Physiology and Pathology of 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
what is Barrett's esophagus
patches of red, velvety mucosa extending upward from the gastroesophageal junction that alternate with the smooth, pale normal esophageal mucosa
26
what is a red flag for esophageal carcinoma
Heartburn that increases in severity and is accompanied by dysphagia