Esophageal Stage

Question 1

Esophageal Phase:
plays integral role in ?
oral and pharyngeal stage deficits can be caused by

Answer 1

swallowing process

esophageal dysfunction

Question 2

The esophagus: 
collapsed ? 
how length 
boundaries are ? 
Primarily innervated by ?

Answer 2

muscular tube at rest

18-26 cm

UES and LES

CN X

Question 3

UES/ CP:

What leads to sphinteric opening and closing of UES ?

different from other ? UES is not

relaxation… OR…. of CP assists with ? but it is NOT

hyolaryngeal excursion places ?

Answer 3

cricopharyngeal muscle, inferior constrictor muscle fibers, proximal esophagus

sphincters in the body/ fully circular ring of muscle

de-innervation/ relaxation of UES opening during swallowing - only opener

traction on anterior portions of the CP during swallow

Question 4

LES:
morphologically differently?
-formed by
-true ?
unlike UES where constant neural firing, the tonic state of LES is ?
pressure from bolus and peristaltic pressures assist
contraction is ?

Answer 4

formed as compared to UES
-thickening of circular muscle fiber of distal esophagus
-secondary to intrinsic characteristics of muscle fibers
-opening upon relaxation
anterior/posterior than from side-to-side

Question 5

the esophagus:
may be divided into?

cervical esophagus: begins at ?

thoracic:
- … portion
- both

abdominal:
- passes through ? enters ? and ends at?

the distal esophagus is most susceptible to ?

Answer 5

three distinct areas related to position

UES and continues 4-5 cm proximally to sternum (striated muscle)

largest portion
-striated and smooth

short 0.5-2.5 cm
-diaphragm (smooth muscle) enters stomach and ends at LES (which forms entrance to stomach)

motility disorders

Question 6

striated:
smooth:

cardiac:

Answer 6

voluntary or skeletal muscle

involuntary muscles of internal organs/blood vessels

specific to heart or myocardium

Question 7

The esophageal body is made up of ?

these layers have ? which are arranged in different directions in order to facilitate ? 
-
-
-
-

highly coordinated movement of ? while ? helps bolus?

Answer 7

4 tissue layers

muscle fibers / bolus propulsion

• mucosa- innermost layer
• lamina propria - connective tissue and mucous secretion
• muscular mucosa
• submucosa

proximal contraction of muscle fibers/ distal relaxation of muscle fibers /bolus propel toward stomach

Question 8

Peristalsis:

persitalsis can be divided into :

Answer 8

primary waves: initiated by pharyngeal swallow

secondary waves: normal waves,not initated by swallow - result from presence of bolus

tertiary waves:
mostly in older adults
-occur at same time as primary and secondary waves
-may or may not be severe enough to cause dysphagia

Question 9

Esophageal stage of swallowing:
approx. ? the LES begins?

the sphincter remains relaxed for about ?

with LES relaxed the bolus then ?

the esophageal stage takes about

Answer 9

2 seconds after esophageal stage has begin - to relax

7 sec

passes into stomach

8-20 sec

Question 10

esophageal deficits can be divided into those of

Answer 10

motility

obstruction

Question 11

Motility: GERD
occurs when stomach acid ?

can result from following conditions:

Answer 11

flows up into esophagus, pharynx and oral cavity

innapropriate relaxation of LES, esophageal peristalsis, delayed emptying of stomach or hiatal hernia

Question 12

motility: achalasia
means?
absence or incomplete relaxation of ?

can cause ?

widened area of the esophagus begins to ?

it is freq. referred to as

symptoms can inlcude:

Answer 12

failure to relax

LES

lower esophagus to dilate and widen

taper and narrow at LES

birds beak

regurgitation, weight loss, choking, coughing, recurrent pneumonias and slow eating with an increase in liquid intake

Question 13

Motility disorders: corkscrew esophagus

results from ?

the esophagus shows ?

usually seen in

Answer 13

diffuse esophageal spasm (muscular activity is increased and uncoordinated)

irregularly spaced contractions causing indentations in thoracic esophagus

elderly

Question 14

Hiatal hernia

an abnormal

part of stomach passes into ?

can lead to ?

hiatus:

Answer 14

weakness or opening in diaphragm

chest cavity

dysfunction of LES which can result in reflux

esophageal opening of diaphragm

Question 15

Diverticulum:
an abnormal?
usually occurs immediately above the ? it may also ?

