Oesophagus And Its Disorders

Question 1

What types of muscle is the oesophagus made up of?

Answer 1

Upper third - skeletal muscle

Smooth muscle - lower two third

Question 2

What are the two oesophageal sphincters?

Answer 2

Upper and lower

Question 3

What is the upper oesophageal sphincter made up of?

Answer 3

Striated muscle - musculo-cartilaginous structure

Question 4

Why does the upper oesophageal sphincter constrict?

Answer 4

To avoid air entering the oesophagus

Question 5

What is the lower oesophageal sphincter made of?

Answer 5

Smooth muscle

Question 6

What does the lower oesophageal sphincter act as?

Answer 6

A flap valve

Question 7

What are the two components of the lower oesophageal sphincter?

Answer 7

Intrinsic and extrinsic

Question 8

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

Answer 8

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

Question 9

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

Answer 9

Myogenic activity

Question 10

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

Answer 10

Cholinergic innervation

Question 11

Why is reflux common in infants?

Answer 11

Angle of his is poorly developed

Question 12

What encircles the lower oesophageal sphincter?

Answer 12

Crural diaphragm muscle- the extrinsic lower oesophageal sphincter component

Question 13

What happens if the lower oesophageal sphincter components malfunction?

Answer 13

Gastro-oesophageal reflux disease (GORD)

Question 14

How is the oesophagus innervated?

Answer 14

Cholinergic and non-cholinergic

Question 15

What molecules cause the intrinsic sphincters to contract?

Answer 15

ACh and substance P

Question 16

What causes relaxation of the intrinsic sphincters?

Answer 16

NO and VIP

Question 17

What nerves supply the upper part of the oesophagus?

Answer 17

Somatic motor neurones of the vagus and splanchnic nerves

Question 18

What is the lower part of the oesophagus innervated by?

Answer 18

Visceral motor neurones of vagus nerve with interruptions

Question 19

What are the functions of the oesophagus?

Answer 19

Swallowing

Moving food and fluids from pharynx to stomach

Question 20

What’s a swanky word for swallowing?

Answer 20

Deglutition

Question 21

What is deglutition triggered by?

Answer 21

Afferent impulses in the trigeminal, glossopharyngeal and vagus nerves

Question 22

Where do the efferent impulses pass?

Answer 22

To the pharyngeal musculature and the tongue

Question 23

What are the nerves that supply the tongue?

Answer 23

Trigeminal, facial and hypoglossal

Question 24

Where are the impulses from the oesophagus integrated into?

Answer 24

Nucleus tractus solitarius, nucleus ambiguous and the dorsal vagal nucleus

Question 25

What initiates swallowing?

Answer 25

Voluntary action

Question 26

What are the reflex responses of the oesophagus?

Answer 26

- 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

Question 27

What is oropharyngeal dysphagia caused by?

Answer 27

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

Question 28

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

Answer 28

Closes

Question 29

What leads to repeated waves of peristalsis?

Answer 29

The oesophageal receptors being stimulated because of continued dilation

Question 30

What is the action of the Cardia?

Answer 30

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

Question 31

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

Answer 31

Abdominal pressure

Question 32

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

Answer 32

Valve- like effect of oblique entry into stomach

Question 33

What is achalasia?

Answer 33

Disorders of motility or peristalsis of the oesophagus

Question 34

How do you asses achalasia?

Answer 34

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

Question 35

What is an oesophageal spasm?

Answer 35

Abnormal oesophageal contractions and food not effectively reaching the stomach

Question 36

What is a diffuse oesophageal spasm?

Answer 36

When there’s chest pain coming from the oesophagus

Question 37

What is the prevalence of achalasia?

Answer 37

1 in 100,000

Question 38

When can achalasia present?

Answer 38

Any age

Question 39

What are the causes of achalasia?

Answer 39

- 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

Question 40

What is the underlying cause of achalasia?

Answer 40

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

Question 41

What are the symptoms of achalasia?

Answer 41

Dysphagia Vomiting Heartburn

Question 42

What is heartburn?

Answer 42

Retrosternal burning sensation due to oesophageal dismotility

Question 43

What can heartburn be caused by?

Answer 43

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

Question 44

What tests can be done to diagnose achalasia?

Answer 44

Barium radiography | Oesophageal manometry

Question 45

What will an achalasic oesophagus look like?

Answer 45

Dilated with a beak deformity at the end

Question 46

Why do you do oesophageal manometry?

Answer 46

- Determine the cause of non-cardiac chest pain - find the cause of GORD - find cause of dysphagia

Question 47

What does a low LOS pressure suggest?

Answer 47

GORD

Question 48

Can GORD happen with a normal LOS pressure?

Answer 48

Yes

Question 49

What does a high LOS pressure suggest?

Answer 49

Achalasia

Question 50

What are abnormal oesophageal manometry results characterised by?

Answer 50

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

Question 51

Why is it helpful for reflux to stimulate salivation?

Answer 51

Saliva = natural antacid- dilute and neutralises refluxed stomach contents

Question 52

What are the causes of GORD (3)?

Answer 52

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

Question 53

What affects the severity of GORD?

Answer 53

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

Question 54

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

Answer 54

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

Question 55

What are some risk factors associated with GORD?

Answer 55

- 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)

Question 56

What are symptoms of GORD?

Answer 56

- Heartburn and acid regurgitation - Disrupted sleep- when reflux irritates the larynx - dysphagia

Question 57

What are the four tests for GORD?

Answer 57

- low dose proton pump inhibitor - upper GI endoscopy - manometry - 24hr ambulatory pH monitoring

Question 58

How does pregnancy induce GORD?

Answer 58

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

Question 59

What are some long term effects of GORD?

Answer 59

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

Question 60

What are the possible treatments for GORD?

Answer 60

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

Question 61

What lifestyle changes will help with GORD?

Answer 61

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