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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
Q

What are the functions of the oesophagus?

A

→ 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

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26
Q

By what impulses is swallowing triggered by?

A

→ trigeminal
→ glossopharyngeal
→ Vagus

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27
Q

How is swallowing initiated?

A

1) voluntary
→collect material on tongue and push it backwards into the pharynx
2) Waves of involuntary contraction push material into oesophagus

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28
Q

Where does food move?

A

→ Mouth
→ Oropharynx
→ Laryngopharynx
→ Oesophagus

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29
Q

What are the reflex responses initiated during swallowing?

A

→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

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30
Q

What is swallowing difficulty caused by?

A

→ Inability of the UOS to open

→Discoordination of the timing between opening of UOS and pharyngeal push of the ingested bolus

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31
Q

What causes repeated waves of peristalsis?

A

→ Stimulation of receptors upon distension of the lumen of the oesophagus by food

32
Q

What prevents the reflux of gastric contents?

A

→ 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
Q

What do circular muscles act as and why?

A

→ 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
Q

What is achalasia?

A

→ Disorders of motility or peristalsis

35
Q

What is a diffuse oesophageal spasm?

A

→ Chest pain coming from the oesophagus

36
Q

What is oesophageal spasm?

A

→ Abnormal oesophageal contractions

→ Food is not effectively reaching the stomach

37
Q

What causes Achalasia?

A

→ Impaired LOS relaxation

→ Accompanied by impaired peristalsis

38
Q

What happens as a result of achalasia?

A

→ 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
Q

What are 3 symptoms of achalasia?

A

→ Heartburn
→ Vomiting
→ Dysphagia

40
Q

What are the two ways to diagnose achalasia?

A

→Barium radiography : dilatation of oesophagus with beak deformity at the lower end
→Oesophageal manometry : absent peristalsis

41
Q

What is normal LOS pressure?

A

< 26 mmHg is normal

42
Q

What is achalasia LOS pressure?

A

> 100 mmHg

43
Q

What is nutcracker achalasia LOS pressure?

A

> 200 mmHg

44
Q

What are abnormal results of oesophageal manometry?

A

→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
Q

What is reflux?

A

→retrograde movement of gastric content into the oesophagus due to the relaxation of the LOS

46
Q

When does reflux occur in normal individuals?

A

→after meals

47
Q

What does reflux stimulate?

A

→ Salivation

48
Q

What does saliva do to gastric acid?

A

→dilutes and neutralizes refluxed gastric contents

49
Q

What kind of a sensation does GORD cause and when?

A

→burning sensation in the chest after meals - angina like pain

50
Q

What are factors that contribute to the severity of GORD?

A

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
Q

What are factors associated with GORD?

A

→Pregnancy or obesity
→Fat, chocolate, coffee or alcohol ingestion
→Large meals, tomatoes, orange juice, onions
→Smoking
→Drugs

52
Q

What is LOS tone like in GORD?

A

→Resting LOS tone is low or absent

→Resting LOS pressure is too weak to resist the pressure within the stomach

53
Q

What happens as a result of poor oesophageal peristalsis?

A

→Decreased clearance of acid

54
Q

What are symptoms of GORD?

A

→heartburn and acid regurgitation
→ waking up at night
→ dysphagia

55
Q

How do you investigate GORD?

A

→Low dose proton pump inhibitor
→Upper GI endoscopy
→Manometry
→24hr ambulatory pH monitoring

56
Q

What does the presence of a fetus do to abdominal contents?

A

→increases pressure on abdominal contents

→Pushes terminal segments of oesophagus into thoracic cavity

57
Q

What is the last trimester of pregnancy associated with?

A

→increased abdominal pressure and this forces gastric contents into the oesophagus

58
Q

Why does heartburn subside in the last months of pregnancy?

A

→ uterus descends into pelvis

59
Q

Why do you get heartburn in the absence of pregnancy?

A

→May occur in some individuals upon eating large meals

→Less efficient LOS

60
Q

What happens to gastric contents during heartburn?

A

→episodically refluxed into the oesophagus

61
Q

What can happen as a result of heartburn?

A

→Ulcer
→ scarring
→obstruction or perforation of the lower oesophagus

62
Q

What are some long term effects of GORD?

A

→Oesophagitis, oesophageal strictures
→Squamous cell carcinoma
→Barrett’s syndrome - this may predispose someone to →oesophageal adenocarcinoma
→Oesophageal ulcer

63
Q

When is manometry ordered?

A

→Heartburn or nausea after eating GORD

→Problems swallowing

64
Q

How do you manage GORD?

A

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
Q

What do Metoclopramide/domperidone do?

A

→enhance peristalsis and help gastric clearance

66
Q

What can fundoplication cause?

A

→dysphagia as it reduces the distensibility of LOS

67
Q

What do antacids do to gastric acid and pH?

A

→Neutralise gastric acid ↑ pH of gastric lumen

68
Q

What do antacids do to peptic activity and acid secretion?

A

→Inhibit peptic activity and stop acid secretion

69
Q

What do magnesium salts cause?

A

→diarrhoea

70
Q

What do aluminum salts cause?

A

→ Constipation

71
Q

What do you combine with alginates for reflux?

A

→ Combine alginates (e.g. gaviscon) with antacids for oesophageal reflux

72
Q

What do alginic acid and saliva form?

A

→Alginic acid + saliva form a raft which floats on content of gastric lumen and protects the oesophageal mucosa from reflux

73
Q

What is essential to stop the ulcer returning?

A

→ removal of H. pylori

74
Q

What happens upon relaxation of upper oesophageal sphincter?

A

→UOS closes as soon as food passes
→Glottis opens
→Breathing resumes

75
Q

Why study oesophageal disorder?

A

→ 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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