Pathology and Physiology of the esophagus Flashcards

1
Q

what are the major arteries of the esophagus?

A
  • thoracic branches of the aorta superiorly
  • Branches of the left gastric artery inferiorly
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2
Q

what is the major venous drainage of the esophagus

A

via the azygous vein and the portal venous system via the left gastric veins

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3
Q

what compresses the esophagus superiorly?

A

larynx

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4
Q

what muscles are the major players in “pushing food down”

A

cricopharyngeus muscle and the rest of the inferior pharyngeal constrictor muscle

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5
Q

Sometimes an outpouching develops and food “gets stuck” – known as a

A

Zencker Diverticulum

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6
Q

what is the term for swallowing

A

deglutition

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7
Q

what are the 3 stages of deglutition?

A
  • voluntary stage
  • pharyngeal stage
  • esophageal stage
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8
Q

what is the voluntary stage of swallowing?

A
  • After chewing, food is voluntarily squeezed or rolled posteriorly into the pharynx
  • By pressure of the tongue upward and backward against the palate
  • From here on, swallowing becomes almost entirely automatic
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9
Q

what is the pharyngeal stage of swallowing?

A
  • Reflex controlled by brain stem (medulla)
    1. Food in pharynx – tactile stimulation
    2. Soft palate pulled upward
    ○ Good idea – blocks the nasal cavity so food doesn’t get shoved out your nose
    3. Palatopharyngeal folds pulled together
    ○ creates “sagittal slit” for selective action
    4. Trachea is closed (respiration inhibited)
    ○ Vocal cords approximated
    ○ Larynx raises and epiglottis covers vocal cords
    5. Relaxation of UES
    6. Peristaltic contraction of pharynx
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10
Q

what is the swallowing center

A

medulla

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11
Q

explain the pharyngeal phase

A

Food in pharynx -> afferent sensory input via vagus N. /glossopharyngeal N. -> swallowing center -> brain stem nuclei -> efferent input to pharynx

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12
Q

what inhibits what of the medulla, halting respiration at any point in its cycle to allow swallowing to proceed

A

swallowing center
respiratory center

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13
Q

what is the secondary peristalsis?

A

Result from distention of the esophagus by retained food, or by reflux of gastric contents into the esophagus

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14
Q

the lower esophageal sphincter normally…?

A

remains tonic and contricted

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15
Q

When a peristaltic wave passes down esophagus, what happens to the LES

A

receptive relaxation relaxes the LES ahead of the peristaltic wave to allow easy propulsion of food into stomach
- prevents reflux

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16
Q

relaxation of the LES mainly due to what?

A

activity of NO- and VIP-secreting branches of the vagus nerve

17
Q

what is nutcracker esophagus

A

Visceral pain from the esophagus is well-localized, and excess distention cause relatively intense, brief chest pain
○ High-amplitude esophageal contractions
○ Outer longitudinal layer of smooth muscle contracts before the inner circular layer

18
Q

what is achalasia

A

incomplete LES relaxation, increased LES tone, and aperistalsis of the esophagus

19
Q

what is primary achalasia

A

idiopathic, caused by failure of distal esophageal inhibitory neurons

20
Q

what is secondary achalasia

A

○ diabetic autonomic neuropathy, malignancy
○ Infections (tropical countries) - Trypanosoma cruzi infection causes destruction of the myenteric plexus, failure of peristalsis, and esophageal dilatation, partial or absent lower esophageal sphincter relaxation

21
Q

what esophagitis is usually a sign of immunosuppression

A

infectious esophagitis

22
Q

what is an example of autoimmune esophagitis?

A

Crohn’s disease

23
Q

what Esophagitis is usually distributed throughout the length of the esophagus, with primarily esosinophilic inflammation

A

eosinophilic esophagitis

24
Q

what is reflux esophagitis?

A

Caused by reflux of bile and gastric acid into the esophagus

25
Q

what is Barrett’s esophagus

A

patches of red, velvety mucosa extending upward from the gastroesophageal junction that alternate with the smooth, pale normal esophageal mucosa

26
Q

what is a red flag for esophageal carcinoma

A

Heartburn that increases in severity and is accompanied by dysphagia