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DIgestive > Oesophageal function > Flashcards

Oesophageal function Flashcards

1
Q

Three phases of swallowing

A

Oral (voluntary, striated muscle)
Pharyngeal (involuntary, striated)
Oesophageal (involuntary, striated and smooth muscle)

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2
Q

Swallowing control centres

A

Swallowing centre in brainstem

Cortex

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3
Q

Describe pathways of the swallowing centre

A

Receives sensory input from receptors in the posterior mouth and upper pharynx and innervates swallowing muscles through cranial nerves

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4
Q

Part one: Two phases of oral phase

A

Preparatory phase and transfer phase

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5
Q

Preparatory phase

A

Mastication, wetting food, forming bolus

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6
Q

Transfer phase

A

Bolus propelled into pharynx

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7
Q

Part two: Pharyngeal phase

A
  • Less than 1 sec, involuntary.
  • Upper and lower airways closed by soft palate and the larynx moves up and epiglottis closes over vocal cords. Also tongue closes off oral cavity.
  • UES relaxes.
  • Bolus exits
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8
Q

UES functions

A

In a state of tonic contraction
Stops air moving freely into stomach.
Prevents reflux of contents of stomach.

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9
Q

Three muscles making up UES and if they contract or relax during swallowing

A 
Cricopharyngeas (relax)
Inferior pharyngeal constrictor (contract)
Cervical oesophagus (contract)
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10
Q

Oesophageal phase (two phase and what initiates them)

A

Primary peristalsis, initiated by swallowing

Secondary peristalsis, initiated by distention from the bolus

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11
Q

Nervous control of oesophageal peristalsis

A

Autonomic nerves

Enteric nerves

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12
Q

Lower oesophageal sphincter

A

Located at the junction to stomach.
Z line- squamocolumnar junction
Normally contracted
Relaxes 1-2 seconds after swallowing and stays relaxed for 5-10 seconds then hyper contraction.
Intermittent physiological opening when upright to let air out of stomach

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13
Q

Barium test

A

Xray test allows us to examine the oesophagus in motion as a person swallows, function and motility. Can’t take biopsies

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14
Q

Endoscopy

A

Useful for structural pathologies e.g. damage to the mucosa. Can take biopsies

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15
Q

24 pH study

A

? reflux. Thin catheter in the oesophagus for 24 hours sits just above LOS measures a drop in pH in distal oesophgus.

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16
Q

Manometry

A

Catheter in oesophagus between UES and LES contraction measured to determine if peristaltic wave is normal.

17
Q

Structural disorders

A 
Ulceration
Diverticulum
Bleeding
Stricture
Inflammation
Stricture
Masses
18
Q

Dysmotility

A

Abnormal contraction of oesophageal muscles

19
Q

Gastro oesophageal reflux disease

A

Occurs when gastric acid enters the oesophagus during physiological opening of the LES. Becomes pathological when pt symptomatic.
Eitiology- relaxed sphincter (foods caffiene, alcohol, fatty food). Hiatus hernia (LES loses support of diaphragm), disorderd peristalis.

20
Q

Symptoms of GORD

A

Burning over chest
Regurgitation
Sour bitter taste in mouth
Symptoms worsen when lying down or after eating

21
Q

Complications of GORD

A

Reflux oesophagitis
Peptic sticture
Barrets oesophagus
Cancer

22
Q

Haemotemisis

A

Vomiting up blood

23
Q

Barrets oesophagus population at risk

A

Males over 50 with high BMI, smokers, chronic GORD. Increased risk of adenocarcinoma.

24
Q

Transition from Barrets to adenocarcinoma

A

Squamous oesophagus, chronic inflammation, barrets metaplasia, low grade dysplasia, high grade dysplasia, invasive adenocarcinoma

25
Q

Two types of oesophageal cancer

A

Adenocarcinoma and squamous cell carcinoma.

Seeing less of adenocarcinoma as treatment for reflux improving. Squamous cell carcinoma a lifestyle cancer.

26
Q

Ring/ web

A

Thin membrane formed around inner edge of oesophagus. Can obstruct passage of food. Associated with hiatus hernia.

27
Q

Zenkers diverticulum

A

Pouch at back of pharynx. People with impaired swallowing. Pressure in pharynx excessive forming diverticulum in weakest part. Present with dysphagia.

28
Q

Stricture

A

Causes: Peptic, caustic (swallowing poisons), post radiotherapy, surgery to oesophagus (enastamosis stricture), cancer.

29
Q

Infections of oesophagus

A 
Oesophageal candidiasis (immunosupressed)
Herpes, CMV (cause ulcerations)
30
Q

Drugs causing ulceration

A

Doxycyclin

31
Q

Eosinophilic oesophagitis

A

Eosinophils infiltrate the oesophagus- allergy mediated

32
Q

Motility disorder:

A

Present with dysphagia, liquids and solids (structural usually just solids).

33
Q

Achalasia

A

Myenteric plexus nerves disfunction. Loss of peristalsis in distal oesophagus, failure of distal oesophageal sphincter to relax.

34
Q

Diffuse oesophageal spasm

A

When peristalsis occurs in random order (spasm). Corkscrew oesophagus.

35
Q

Nutcracker oesophagus

A

Normal wave but high amplitude

36
Q

Scleroderma

A

Connective tissue disease causing fibrosis of skin and connective tissue. Oesophagus turns into a rubbery hose pipe! Severe reflux.

DIgestive (23 decks)

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