esophageal physiology and swallowing disorder Flashcards
0
Q
odynophagia
A
painful swallowing
1
Q
dysphagia
A
difficulty swallowing
2
Q
globus
A
sensation of fullness in upper throat (feels better with swallowing) –marble
3
Q
pyrosis
A
heart burn, substernal lcoation-ascneding up chest
4
Q
regurgitation
A
return of sour gastric contents
5
Q
water brash
A
spontaneous salivation from reflux
triggered frm vagus
6
Q
rumination
A
chewing one’s cud
can get dental erosion
7
Q
primitive gut forms during
A
week 4 gestation
8
Q
trachoesophageal septum splits primitive gut into
A
ventral trachea and dorsal esophagus
9
Q
developmental abnormalities of esophagus include
A
short esophagus esophageal stenosis (usually in distal third due to incomplete recanalization during 8th week dev) esophageal atresia (typically occurs with a tracheoesophageal fistula)
10
Q
upper 5% of esoph
A
skeletal/striated
11
Q
middle 35%
A
mixed skeletal and striated with circular muscles and long muscles
12
Q
lower 60%
A
smooth muscle w/ circular msucles and long. muscles
13
Q
c6
A
beginning at upper eso spinchter
14
Q
t3
A
aortic arch presses on eso
15
Q
t10
A
passes through diaphragmatic hiatus to reach stomach
16
Q
job of inner circular layer of muscles
A
prox connected to cricopharyngeous
forms upper eso spinchter (UES) and (LES)
17
Q
UES formed by
A
cricopharyngeus muscles
18
Q
at rest, UES is
A
closed to avoid swallowing air
19
Q
N supply UES
A
pharyngeal branch of vagus
20
Q
LES at rest
A
closed to prevent reflux
21
Q
what keeps LES closed
A
normal muscle tone + fibers of right diaphragmatic crus and phrenoesophageal ligament
22
Q
nerve supply to LES
A
parasymp, symp, enteric fibers
23
Q
neurotransmitters at LES
A
inhib: NO>VIP
excite: Ach>substance P
24
microscopic anatomy (4 layers) of esophagus
mucosa
submucousa
muscularis propia (inner and outer layers)
*no serosal layers
25
arteries of esophagus
upper-inferior thyroid artery
middle- R & L bronchial arterioles
mid-distal/distal- branch from thoracic aorta and esophagial branch of L gastric artery
26
veins of esophagus
upper: submucosal plexus-->inferior thyroid vein
middle: azygous and hemizygous
mid-distal.distal- gastric vein
27
intrinsic motor system nerves
ens-->myenteric plexus between muscle layers
28
extrinsic motor/secretory
post gang fibers (symp)-inhibit motility
| vagus (parasymp)- stim motility/secretory
29
sensory nerves
vagus-->nucleus tractus solitaris-->CNS
30
sensory issues present as
chest pain
heart burn
dusphagia
31
sensory chemo R
located in mucosa and submucosa-->sense chemical irritants
32
sensory mechano-nociceptors
submucosa-->adventitia-->respond to lumen distention NOT teraing (why endoscopy doesnt hurt)
33
normal swallowing relies upon
intact neuromuscular fx of the tongue, pharynx, and esophagus
34
swallowing is controlled by this brainr egion
medulla
35
sensory input from pharynx via
CN 5, 10, 11
36
motor output via CN
5,7,9,10,12
37
3 regions of stomach
LES and cardia
fundus/body
antrum/pyloris
38
LES and cardia
mucous, hco3-
prevents reflux, entry of food, regluates burps
39
fundus and body
H+, intrinsic factor, mucous, hco3-
reservoir, tonic force during emptying
40
antrum and pyloris
mucous, hco3-
mixing, grinding, seviing, regulate emptying
41
surface and neck cells
mucous, hco3-, peptides
lubricate, protect/repair
42
parietal cells
H+, intrinsic factor
protein degradation, binding B12, protection from bacteria
43
chief cells
pepsinogen, gastric lipase
p: protein digestion
gl: triglyc digestion
44
endocrine cells
gastric (gcell), histamine (ECL cell), somatostatin (d cell)
regulate acid secretion
45
parietal cells have lots of mito
becuse runnign their h pumps takes lots of energy
46
resting state has
short microvilli with a cystoplasmic tubulovesicular system
47
secretory state has
long microvilli and canalicular system
48
resting state mech
gastric acid pump (HK ATPase) in tubulovesicle and inactive
cannicully collapsed
low flow of acid
49
secretroy state
stimulation by Ach, gastrin, histamine-->g pump incorporated into canaliculus-->expands canaliculus and activates it-->excahnges H for K-->releases HCL
50
2 component model
inr esting state, juice is mostly NaCl, with little H and K so PH >4 and non-parietal predominates
while n secretory state, mostly Hcl, little Na and K so PH<4, parietal predominates
51
why is it important HCO3- is recycled
alkaline tide-- Hco3 drains into capillaries of parietals cells then drains to venous surrounding surface cells to help make surface mucosa
104
what protects the gastric mucosa?
