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P1: GI > Oesophagus and Its Disorders > Flashcards

Oesophagus and Its Disorders Flashcards

1
Q

What is the oesophagus?

A

→ Fibromuscular tube of striated squamous epithelium

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2
Q

Where is the oesophagus?

A

→ Posterior to the trachea

→ Beneath the cricoid cartilage

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3
Q

What does the oesophagus connect?

A

→ Begins at the end of the laryngopharynx and joins the stomach a few cm from the diaphragm- at the cardiac orifice of the stomach

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4
Q

What is the oesophagus wall made from?

A

→ Striated muscle in the upper part
→ Smooth muscle in the lower part
→ Mixture of the two in the middle

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5
Q

What is the angle between the cardiac orifice and the fundus called?

A

→ Angle of His

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6
Q

What is the function of the angle of His?

A

→ Prevents the reflux of the contents of the stomach into the oesophagus

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7
Q

What is the function of the oesophagus?

A

→ Transports food to the stomach

→ Secretes mucus

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8
Q

What promotes the ingestion of food into the stomach?

A

→ Relaxation of UOS and LOS sphincters
→ Involves contraction and relaxation of the oesophagus
→ highly coordinated muscular process

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9
Q

What is the UOS for?

A

→ Relaxes to allow food through and closes to prevents air entering the oesophagus

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10
Q

What is the LOS for?

A

→ Remains open as long as swallowing is occurring
→ Close to prevent reflux of the stomach contents into the oesophagus
→smooth muscle; acts as a flap valve

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11
Q

What kind of structure and muscle does the UOS have?

A

→ Musculo-cartilaginous structure

→ Striated muscle

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12
Q

What are the intrinsic and extrinsic components of the LOS?

A

INTRINSIC
→ Oesophageal muscles which are under neurohormonal influence

EXTRINSIC
→ Diaphragm muscles

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13
Q

What are the intrinsic components of the LOS?

A

→ Thick circular smooth muscle layers
→ Clasp like semi circular smooth muscle
→ Sling like oblique gastric

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14
Q

What activity do the clasp like muscles have?

A

→ Myogenic but less ACh responsive

→Ability to have tone without external factors

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15
Q

How do the sling-like oblique gastric muscles prevent regurgitation?

A

→ Works in concert with semicircular smooth muscle

→ Response to cholinergic innervation

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16
Q

Why is reflux common in infants?

A

→ The angle of His is poorly developed

→ Forms a vertical junction with the stomach

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17
Q

What does the crural diaphragm form?

A

→ encircles the LOS
→ forms a channel through which the oesophagus enters the abdomen
→ Forms the oesophageal hiatus

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18
Q

What kind of action does the crural diaphragm possess?

A

→ Pinchcock like

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19
Q

What controls the tone of the LOS?

A

→ Involvement of cholinergic

→ NANC

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20
Q

What causes the intrinsic sphincters to contract?

A

→ Acetylcholine

→ SP

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21
Q

What causes the intrinsic sphincters to relax?

A

→ NO and VIP

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22
Q

What is the upper part of the oesophagus supplied by?

A

→ Somatic motor neurons of vagus nerves without interruption

→Splanchnic nerves

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23
Q

What is the lower part of the oesophagus innervated by?

A

→ Visceral motor neurons of vagus nerves with interruptions

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24
Q

How is sensory information integrated?

A

→ Sensory information is sent to the NTS
→ Integration occurs between NTS, nucleus ambiguus and vaso vagal nucleus
→ Food makes its way down
→ UOS relaxes
→ mediated by NO and VIP
→ Information gets sent to LOS via vagus nerve
→ ACh allows contraction to occur

