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Digestive System > Oesophageal Function > Flashcards

Oesophageal Function Flashcards

1
Q

What happens if accurate swallowing isn’t achieved?

A

Choking

Aspiration (wrong hole)

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2
Q

What are the 3 phases of swallowing? Their sensory components are?

A

1) Oral (voluntary/striated muscle)
2) Pharyngeal (involuntary/stirated muscle)
3) Oesophageal (involuntary/ striated and smooth)

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3
Q

Swallowing centre

A

region in brainstem that receives sensory input from receptors in back of mouth and upper pharynx.
Also innervates swallowing muscles via cranial nerves

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4
Q

What is swallowing controlled by? What does that mean for stroke sufferers?

A

Cortex and brainstem. People who have had strokes in these areas can develop swallowing disorders

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5
Q

What are the phases of Oral Phase?

A 
Preparatory phase ( formation of bolus)
Transfer Phase (bolus propelled into the pharynx)
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6
Q

Describe Preparation phase (oral phase)

A 
Saliva= Lubrication and dissolving
Mastication = breaks down solids into smaller size, shape and consistency suitable for transport. Teeth grind, and tongue and cheeks position this to happen.
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7
Q

Describe Transfer phase (oral phase)

A

tip of tongue comes into contact with the hard palate.
close off anterior oral cavity
Bolus pushed to back off mouth

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8
Q

The Pharyngeal Phase #2

A

lasts

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9
Q

What are the 3 passages required to be closed in the pharyngeal phase?

A

1) mouth
2) upper airway/nasopharynx
3) Lower airway (to protect trachea from aspiration)

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10
Q

what is the UOS

A

upper oesophageal sphincter.
Acts as a barrier between the pharynx and oesophagus and is usually closed.
A complex of muscles often in a state of tonic contraction, that relaxes intermittently

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11
Q

What does UOS prevent?

A

air distending the stomach

reflux of contents into pharynx and larynx during oesophageal peristalsis

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12
Q

What muscles do UOS consist of?

A

Cricopharyngeus
Inferior Pharyngeal constrictor
cervical oesophagus

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13
Q

How is it that UOS opens how for how long?

A
  • Cricopharyngeus relaxes
  • suprahyoid and thyrohoid muscles contract
  • pressure of descending bolus distendeds UOS

Opens for 0.5 s

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14
Q

Oesophagus Function and structure?

A 
from UOS to LOS
~20-25cm long
mucosa= stratified squamous epithelium
upper 1/3 striated (voluntary)
lower 2/3 smooth (involuntary)
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15
Q

Oesophageal Phase?

A

UOS relaxes, bolus enters and is propelled down oesophagus via peristalsis
Primary: initiated by swallowing, cont of pharyngeal contraction wave but slower, 3-5cm/s
Secondary: initiated by distention, activated stretch receptors initiate local reflex response > peristalsis

lasts 5-6s

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16
Q

How does oesophageal peristalsis occur

A

ANS (para/sympathetic) and the Enteric NS

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17
Q

What are the nerve plexus of the GI tract

A 
submucosal plexus
myenteric plexus (between circular longitudinal muscles)
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18
Q

Why is ES interesting?can operate independent/autonomously

A

can operate independent/ autonomously. Can also communicate with PS and S

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19
Q

The oesophagus is mostly covered in…

A

Adventitia

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20
Q

the circular layer contracts…

A

above and relaxes below bolus

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21
Q

the longitudinal layer

A

shortens during peristalsis

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22
Q

what is the LOS

A

a specialised segment of smooth muscle that is tonically contracted, close to the squamocolumnar junction (20-35 mmHg)

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23
Q

What causes LOS to relax

A

Swallowing: 1-2s after swallow, lasts 5-10s, followed by hypercontraction
Physiologically: intermittently relaxes to release air from stomach, only happens in an upright position, mediated via vagus nerve

24
Q

Investigation of the Oesophagus

A

Gastroscopy: flexible telescope
Barium Swallow: xray test, asses function/motility
pH Study: may have reflux but unsure. involves cathater above gastro-oesophageal junction to test pH
Manometry: Like pH to test pressure/propagation of wave.

25
Q

Structural diseases of the oesophagus

A
  • inflammation
  • ischemia/necrosis
  • ulceration
  • bleeding
  • narrowing
  • masses
  • diverticulum
26
Q

Dysmotility diseases of the oesophagus

A

abnormal contraction of the oesophageal muscles

27
Q

Functional diseases of the oesophagus

A

disorders of motility, sensation and brain-gut dysfunction.

28
Q

Gastro-oesophageal reflux disease

A

gastric contents into oesophagus. Occurs during transient LOS relaxation without the protective columnar epithelium, acidic contents damage.