mycous and bicarb
105
mucous neck cells secrete and are stim by
stim by vagus (ach)
| secrete soluble mucous
106
surface neck cells are stim by and secrete
stim by alcohol/chemicals nad physical friction of food--> release insoluble mucous
107
agents known to disrupt the barrier and cause ulceration
weak acids
alcohol
nsaids
detergents (bile salts)
108
three responses to a meal
endocrine/paracrine/neurocrine
109
cephalic phase
thinking about food via vagally mediated pathway
110
gastric phase
foo enters and buffers gastric juice
111
when ph gets to six
more gastrin secreted
112
fundal distention does
2 things- vagal arch and mechanoreceptor stim (to increase parietal cell H+ secretioin)
113
what shuts everything off
somatostatin
114
intestinal phase
mediated by chyme entering duodenum 1st hour post meal
115
what does chyme do
slows gastric emptying
| decreases acid secretion actively by producing inhibitors and passively by decreasing distention
116
stimulatory factors
amino acids ins mall intestine stim relase of gastrin
117
inhibitory factors
chyme in upper intesting inhibit gastric acid scertion-- maybe via secretin and GIP
118
swallowing sensory input to pharynx via
CN 5, 10, 11
119
motor output of swallowing via
CN 5,7,9,10,12
120
globus
feeling of lump or tickle int hroat that's constant in nature, does not interfere with swallowing
121
main cause globus
UES problem-spasm, incomplete relaxation, or hypertensive UES
122
other ddx globus
GERD
| visceral hypersenstivity
123
odynophagia
pain swallowing cause by injurt to mucoa=sal lining by viral infection, medications, gerd
124
tx odynophagia in known hiv
2 PPI+ antifungal agent until sx reslve
125
tx odoynophagia in non HIV or refractory HIV
upper endo to figure out whats going on
126
oropharyngeal dysphagia
transfer dysphagia; difficulty initiating a swallow or transferring food from mouth to esophagus; food "sticks int hroat"
127
three types of abnormalities by oropharyngeal dysphagia
neuro
structural
muscoloskeleton
128
dx of oropharyngeal dysphagia
Hx Pe
| cineradio is the best
129
tx OD
speech path, tx underlying disorder, avoid thin fluids, maybe entubation
130
esophageal dysphagia
food sticks in chest
| --intralumninal obstruction
131
functional esophageal dysphagia
spasm; motor failure
132
anatomical esophageal dysphagia
extrinsic compression by vessesls or mass
| structural lesions- diverticula, esoph rings, webs, esophagitis, strictures, tumors
133
red flag symptoms
```
weight loss
anemia
chronic GERD
melena
hemataemesis
```
134
studies to asscess esophgeal fxq
barium swallow FIRSt
cineesophragram
upper endoscopy (EGD)- if positive red flag or barium swallow is abnormal
esophageal manometry- to assess LES fux and eso body peristalsis
ph studies
impedence
135
hypercontractle manometric states
achlasia- failure relax LES
| spastic disorders- diffuse esophageal spasm
136
hypocontractile states manometric fingeings
```
ineffective motility (achalsia, scleroderma/crest)
hypotensive LES, transient LES relaxations
```
