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Physiology 1 > Oesophagus And Its Disorders > Flashcards

Oesophagus And Its Disorders Flashcards

1
Q

What types of muscle is the oesophagus made up of?

A

Upper third - skeletal muscle

Smooth muscle - lower two third

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2
Q

What are the two oesophageal sphincters?

A

Upper and lower

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3
Q

What is the upper oesophageal sphincter made up of?

A

Striated muscle - musculo-cartilaginous structure

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4
Q

Why does the upper oesophageal sphincter constrict?

A

To avoid air entering the oesophagus

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5
Q

What is the lower oesophageal sphincter made of?

A

Smooth muscle

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6
Q

What does the lower oesophageal sphincter act as?

A

A flap valve

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7
Q

What are the two components of the lower oesophageal sphincter?

A

Intrinsic and extrinsic

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8
Q

What are the muscular formations in the intrinsic component of the lower oesophageal sphincter?

A

Clasp-like semicircular smooth muscle fibres and sling-like oblique gastric muscle fibres on the left side

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9
Q

What is the clasp like component of the lower oesophageal sphincter activated by?

A

Myogenic activity

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10
Q

What are the sling-like gastric muscle fibres responsive to in the lower oesophageal sphincter?

A

Cholinergic innervation

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11
Q

Why is reflux common in infants?

A

Angle of his is poorly developed

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12
Q

What encircles the lower oesophageal sphincter?

A

Crural diaphragm muscle- the extrinsic lower oesophageal sphincter component

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13
Q

What happens if the lower oesophageal sphincter components malfunction?

A

Gastro-oesophageal reflux disease (GORD)

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14
Q

How is the oesophagus innervated?

A

Cholinergic and non-cholinergic

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15
Q

What molecules cause the intrinsic sphincters to contract?

A

ACh and substance P

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16
Q

What causes relaxation of the intrinsic sphincters?

A

NO and VIP

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17
Q

What nerves supply the upper part of the oesophagus?

A

Somatic motor neurones of the vagus and splanchnic nerves

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18
Q

What is the lower part of the oesophagus innervated by?

A

Visceral motor neurones of vagus nerve with interruptions

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19
Q

What are the functions of the oesophagus?

A

Swallowing

Moving food and fluids from pharynx to stomach

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20
Q

What’s a swanky word for swallowing?

A

Deglutition

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21
Q

What is deglutition triggered by?

A

Afferent impulses in the trigeminal, glossopharyngeal and vagus nerves

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22
Q

Where do the efferent impulses pass?

A

To the pharyngeal musculature and the tongue

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23
Q

What are the nerves that supply the tongue?

A

Trigeminal, facial and hypoglossal

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24
Q

Where are the impulses from the oesophagus integrated into?

A

Nucleus tractus solitarius, nucleus ambiguous and the dorsal vagal nucleus

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25
Q

What initiates swallowing?

A

Voluntary action

26
Q

What are the reflex responses of the oesophagus?

A
  • Inhibition of breathing
  • closure of glottis (or vocal cords) by the epiglottis
  • ring of peristaltic waves behind the material
  • A second peristaltic wave moving any food remnants along
27
Q

What is oropharyngeal dysphagia caused by?

A

Upper oesophageal sphincter not being able to open or a disco-ordination of the timing between opening of the UOS and the pharyngeal push behind the ingested bolus

28
Q

What happens to the upper oesophageal sphincter as soon as the food passes?

A

Closes

29
Q

What leads to repeated waves of peristalsis?

A

The oesophageal receptors being stimulated because of continued dilation

30
Q

What is the action of the Cardia?

A

Plug-like by the mucosal folds to block the lumen in the gastro-oesophageal junction

31
Q

What is the pressure acting on the intra-abdominal parts of the oesophagus?

A

Abdominal pressure

32
Q

What is the part of the lower oesophageal sphincter that only adults have?

A

Valve- like effect of oblique entry into stomach

33
Q

What is achalasia?

A

Disorders of motility or peristalsis of the oesophagus

34
Q

How do you asses achalasia?

