Pharynx and Oesophagus

Question 1

What is the pharynx?

Answer 1

The part of the throat that connects to the oesophagus

Question 2

What is the difference between the upper 1/3 and lower 2/3 of the oesophagus?

Answer 2

Upper 1/3 is striated, skeletal muscle

Lowe 2/3 are composed of smooth muscle

Question 3

What type of epithelium is the oesophagus lined by?

Answer 3

Stratified squamous

Question 4

Is the upper oesophageal sphincter normally contracted or relaxed?

Answer 4

Contracted

Question 5

What is the function of the lower oesophageal sphincter?

Answer 5

Prevention of gastric reflux

Question 6

What are the three phases of swallowing?

Answer 6

The swallowing centre causes initial relaxation
Primary peristalsis
Secondary peristalsis, stimulated by the presence of the food bolus in the lumen

Question 7

What are tertiary contractions in swallowing?

Answer 7

Pathological, non-peristaltic contractions

Question 8

What are common symptoms of oesophageal disorders?

Answer 8

Dysphagia
Odynophagia
Heartburn
Regurgitation

Question 9

How is dysphagia defined?

Answer 9

A sensation of obstruction during the passage of liquid or solid through the pharynx or oesophagus

Question 10

What does a slow progression of dysphagia with a history of heartburn suggest?

Answer 10

Benign peptic stricture

Question 11

What does relentless progression of dysphagia over a few weeks suggest?

Answer 11

Malignancy

Question 12

What does the slow onset of dysphagia for solids and liquids at the same time suggest?

Answer 12

A motility disorder, e.g. achalasia

Question 13

What are the categories of causes of dysphagia?

Answer 13

Disease of mouth and tongue
Neuromuscular disorder
Oesophageal motility disorder
Extrinsic pressure cause
Intrinsic lesion cause

Question 14

What is an example of a disease of the mouth and tongue that can cause dysphagia?

Answer 14

Candidiasis

Question 15

What are examples of neuromuscular disorders that can cause dysphagia?

Answer 15

Pharyngeal
Bulbular palsy
Myasthenia gravis

Question 16

What are examples of oesophageal motility disorders that can cause dysphagia?

Answer 16

Achalasia
Scleroderma
Diffuse oesophageal spasm
Presbyoesophagus
Diabetes mellitus

Question 17

What is achalasia?

Answer 17

The lower oesophageal sphincter fails to open causing food and drink to be unable to pass into the stomach. They are often regurgitated

Question 18

What are examples of extrinsic pressures that can cause dysphagia?

Answer 18

Mediastinal glands
Goitre
Enlarged left atrium

Question 19

What are examples of intrinsic pressures that can cause dysphagia?

Answer 19

Foreign body
Stricture (peptic, carcinoma)
Lower oesophageal ring
Oesophageal web
Pharyngeal pouch

Question 20

What is odynophagia?

Answer 20

Pain during swallowing

Question 21

What is odynophagia suggestive of>

Answer 21

Oesophagitis

Question 22

What are causes of odynophagia?

Answer 22

Reflux
Infection
Chemical oesophagitis
Oesophageal stenosis

Question 23

What is heartburn a common symptom of?

Answer 23

Reflux of gastric contents into the oesophagus

Question 24

How is heartburn felt?

Answer 24

Retrosternal burning pain that can spread to the neck and across the chest

Question 25

When is heartburn often worse?

Answer 25

When lying down, bending or stooping

Question 26

What is regurgitation?

Answer 26

Effortless reflux of oesophageal contents into the mouth and pharynx

Question 27

In which conditions is regurgitation common?

Answer 27

GORD | Organic stenosis

Question 28

What investigations can be done for oesophageal disorders?

Answer 28

``` Barium swallow/meal Gastroscopy Manometry Ambulatory pH monitoring Impedance ```

Question 29

What is a barium swallow/meal

Answer 29

Radiological contrast study of the oesophagus

Question 30

When is a barium swallow used?

Answer 30

To give anatomical and functional information but has been superseded by gastroscopy as initial investigation of choice

Question 31

When is a gastroscopy used?

Answer 31

As the usual first line investigation for suspected oesophageal disorders

Question 32

How is a manometry study performed?

Answer 32

A catheter is passed through the nose to measure the pressures generated within the oesophagus

Question 33

When is a manometry study used?

Answer 33

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

Question 34

Which is preferred, high-resolution or conventional manometry?

Answer 34

High-resolution

Question 35

What is involved in a ambulatory pH monitoring?

Answer 35

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

Question 36

When is ambulatory pH monitoring useful?

Answer 36

To correlate episodes of acid reflux with a patient's symptoms

Question 37

What is impedance?

Answer 37

A catheter is used to measure the resistance to flow of alternating current in the contents of the oesophagus

Question 38

When is impedance helpful?

Answer 38

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