Oesophagus and Its Disorders

Question 1

The oesophagus has 2 sphincters, name these sphincters and the muscle type associated with each

Answer 1

Upper oesophageal sphincter: striated muscle – constricted to avoid air entering the oesophagus and the stomach
Lower oesophageal sphincter: smooth muscle – smooth muscle components act as a flap to avoid reflux of gut contents

Question 2

List 3 components of the lower oesophageal sphincter.

Answer 2

There are oesophageal smooth muscle (intrinsic sphincters – can initiate contractions within the oesophagus)
They have clasp-like semicircular smooth muscle fibres – prevent reflux
The lower oesophageal sphincter has fibres of the crural portion of the diaphragm – pinchcock-like action (extrinsic sphincter)- myogenic tone – have inherent capacity to contract
Oblique and sling fibres of the stomach help to prevent regurgitation – Ach can affect he behaviour of these muscle fibres by causing them to contract

Question 3

Which of the following is an important mediator of the neural control of the oesophagus?

Answer 3

Acetylcholine

Question 4

Which of the following best describes the function of the oblique or sling fibres of the stomach?

Answer 4

They form a flap valve which closes off the oesophagogastric junction to prevent regurgitation when the intragastric pressure is high

Question 5

Swallowing is triggered by afferent impulses which travel via 3 nerves; names these nerves

Answer 5

Trigeminal nerve
Glossopharyngeal nerve
Vagus nerve

Question 6

Why does the epiglottis close the glottis during the process of swallowing?

Answer 6

To avoid food entering the trachea

Question 7

List three ways to treat gastro-oesophageal reflux disease (GORD)

Answer 7

Life style changes: avoid large meals; lose weight; raise the head at night; reduce alcohol intake; and talk to your Dr about drugs that precipitate attacks; stop smoking
Take antacids – e.g. magnesium trisilicate
Take histamine receptor antagonists (e.g., ranitidine) or proton-pump inhibitors (omeprazole)

Question 8

Name some of the predisposing factors to GORD

Answer 8

Fat, smoking, chocolate, coffee, alcohol, other drugs – anticholinergic agents, calcium channel blockers and nitrate drugs
Large meals, tomatoes, orange juice, onions, milk
Pregnancy

Question 9

Name three potential long term complications of GORD

Answer 9

Squamous cell carcinoma
Barrett’s syndrome
Ulcer
Oesophagitis
Oesophageal strictures

Question 10

Which of the following is an antacid?

Answer 10

Magnesium trisilicate

Question 11

Mrs Smyth is a 36-year-old female patient who presented with a history of episodic coughs with purulent sputum, fever, dyspnoea, and chest pain over the last six months. She gave a history of vomitings and hiccups on and off for 7-10 years. She says that she has difficulty swallowing her food and sometimes regurgitates it. What is the most likely diagnosis?

Answer 11

Achalasia

Question 12

List 2 methods that can be used to diagnose Mrs Smyth’s condition (i.e., the case immediately above).

Answer 12

Radiography (barium swallow)

Oesophageal manometry