A

Assess the motor function of the UOS, LOS and oesophageal body

35
Q

What is an oesophageal spasm?

A

Abnormal oesophageal contractions and food not effectively reaching the stomach

36
Q

What is a diffuse oesophageal spasm?

A

When there’s chest pain coming from the oesophagus

37
Q

What is the prevalence of achalasia?

A

1 in 100,000

38
Q

When can achalasia present?

A

Any age

39
Q

What are the causes of achalasia?

A
  • Peristaltic disorders of the oesophagus
  • nerve damage on the oesophagus
  • degenerative lesions on the vagus nerve
  • loss of myenteric plexus ganglionic cells in the oesophagus
40
Q

What is the underlying cause of achalasia?

A

We don’t know but possibly autoimmune or triggered by infection

41
Q

What are the symptoms of achalasia?

A

Dysphagia
Vomiting
Heartburn

42
Q

What is heartburn?

A

Retrosternal burning sensation due to oesophageal dismotility

43
Q

What can heartburn be caused by?

A

Retention of small quantities of acid refluxed in the oesophagus due to poor emptying and incomplete relaxation of LOS

44
Q

What tests can be done to diagnose achalasia?

A

Barium radiography

Oesophageal manometry

45
Q

What will an achalasic oesophagus look like?

A

Dilated with a beak deformity at the end

46
Q

Why do you do oesophageal manometry?

A
  • Determine the cause of non-cardiac chest pain
  • find the cause of GORD
  • find cause of dysphagia
47
Q

What does a low LOS pressure suggest?

A

GORD

48
Q

Can GORD happen with a normal LOS pressure?

A

Yes

49
Q

What does a high LOS pressure suggest?

A

Achalasia

50
Q

What are abnormal oesophageal manometry results characterised by?

A

Muscle spasms in the oesophageal body or weak contractions along the oesophagus

51
Q

Why is it helpful for reflux to stimulate salivation?

A

Saliva = natural antacid- dilute and neutralises refluxed stomach contents

52
Q

What are the causes of GORD (3)?

A

Normally (98% of time) its transient spontaneous LOS relaxation

Or the resting LOS pressure is too weak to resist pressure within the stomach

Or sudden relaxation of LOS not induced by swallowing

53
Q

What affects the severity of GORD?

A
  • Weak or uncoordinated oesophageal contractions
  • length of time oesophagus is exposed to gastric acid
  • amount of pressure placed on the anti-reflux barrier
54
Q

When does the pressure on the anti-reflux barrier change?

A

After eating, lying down and when there’s delayed gastric emptying

55
Q

What are some risk factors associated with GORD?

A
  • Pregnancy, obesity
  • fat, chocolate, coffee or alcohol ingestion
  • large meals- tomatoes, orange juice and onions
  • cigarette smoking
  • drugs (anti cholinergic agents, calcium channel blockers and nitrate drugs)
56
Q

What are symptoms of GORD?

A
  • Heartburn and acid regurgitation
  • Disrupted sleep- when reflux irritates the larynx
  • dysphagia
57
Q

What are the four tests for GORD?

A
  • low dose proton pump inhibitor
  • upper GI endoscopy
  • manometry
  • 24hr ambulatory pH monitoring
58
Q

How does pregnancy induce GORD?

A

Foetus pushing on abdominal contents-> end of the oesophagus pushed into the thoracic cavity -> forces gastric contents into the oesophagus

59
Q

What are some long term effects of GORD?

A

Oesophageal strictures, squamous cell carcinoma, Barretts syndrome, oesophageal ulcers

60
Q

What are the possible treatments for GORD?

A
  • Lifestyle changes
  • anti-reflux surgery
  • antacids
  • H2 receptor antagonists and proton pump inhibitors
  • metaclopramide and domperidone
61
Q

What lifestyle changes will help with GORD?

A
  • raise the head of the bed at night
  • weight loss
  • modify food (dec fat intake)
  • avoid lying down after meals

Physiology 1 (65 decks)

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