Pharynx and Oesophagus Flashcards
What is the pharynx?
The part of the throat that connects to the oesophagus
What is the difference between the upper 1/3 and lower 2/3 of the oesophagus?
Upper 1/3 is striated, skeletal muscle
Lowe 2/3 are composed of smooth muscle
What type of epithelium is the oesophagus lined by?
Stratified squamous
Is the upper oesophageal sphincter normally contracted or relaxed?
Contracted
What is the function of the lower oesophageal sphincter?
Prevention of gastric reflux
What are the three phases of swallowing?
The swallowing centre causes initial relaxation
Primary peristalsis
Secondary peristalsis, stimulated by the presence of the food bolus in the lumen
What are tertiary contractions in swallowing?
Pathological, non-peristaltic contractions
What are common symptoms of oesophageal disorders?
Dysphagia
Odynophagia
Heartburn
Regurgitation
How is dysphagia defined?
A sensation of obstruction during the passage of liquid or solid through the pharynx or oesophagus
What does a slow progression of dysphagia with a history of heartburn suggest?
Benign peptic stricture
What does relentless progression of dysphagia over a few weeks suggest?
Malignancy
What does the slow onset of dysphagia for solids and liquids at the same time suggest?
A motility disorder, e.g. achalasia
What are the categories of causes of dysphagia?
Disease of mouth and tongue Neuromuscular disorder Oesophageal motility disorder Extrinsic pressure cause Intrinsic lesion cause
What is an example of a disease of the mouth and tongue that can cause dysphagia?
Candidiasis
What are examples of neuromuscular disorders that can cause dysphagia?
Pharyngeal
Bulbular palsy
Myasthenia gravis
What are examples of oesophageal motility disorders that can cause dysphagia?
Achalasia Scleroderma Diffuse oesophageal spasm Presbyoesophagus Diabetes mellitus
What is achalasia?
The lower oesophageal sphincter fails to open causing food and drink to be unable to pass into the stomach. They are often regurgitated
What are examples of extrinsic pressures that can cause dysphagia?
Mediastinal glands
Goitre
Enlarged left atrium
What are examples of intrinsic pressures that can cause dysphagia?
Foreign body Stricture (peptic, carcinoma) Lower oesophageal ring Oesophageal web Pharyngeal pouch
What is odynophagia?
Pain during swallowing
What is odynophagia suggestive of>
Oesophagitis
What are causes of odynophagia?
Reflux
Infection
Chemical oesophagitis
Oesophageal stenosis
What is heartburn a common symptom of?
Reflux of gastric contents into the oesophagus
How is heartburn felt?
Retrosternal burning pain that can spread to the neck and across the chest
When is heartburn often worse?
When lying down, bending or stooping
What is regurgitation?
Effortless reflux of oesophageal contents into the mouth and pharynx
In which conditions is regurgitation common?
GORD
Organic stenosis
What investigations can be done for oesophageal disorders?
Barium swallow/meal Gastroscopy Manometry Ambulatory pH monitoring Impedance
What is a barium swallow/meal
Radiological contrast study of the oesophagus
When is a barium swallow used?
To give anatomical and functional information but has been superseded by gastroscopy as initial investigation of choice
When is a gastroscopy used?
As the usual first line investigation for suspected oesophageal disorders
How is a manometry study performed?
A catheter is passed through the nose to measure the pressures generated within the oesophagus
When is a manometry study used?
To assess oesophageal motility and measure pressures within the sphincters.
Not a primary investigation, only used when diagnosis has not been achieved by history, imaging or endoscopy
Gold standard for motility disorders
Which is preferred, high-resolution or conventional manometry?
High-resolution
What is involved in a ambulatory pH monitoring?
A pH sensitive probe is placed in the lower oesophagus to measure the pH of acid reflux episodes
Catheter and implantable sensors are in place for 24-96 hours
When is ambulatory pH monitoring useful?
To correlate episodes of acid reflux with a patient’s symptoms
What is impedance?
A catheter is used to measure the resistance to flow of alternating current in the contents of the oesophagus
When is impedance helpful?
Combined with a measurement go pH to assess acid, alkaline and gaseous reflux to understand symptoms produced by non-acid reflux, particularly in those continuing to have symptoms while on PPIs
