal manometry?

A
  • The technique for measurement of esophageal intra-luminal pressures (gold standard for diagnosis of esophageal motor disorders)
  • Time vs. Amplitude of contraction
35
Q
  • How long does the UES relax to allow bolus passage?
  • What is the amplitude of the contraction produced by the primary peristaltic wave?
  • What is the duration and speed of peristalsis?
  • How long does the LES relax to allow bolus emptying into stomach?
A
  • Half a second;
  • 150mmHg;
  • 3-7 sec at a speed of 3-5 cm/sec;
  • relaxes for 3-8 seconds
36
Q

What two processes make up achalasia?

A
  • Impaired relaxation of the LES and increased LES tone
  • Loss of peristalsis in the body of the esophagus
37
Q

What causes abnormal function of LES In achalasia?

A

Due to impaired and then loss of inhibitory (NO) activity

38
Q

What morphology is associated with achalasia?

A
  • Degeneration of ganglion cells in myenteric plexus
  • Inflammatory lymphocytic infilatration
39
Q

How does achalasia present?

A
  • Peak incidence in 7th decade (and 20-30) - Bimodal
  • Dysphagia is predominant symptom (solids and liquids)
  • Heartburn, chest pain, regurgitation and weight loss
  • Food stasis, bacterial fermentation and acidity Accommodative behavior
40
Q

How many modalities are needed for diagnosis of achalasia?

A

Two or three (must be observed structurally AND functionally)

41
Q

What are two different appearances of the barium esophagram that may indicate achalasia?

A
  • Bird beak
  • Sigmoid shape
42
Q

What is the differential diagnosis of achalasia (or what causes secondary achalasia)?

A
  • Malignancy
  • Other infiltrative disorders
  • Chagas disease
  • Para-neoplastic syndromes
  • Autonomic nerve damage
43
Q

What are the three types of therapy for achalasia?

A
  • Pharmacotherapy (NO donors and anticholinergic agents)
  • Endoscopic therapy - Botulinum toxin injection or pneumatic dilation
  • Operative therapy
44
Q

What characterizes an esophageal spasm?

A

Dis-coordinated contraction of the muscularis layer

45
Q

Why is esophageal spasm an issue?

A

It interferes with efficient delivery of food and fluids to the stomach

46
Q

In scleroderma esophagus the esophagus loses much of its ability to ______

A

contract (complete aperistalsis)

GI/Nutrition (36 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions