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BMS150 - Post Test 2 > Esophagus (Week 10) > Flashcards

Esophagus (Week 10) Flashcards

1
Q

How long is the esophagus?

A

~ 25cm

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2
Q

Where is the esophagus located?

A

posterior to trachea

begins at inferior end of laryngopharynx and ends in superior portion of stomach

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3
Q

The esophagus pierces the diaphragm through the ______________

A

esophageal hiatus

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4
Q

What type of cells are in the epithelium of the esophagus?

A

squamous stratified

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5
Q

What is the name of the resident dendritic cells that reside in the esophagus’ epithelium?

A

Langerhans cells

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6
Q

Lymphoid nodules (containing B cells and T cells) are found in the ____________ of the esophagus

A

lamina propria

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7
Q

Cardiac glands, that secrete mucous to protect the esophagus, are found where?

A

lamina propria

Note: there are 2 clusters (near pharynx and stomach)

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8
Q

What type of connective tissue is found in the submucosa of the esophagus?

A

dense, irregular fibroelastic connective tissue

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9
Q

What are the different layers of the muscularis of the esophagus?

A

upper 1/3 = mostly skeletal muscle

middle 1/3 = mixed

lower 1/3 = mostly smooth muscle

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10
Q

True or False: We see the adventitia of the esophagus until it pierces the diaphragm, after which it is serosa

A

True

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11
Q

What are the major arteries that supply the esophagus?

A
  • thoracic branches of the aorta (superiorly)
  • branches of the left gastric artery (inferiorly)
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12
Q

What are the major veins that drain the esophagus?

A
  • azygous vein
  • portal venous system via the left gastric veins
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13
Q

The __________ compresses the esophagus superiorly to some extent

A

larynx

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14
Q

What muscles are involved in “pushing food down” when swallowing?

A
  • cricopharyngeus muscle
  • the rest of the inferior pharyngeal constrictor muscle
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15
Q

when an out-pouching develops and food gets stuck in the weak spot just above the cricopharyngeus muscle

A

Zencker Diverticulum

Note: out-pouching occurs due to cricopharyngeus muscle over-tightening

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16
Q

What are the three stages of deglutition (swallowing)?

A

1) voluntary stage
2) pharyngeal stage
3) esophageal stage

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17
Q

Describe the voluntary stage of deglutition (swallowing)

A

after chewing, food is voluntarily squeezed/rolled posteriorly into the pharynx by pressure of the tongue upward and backward against the palate

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18
Q

Describe the pharyngeal stage of deglutition (swallowing)

A
  • a reflex controlled by the brain stem (medulla), triggered by food in the pharynx (tactile stimulation)
  • soft palate is pulled upwards (prevents food from getting into nose)
  • palatopharyngeal folds pulled together, creating a sagittal slit for food to pass with ease
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19
Q

Describe the esophageal stage of deglutition (swallowing)

A
  • trachea is closed (respiration inhibited temporarily), as vocal chords are brought together and larynx is raised and epiglottis covers vocal chords
  • upper esophageal sphincter relaxes
  • peristaltic contraction of pharynx
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20
Q

Where is the swallowing center? What does it do?

A

medulla (brain stem)

coordinates activity from vagal nuclei with other centers (e.g., inhibits respiratory center)

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21
Q

Where does the swallowing center receive sensory inputs from?

A

pharynx and esophagus

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22
Q

How long is the pharyngeal swallowing stage?

A

less than 2 seconds

Note: Therefore, only interrupts respiration for a very small amount of time

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23
Q

_____________ results from distension of the esophagus by retained food, or by reflux of gastric contents into the esophagus; continues until all the food has emptied into the stomach

A

Secondary peristalsis

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24
Q

Where is the lower esophageal sphincter located?

A

1-2 cm below diaphragm

2-5 cm above juncture with stomach

25
Q

True or False: The lower esophageal sphincter (LES) relaxes ahead of the peristaltic wave to allow easy propulsion of food into the stomach and to prevent reflux

A

True

26
Q

At rest, is the pressure high or low at the upper esophageal sphincter (UES)?

A

high

27
Q

At rest, is the pressure high or low at the lower esophageal sphincter (LES)?

A

low

(so that food can pass through)

28
Q

After food has passed into the stomach, is pressure high or low in at the lower esophageal sphincter (LES)?

A

high

29
Q

What causes relaxation of the lower esophageal sphincter (LES)?

A

nitric oxide (NO) and VIP-secreting branches of the vagus nerve

30
Q

What are some types/groups of pathologies that can occur in the esophagus?

