Esophageal Stage Flashcards
Esophageal Phase:
plays integral role in ?
oral and pharyngeal stage deficits can be caused by
swallowing process
esophageal dysfunction
The esophagus: collapsed ? how length boundaries are ? Primarily innervated by ?
muscular tube at rest
18-26 cm
UES and LES
CN X
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 ?
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
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 ?
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
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 ?
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
striated:
smooth:
cardiac:
voluntary or skeletal muscle
involuntary muscles of internal organs/blood vessels
specific to heart or myocardium
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?
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
Peristalsis:
persitalsis can be divided into :
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
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
2 seconds after esophageal stage has begin - to relax
7 sec
passes into stomach
8-20 sec
esophageal deficits can be divided into those of
motility
obstruction
Motility: GERD
occurs when stomach acid ?
can result from following conditions:
flows up into esophagus, pharynx and oral cavity
innapropriate relaxation of LES, esophageal peristalsis, delayed emptying of stomach or hiatal hernia
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:
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
Motility disorders: corkscrew esophagus
results from ?
the esophagus shows ?
usually seen in
diffuse esophageal spasm (muscular activity is increased and uncoordinated)
irregularly spaced contractions causing indentations in thoracic esophagus
elderly
Hiatal hernia
an abnormal
part of stomach passes into ?
can lead to ?
hiatus:
weakness or opening in diaphragm
chest cavity
dysfunction of LES which can result in reflux
esophageal opening of diaphragm
Diverticulum:
an abnormal?
usually occurs immediately above the ? it may also ?
pocket or pouch in wall of pharynx or esophagus
cricopharyngeal sphincter / form anywhere along walls of lower esophagus
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 ?
Zenker’s Diverticulum
cricopharyngeus fails to open completely
increased pressure
pharyngeal muscles to weaken and herniate
Pill induced esophagitis: inflammation of mucosal wall caused by
symptom inlcude
pill tablet or capsule lodged in esophagus
pain in chest when swallowing
Obstruction deficit: stricture -esophageal stricture: narrowing of narrowing can cause there are various possible causes include
segment of esophagus
food to stick which can contribute to backflow of material
causes for a stricture
GERD, esophageal webs, tumors, post radiation changes
obstruction deficits:
most freq. seen in ?
seen as a small?
patient may be without ? or complain of
front portion of upper esophagus just above or below cricopharyngeus
indentation in upper esophageal wall
without symptoms/ food sticking and odynophagia
Cricopharyngeal bar:
cricopharyngeus is ? and looks like
patient may or may not have
cause is ?
prominent/ finger like projection into esophagus
have associated dysphagia
speculative: GERD, neurogenic disorders that affect striated muscles, inability for muscle to relax and contract
Obstruction deficits:
tumors
Barrett’s esophagus: a disorder in which the ?
a patient with barrett’s esophagus has an increased chance o
esophagus undergoes a change in response to repeated irritation and inflammation from reflux of acid into esophagus
developing esophageal cancer
esophagectomy:
the two most commonly used approaches to esophagectomy include?
pharyngeal stage dysphagia may occur post surgery dued to ?
transhiatal approach and the ivor-lewis esophagectomy
damage to the recurrent laryngeal nerve or nerve fibers in the pharyngeal plexus
esophagectomy: mechanical? when combined with recurrent laryngeal nerve impairment you could see a ?
tethering of larynx may also occur following neck anastomosis
synergistic effect that results in bilateral pharyngeal involvement immediately post surgery
esophagectomy: general swallowing suggestions: -small proper limited limit ?
frequent meals
positioning
exercise/extreme movement after meals
liquids during meals to avoid rapid transfer of food through the bowel
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 ?
organic and extrinsic lesions of the esophagus
motility, structure and function of esophagus/undistended and distended esophagus and sphincteric opening
esophageal evaluation:
esophagogastronodu odensocopy EGD: an evaluation of the esophagus performed to assess
the EGD evaluates ? and notes ?
mucosal integrity of the esophagus, duodenum and stomach
structure, inflammation, and lesions / appearence, location, distribution, and extent of mucosal disease
Esophageal stage diagnostics:
quantifies?
manometry measures ? and ? using ?
esophageal contractions
contractile pressure amplitude and duration int he esophagus/ catheters placed transnasally in the esophagus to record luminal pressures
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 ?
highly corrosive to esophageal mucosa
barrier to reduce flow of acid
reflux under conditions of normal daily eating and physical activity