Answer 15

pocket or pouch in wall of pharynx or esophagus

cricopharyngeal sphincter / form anywhere along walls of lower esophagus

Question 16

diverticulum:
a diverticulum found in area directly above cricopharyngus is called?

develops when the ?

the failure causes

it is believed that increase in pressure causes ?

Answer 16

Zenker’s Diverticulum

cricopharyngeus fails to open completely

increased pressure

pharyngeal muscles to weaken and herniate

Question 17

Pill induced esophagitis: inflammation of mucosal wall caused by

symptom inlcude

Answer 17

pill tablet or capsule lodged in esophagus

pain in chest when swallowing

Question 18

Obstruction deficit: 
stricture 
-esophageal stricture: narrowing of 
narrowing can cause 
there are various 
possible causes include

Answer 18

segment of esophagus

food to stick which can contribute to backflow of material

causes for a stricture

GERD, esophageal webs, tumors, post radiation changes

Question 19

obstruction deficits:
most freq. seen in ?

seen as a small?

patient may be without ? or complain of

Answer 19

front portion of upper esophagus just above or below cricopharyngeus

indentation in upper esophageal wall

without symptoms/ food sticking and odynophagia

Question 20

Cricopharyngeal bar:
cricopharyngeus is ? and looks like

patient may or may not have

cause is ?

Answer 20

prominent/ finger like projection into esophagus

have associated dysphagia

speculative: GERD, neurogenic disorders that affect striated muscles, inability for muscle to relax and contract

Question 21

Obstruction deficits:

Answer 21

tumors

Question 22

Barrett’s esophagus: a disorder in which the ?

a patient with barrett’s esophagus has an increased chance o

Answer 22

esophagus undergoes a change in response to repeated irritation and inflammation from reflux of acid into esophagus

developing esophageal cancer

Question 23

esophagectomy:

the two most commonly used approaches to esophagectomy include?

pharyngeal stage dysphagia may occur post surgery dued to ?

Answer 23

transhiatal approach and the ivor-lewis esophagectomy

damage to the recurrent laryngeal nerve or nerve fibers in the pharyngeal plexus

Question 24

esophagectomy: mechanical? when combined with recurrent laryngeal nerve impairment you could see a ?

Answer 24

tethering of larynx may also occur following neck anastomosis

synergistic effect that results in bilateral pharyngeal involvement immediately post surgery

Question 25

esophagectomy: 
general swallowing suggestions: 
-small 
proper
limited 
limit ?

Answer 25

frequent meals
positioning
exercise/extreme movement after meals
liquids during meals to avoid rapid transfer of food through the bowel

Question 26

esophageal stage diagnostics:
Radiographic imaging:
MRI and CT used to evaluate ?

the radiographic esophagram evaluates: when the patient is both

it allows for views of the ?

Answer 26

organic and extrinsic lesions of the esophagus

motility, structure and function of esophagus/undistended and distended esophagus and sphincteric opening

Question 27

esophageal evaluation:
esophagogastronodu odensocopy EGD: an evaluation of the esophagus performed to assess

the EGD evaluates ? and notes ?

Answer 27

mucosal integrity of the esophagus, duodenum and stomach

structure, inflammation, and lesions / appearence, location, distribution, and extent of mucosal disease

Question 28

Esophageal stage diagnostics:
quantifies?
manometry measures ? and ? using ?

Answer 28

esophageal contractions

contractile pressure amplitude and duration int he esophagus/ catheters placed transnasally in the esophagus to record luminal pressures

Question 29

pH monitoring:
hydrochloric acid produced and secreted by the stomach during digestion is ?

and the LES can serve as an effective?

esophageal pH monitoring assesses ?

Answer 29

highly corrosive to esophageal mucosa

barrier to reduce flow of acid

reflux under conditions of normal daily eating and physical activity