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25
What are the functions of the oesophagus?
→ Swallowing → Conveys food from the pharynx to the stomach → Efferent impulses pass to the pharyngeal musculature and the tongue → Integration of impulses in the NTS, nucleus ambiguus and DVN
26
By what impulses is swallowing triggered by?
→ trigeminal → glossopharyngeal → Vagus
27
How is swallowing initiated?
1) voluntary →collect material on tongue and push it backwards into the pharynx 2) Waves of involuntary contraction push material into oesophagus
28
Where does food move?
→ Mouth → Oropharynx → Laryngopharynx → Oesophagus
29
What are the reflex responses initiated during swallowing?
→Inhibition of respiration → nasopharynx is closed off → Closure of the glottis by the epiglottis →Ring of peristaltic waves behind the material move it towards the stomach → Second wave of peristalsis moves the food along
30
What is swallowing difficulty caused by?
→ Inability of the UOS to open | →Discoordination of the timing between opening of UOS and pharyngeal push of the ingested bolus
31
What causes repeated waves of peristalsis?
→ Stimulation of receptors upon distension of the lumen of the oesophagus by food
32
What prevents the reflux of gastric contents?
→ The LOS closes after the material has passed → Pinchcock effect of the diaphragmatic sphincter on the lower oesophagus → Plug like action of the mucosal folds in the cardia
33
What do circular muscles act as and why?
→ Act as valves to control the movement of the food mass aborally → Prevents reflux by forming an opening when relaxed and closing completely when contracted
34
What is achalasia?
→ Disorders of motility or peristalsis
35
What is a diffuse oesophageal spasm?
→ Chest pain coming from the oesophagus
36
What is oesophageal spasm?
→ Abnormal oesophageal contractions | → Food is not effectively reaching the stomach
37
What causes Achalasia?
→ Impaired LOS relaxation | → Accompanied by impaired peristalsis
38
What happens as a result of achalasia?
→ Food and liquids fail to reach the stomach - delayed opening of LOS → Dilatation of the oesophageal body with distal narrowing → birds beak appearance → Sporadic dysphagia → Regurgitation of food
39
What are 3 symptoms of achalasia?
→ Heartburn → Vomiting → Dysphagia
40
What are the two ways to diagnose achalasia?
→Barium radiography : dilatation of oesophagus with beak deformity at the lower end →Oesophageal manometry : absent peristalsis
41
What is normal LOS pressure?
< 26 mmHg is normal
42
What is achalasia LOS pressure?
>100 mmHg
43
What is nutcracker achalasia LOS pressure?
> 200 mmHg
44
What are abnormal results of oesophageal manometry?
→Presence of muscle spasms in the oesophageal body →Presence of weak contractions along the length of the oesophagus →LOS pressure is less than 10 mmHg
45
What is reflux?
→retrograde movement of gastric content into the oesophagus due to the relaxation of the LOS
46
When does reflux occur in normal individuals?
→after meals
47
What does reflux stimulate?
→ Salivation
48
What does saliva do to gastric acid?
→dilutes and neutralizes refluxed gastric contents
49
What kind of a sensation does GORD cause and when?
→burning sensation in the chest after meals - angina like pain
50
What are factors that contribute to the severity of GORD?
Weak or uncoordinated oesophageal contractions Prolonged duration of contact of refluxed digestive contents with oesophagus →Length of time that the oesophagus is exposed to gastric acid Increase in gastric acid secretion coupled with the presence of bile in gastric contents → severe oesophageal damage →Amount of pressure placed on the antireflux barrier Reflux occurs after eating, lying down and when there is delayed gastric emptying Impaired gastric emptying alone can cause severe GORD
51
What are factors associated with GORD?
→Pregnancy or obesity →Fat, chocolate, coffee or alcohol ingestion →Large meals, tomatoes, orange juice, onions →Smoking →Drugs
52
What is LOS tone like in GORD?
→Resting LOS tone is low or absent | →Resting LOS pressure is too weak to resist the pressure within the stomach
53
What happens as a result of poor oesophageal peristalsis?
→Decreased clearance of acid
54
What are symptoms of GORD?
→heartburn and acid regurgitation → waking up at night → dysphagia
55
How do you investigate GORD?
→Low dose proton pump inhibitor →Upper GI endoscopy →Manometry →24hr ambulatory pH monitoring
56
What does the presence of a fetus do to abdominal contents?
→increases pressure on abdominal contents | →Pushes terminal segments of oesophagus into thoracic cavity
57
What is the last trimester of pregnancy associated with?
→increased abdominal pressure and this forces gastric contents into the oesophagus
58
Why does heartburn subside in the last months of pregnancy?
→ uterus descends into pelvis
59
Why do you get heartburn in the absence of pregnancy?
→May occur in some individuals upon eating large meals | →Less efficient LOS
60
What happens to gastric contents during heartburn?
→episodically refluxed into the oesophagus
61
What can happen as a result of heartburn?
→Ulcer → scarring →obstruction or perforation of the lower oesophagus
62
What are some long term effects of GORD?
→Oesophagitis, oesophageal strictures →Squamous cell carcinoma →Barrett’s syndrome - this may predispose someone to →oesophageal adenocarcinoma →Oesophageal ulcer
63
When is manometry ordered?
→Heartburn or nausea after eating GORD | →Problems swallowing
64
How do you manage GORD?
Lifestyle changes - raise head of bed at night, weight loss, modify food →Decreased intake of foods and drink which cause symptoms →Anti reflux surgery ( fundoplication - wrap fundus around LOS) →Take antacids →H2 receptor antagonists and proton pump inhibitors- blocks release of acids
65
What do Metoclopramide/domperidone do?
→enhance peristalsis and help gastric clearance
66
What can fundoplication cause?
→dysphagia as it reduces the distensibility of LOS
67
What do antacids do to gastric acid and pH?
→Neutralise gastric acid ↑ pH of gastric lumen
68
What do antacids do to peptic activity and acid secretion?
→Inhibit peptic activity and stop acid secretion
69
What do magnesium salts cause?
→diarrhoea
70
What do aluminum salts cause?
→ Constipation
71
What do you combine with alginates for reflux?
→ Combine alginates (e.g. gaviscon) with antacids for oesophageal reflux
72
What do alginic acid and saliva form?
→Alginic acid + saliva form a raft which floats on content of gastric lumen and protects the oesophageal mucosa from reflux
73
What is essential to stop the ulcer returning?
→ removal of H. pylori
74
What happens upon relaxation of upper oesophageal sphincter?
→UOS closes as soon as food passes →Glottis opens →Breathing resumes
75
Why study oesophageal disorder?
→ Oesophagus has squamous mucosa → Acid reflux → desquamation of oesophageal cells (injury of squamous mucosa) ↑ cell loss → basal cell hyperplasia → Excessive desquamation → ulceration → Ulcers may haemorrhage, perforate or heal by fibrosis with strictures

P1: GI (15 decks)

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