29
Q

When does Transient LOS relaxation become pathological?

A

When too much gastric juice refluxes into the oesophagus causing symptoms/disease

30
Q

Causes of G-O reflux

A

Hypotensive LOS (caffiene, alcohol, fats or certain meds eg) beta-blockers, nitrates)
Hiatus Hernia
Impaired oesophageal peristalsis (less clearance)

31
Q

Hiatus Hernia

A

Hiatus = diaphragm opening
diaphragm = additional support to the sphincter
stomach passes through hiatus into the chest, due to a diaphragmatic weakening, now you have an area that can freely reflux

32
Q

pH of oesphagus and stomach

A 
oesophagus= 6-7
stomach= 1-2
33
Q

Symptoms of acid reflux

A

Heartburn
regurgitation
sour/bitter taste in mouth (worse after eating/lying down)

34
Q

Why to the symptoms of gastric acids occur?

A

The gastric acid (pH 1-2) comes into contact with the oesophageal mucosa (pH6-7) which is sensitive to it, and nerve fibres give the sensation of burning. Chronic acid causes damage

35
Q

Structural complication of GORD

A

Reflux oesophagitis (inflammation, ulceration and bleeding)
Peptic Stricture (narrowing from prolonged inflammation leading to fibrosis and scarring)
Barretts oesophagus
cancer

36
Q

Whats Barrett’s oesophagus

A 
Oesophageal epithelium (squamous) transforms to become like gastric (columnar + goblet) in an attempt to adapt to damage.
"intestinal metaplasia"
loss of z line
37
Q

Evolution of Barrets oesophagus to cancer?

A

Squamous oesophagus > chronic inflammation > Barrets metaplasia > Low-grade dysplasia > High-grade dysplasia > cancer (adenocarcinoma)

38
Q

2 types of oesophageal cancer the the risk factors

A

Adenocarcinoma (adenoCa): GORD, Barret’s
more in distal oesp/GO junction

Squamous cell carcinoma (SqCC): smoking, alcohol, diet
SqCC usually higher up

39
Q

Ring/web

A

found distally, thin mucosal memmbrane, associated with hiatus hernia. Can obstruct passage of food, difficulty swallowing (dysphasia)

40
Q

Zenker’s Diverticulum

A

Excessive pressure cause weakest part of pharynx to balloon out
Leads to poor swallowing and impair relaxation of cricopharyngeus, more common in eldery

41
Q

Stricture

A

Peptic: reflux related
Caustic: custic injury
post-radiotherapy/surgical
malignant

Narrowing of oesophagus

42
Q

Reflux oesophagitis

A

inflammation due to GORD. Bleeding, ulceration, perforation

1) bleeding - haematemesis (vomiting blood)
2) Dysphagia

can lead to peptic strictures

43
Q

Oesophageal Candidiasis

A

Thrush, with white plaques coating oesophagus

44
Q

Ulceration

A

Herpes simple virus. Pill induced (doxycycline)

or bisphosphates

45
Q

Eosinophilic oesophagitis

A

Eosinophils infiltrate the epithelium of oesophagus = circular appearance
-allergy mediated

46
Q

Motility Disorders of the oesophagus

A 
Dysphasia present (difficult swallowing). Likely intermittent/variable symptoms. 
Liquids just as affected
47
Q

Achlasia (motility disorder)

A

neuro-degenration of oesophageal nerves

  • myenteric plexus and LOS inhibitory nerves
  • loss of peristalsis and failure of LOS to relax, birds beak of dilation occurs
48
Q

Diffuse oesophageal spasm

A

“corkscrew oesophagus”
non-peristaltic onset of contraction
-dysphasia and chest pain

49
Q

Nutcracker Oesophagus

A

Normal but extremely strong peristaltic contractions

50
Q

Sclerodema

A

CT disease, hardening (fibrosis) of skin and CT
Damage occurs to submucosa (nerves/BV) =rubbery hose-pipe
No peristalsis, weak contraction, LOS has no tone
-dysphagia and reflux

51
Q

What can you use to diagnose motility disorders

A

manometry

52
Q

Four landmarks that indent the oesophagus

A

cricoid
Aortic arch
left main bronchus
diaphragm

53
Q

Sup border of mouth

A

hard & soft palate

54
Q

Ant/Lat border of the mouth

A

Cheeks, lips, tongue body

55
Q

Inferior border of the mouth

A

glenohyoid and thyrahyoid

56
Q

Posterior border of the mouth

A

ulva (soft palate)
Palantine tounsils
root of tongue
Linguinal tonsil

Digestive System (27 decks)

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