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Alim 1 > oesophagus and its disorders > Flashcards

oesophagus and its disorders Flashcards

1
Q

brief phsyiology of oesophagus

A

fibromuscular 25cm tube of striated squamous epithelium

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2
Q

where is the oesophagus

A

posterior to the trachea

begins at end of laryngopharynx and joins stomach a few cm from diaphragm at the cardiac orifice

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3
Q

what does the oesophagus do

A

transports food to the stomach and secretes mucus

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4
Q

how is muscle type distributed in the oesophagus

A

skeletal muscles surround the upper third - smooth muscle in the lower 2/3

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5
Q

action of the upper oesophageal sphincter

A

striated muscle - constricts to stop air entering oesophagus

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6
Q

action of the lower oesophageal sphincter

A

smooth muscle - intra abdominal segment - acts as flap valve. it’s an area of high pressure, with intrinsic and extrinsic components

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7
Q

what can malfunction of the intrinsic and extrinsic components of the LOS do

A

lead to GORD

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8
Q

intrinsic components of the LOS

A

thick oesophageal smooth muscle
clasp-like semicircular smooth muscle fibres
myogenic activity - some resting tone, but less ACh-responsive

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9
Q

extrinsic components of the LOS

A

crural diaphragm encircles LOS - forms channels where oes. enters abdomen.

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10
Q

what makes up the extrinsic sphincter

A

fibres of the crural portion of the diaphragm which possess and pinchcock-like action - has myogenic tone

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11
Q

in neural control of oes. sphincters, what happens when ach is released

A

contraction of intrinsic sphincters

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12
Q

what cause relaxation of intrinsic sphincters

A

nitric oxide and vasoactive intestinal peptide release

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13
Q

how is the upper part of the oes innervated

A

supplied by somatic motor neurons of the vagus nerve, w/o interruption

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14
Q

how is the lower part of the oes innervated

A

visceral motor neruons of vagus nerve w/ interruptions - synapses w/ postganglionic neurons - cell bodies in oesophagus and splanchnic plexus

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15
Q

what encircles the lower oes.

A

nerves of the oesophageal plexus

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16
Q

functions of the oesophagus

A

swallowing - conveys food, fluid from the pharynx to the stomach

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17
Q

what triggers swallowing

A

afferent impulses in the trigeminal, glossopharyngeal and vagus nerves

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18
Q

what is swallowing coordinated with

A

opening and closing of the upper and lower oes. sphincters

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19
Q

how is swallowing initiated

A
  1. voluntary action - material on tongue collected, pushed back into pharynx
  2. waves of INvol contractions push the material into the oesophagus
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20
Q

what does #MOLO stand for

A

Mouth
Oropharynx
Laryngopharynx
Oesophagus

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21
Q

how does inhibition of respiration occur

A

nasopharynx closed off
closure of glottis by epiglottis
prevents food entering trachea

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22
Q

what is secondary peristalsis

A

peristalsis of oes. after stimulation of receptors on distension of the lumen by food.

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23
Q

what prevents reflux of the gastric contents

A

LOS closes after material has passed
abd pressure acts on oes.
pinchcock effect of diaphragm of LO

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24
Q

how do mucosal folds help prevent reflux of gastric contents

A

plug-like action of mucosal fold occludes the lumen of the gastro-oesophageal junction

25
Q

what is achalasia

A

loss of coordinated peristalsis/spasm of LOS - food fails to reach the stomach

26
Q

symptoms of achalasia

A

long period of sporadic dysphagia
food regurgitation
spasm disorders - chest pain, not of cardiac origin

27
Q

achalasia aetiology

A

damage to innervation of oesophagus

degenerative lesions to vagus nerve and loss of ganglionic cells in the oesophagus