A

1) dysphagic/motility diseases
2) inflammatory diseases
3) metaplastic/neoplastic diseases (future lectures)
4) vascular diseases (future lectures)

31
Q

a motility/obstructive disorder whereby swallowing contractions are too powerful (high amplitude esophageal contractions), visceral pain from the esophagus is well-localized, and excess distension causes intense and brief chest pain

A

Nutcracker esophagus

32
Q

In Nutcracker esophagus, the ___________ layer of smooth muscle contracts before the ___________ layer

A

outer longitudinal,

inner circular

33
Q

a motility disorder of the esophagus characterized by a dysfunction of inhibitory nerves resulting in minor obstruction or chest pain

A

diffuse esophageal spasm

Note: this is very common

34
Q

a motility disorder of the esophagus characterized by increased tone of the lower esophageal sphincter (LES) due to impaired smooth muscle relaxation (aka LES won’t relax), and aperistalsis of the esophagus

A

achalasia

Note: If inhibitory neurons do not release NO or VIP after swallowing, the LES won’t relax properly

35
Q

__________ (primary/secondary) achalasia may be associated with diabetic autonomic neuropathy, malignancy, and infections (e.g., from tropical countries)

A

Secondary

36
Q

____________ (primary/secondary) achalasia is idiopathic and caused by failure of distal esophageal inhibitory neurons

A

Primary

37
Q

How does achalasia present clinically?

A
  • dysphagia (difficulty swallowing)
  • chest pain
  • regurgitation
38
Q

True or False: Achalasia increases mortality, especially when malignancy is involved

A

False

Achalasia does NOT affect mortality, UNLESS malignancy is involved

39
Q

What is the treatment for achalasia?

A
  • botox
  • myotomy
40
Q

Other causes of dysphagia may include iron-deficiency anemia or chronic reflex disease. How do these conditions cause dysphagia?

A

they can sometimes cause fibrosis or non-malignant growths that obstruct the esophagus

41
Q

True or False: Worsening dysphagia and reflux symptoms need to be investigated to ensure that the patient has not developed esophageal cancer

A

True

42
Q

an inflammatory condition of the esophagus that is usually a sign of immunosuppression involving HSV, cytomegalovirus (CMV) or fungal organisms (candidiasis = most common)

A

infectious esophagitis

43
Q

an inflammatory condition of the esophagus which may be due to Crohn’s disease (rare), scleroderma, or eosinophilic esophagitis

A

autoimmune esophagitis

44
Q

In eosinophilic esophagitis, there are ______ eosinophils/per high-power field

A

> 15

45
Q

True or False: Eosinophilic esophagitis is an emerging disease, with increasing incidence (both children and adults)

A

True

46
Q

Describe the pathophysiology of eosinophilic esophagitis

A
  • Th2 response with an abundance of IL-4, IL-5, and IL-13 in the serum and in affected tissue
  • often a history of atopic illness (e.g., asthma, eczema) during or before GI symptoms
  • food intolerances/allergies = major inciting factors
47
Q

What are the clinical features of eosinophilic esophagitis in children?

A
  • nausea
  • vomiting
  • small for age
  • weight loss (severe cases)
  • heartburn/reflux (in older children)
48
Q

What are the clinical features of eosinophilic esophagitis in adults?

A
  • dysphagia (difficulty swallowing)
  • food impaction
  • chest pain (possible)
  • heartburn that is usually resistant to PPI treatment
49
Q

How is eosinophilic esophagitis diagnosed?

A
  • endoscopy
  • IgE levels elevated
50
Q

What is the most frequent cause of esophagitis?

A

reflux esophagitis

(reflux of gastric contents into the lower esophagus)

51
Q

True or False: In reflux esophagitis, the histology of the esophagus is normal (e.g., stratified squamous epithelium)

A

True

Note: Stratified squamous epithelium is resistant to abrasion from food but is sensitive to acid

52
Q

True or False: Decreased LES tone or increased abdominal pressure can contribute to GERD

A

True

53
Q

What are some aggravating factors for reflux esophagitis?

A
  • alcohol and tobacco use
  • obesity
  • CNS depressants
  • pregnancy
  • hiatal hernia
  • delayed gastric emptying
  • increased gastric volume
54
Q

What are some findings associated with reflux esophagitis?

A
  • hyperemia (increased blood flow to esophagus)
  • mild eosinophilic infiltration
  • basal zone hyperplasia** exceeding 20% of total epithelial thickness
  • elongation of lamina propria papillae (severe cases)
  • Barrett’s esophagus* in more severe cases (patches of red, velvety mucosa; can be pre-malignant in rare cases and should be followed over time via endoscopy)
55
Q

What are the clinical features of reflux esophagitis?

A
  • dysphagia
  • heartburn
  • regurgitation (less frequently)
  • chronic GERD may be punctuated by severe chest pain attacks (rare)
56
Q

How is reflux esophagitis treated?

A

proton pump inhibitors or H2 histamine receptor antagonists

57
Q

True or False: Severity of symptoms and disease duration in reflux esophagitis is closely related to the degree of histological damage

A

False

Only disease duration is closely related to degree of histological damage (severity of symptoms is not necessarily related to degree of histological damage)

58
Q

Heartburn that increases in severity and is accompanied by dysphagia is a red flag for _______________

A

esophageal carcinoma

59
Q

What are some food triggers for reflux esophagitis?

A
  • coffee and tea
  • choclate
  • spicy food
  • beer, wine, other forms of alcohol
  • fried or greasy foods
  • mint
  • tomatoes or tomato-based food
  • sweets and high-glycemic foods

Note: over-eating and stress can also trigger reflux

BMS150 - Post Test 2 (9 decks)

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