28
Q

methods of diagnosis for achalasia

A

radiography - Ba swallow

oesophageal manometry

29
Q

what is oesoohageal manometry

A

test if oes if relaxing and contracting properly - diagnoses swallowing problems

30
Q

what are normal manometry results

A

normal LOS pressure

normal muscle contractions upon swallowing

31
Q

what does low LOS pressure suggest

A

GORD, although this can occur in individual with normal LOS pressure

32
Q

procedure for manomentry

A 
local
catheter: nostril > stomach
deep inhale, swallow water
measure strength and coord of muscle contractions, and LOS function
slowly remove catheter
33
Q

methods of achalasia treatment

A

endoscopic balloon dilatation of LOS/surgery to weaken sphincter
inhibtion of Ach release by injecting botox into LoS

34
Q

what causes GORD symptoms

A

irritation caused by gastric contents

35
Q

benefit of reflux stimulating salivation

A

saliva is an antacid - enhances, dilutes, neutralises refluxed gastric contents

36
Q

what are the consequences in GORD of a low salivation rate

A

lack of ability to swallow own saliva - prolonged contact of refluxed material with oesophagus > oesophageal irritation/damage

37
Q

cause of reflux in GORD patients

A

Transient spontaneous relaxation of LOS aka TSR

38
Q

what causes TSR

A

resting LOS pressure too weak to resist pressure within the stomach - sudden relaxation of LOS, not induced by swallowing

39
Q

what factors contribute to the severity of GORD

A

weak/uncoordinated oesophageal contractions - length of time in contact with gastric contents
amount of pressure placed on the anti reflux barrier

40
Q

when does reflux occur

A

after eating, lying down, and when there is delayed gastric emptying - impaired gastric emptying alone can cause severe GORD

41
Q

use of secondary peristalsis in GORD

A

causes salivation - neutralises acid in oesophagus

42
Q

what causes GORD

A

reflux of gastric contents through the LOS - chronic oesophagitis

43
Q

RFs through GORD

A

pregnancy, obesity
fat, chocolate, coffee, alcohol ingestion
large meals, esp if high acid content - onions, tomatoes
cigarettes
drugs

44
Q

GORD complications

A

reflux causes desquamation of oesophageal cells - causing ulceration and basal cell hyperplasia
barrett’s oes. may form

45
Q

clinical features of GORD

A

low/absent resting LOS tone
LOS tone fails to increase when lying flat
poor oesophageal peristalsis - dec acid clearance
delayed gastric emptying

46
Q

GORD symptoms

A

heartburn, acid regurgitation
wake up at night due to laryngeal irritation by reflux
dysphagia

47
Q

why does GORD occur in pregnancy

A

increased abdominal pressure from foetus - gastric contents forced into oesophagus

48
Q

what causes heartburn in the absence of pregnancy

A

large meals - less efficient LOS

49
Q

potential long term effects of GORD

A

oesophagitis, oesophageal strictures
squamous cell carcinoma
barrett’s syndrome
ulcer

50
Q

if a patient has heartburn/nausea after eating (GORD) or problems swallowing / achalasia what will get ordered

A

MANOMETRY

51
Q

how is GORD treated through lifestyle change

A

raise head of bed, dec intake of food that precipitates attacks, take antacids, lose weight

52
Q

what surgery treats GORD

A

anti - reflux surgery: fundoplication - wrap fundus around LOS

53
Q

what drugs can treat GORD

A

H2 receptor antagonists, Proton pump inhibitors

Metclopramide - may enhance peristalsis and aid acid clearance

54
Q

how do antacids work

A

neutralise gastric acif - inc pH of gastric lumen
inhibit peptic activity
stop acid secretion

55
Q

complication of using Mg salt antacid

A

can cause diarrhoea

56
Q

complication of Aluminium salts as antacid

A

constipation

57
Q

how does combination of alginic acid & saliva help protect from GORD

A

forms raft which floats on content of gastric lumen and protects oesophageal mucosa from reflux

58
Q

what is essential to stop ulcers returning

A

removal of H. pylori

Alim 1 (11 decks)

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