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BMS150 Post-MT2 > Physiology and Pathology: The Esophagus > Flashcards

Physiology and Pathology: The Esophagus Flashcards

1
Q

Where esophagus passes through the diaphragm?

A

Esophageal hiatus

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2
Q

Esophageal Epithelium?

A
  • Nonkeratinized stratified squamous epithelium
  • Langerhans cells present
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3
Q

Esophageal Lamina Propria? (2)

A
  • Esophageal cardiac glands (2 clusters) - secrete mucous
  • Lymphoid nodules
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4
Q

Esophageal Muscularis Mucosa?

A
  • Single layer of longitudinally smooth muscle
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5
Q

Esophageal Submucosa?

A
  • Dense, irregular fibroelastic CT
  • Mucous and serous cells
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6
Q

Esophageal Muscularis Externa?

A
  • upper 1/3 mostly skeletal
  • middle 1/3 mixed
  • lower 1/3 mostly smooth muscle
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7
Q

When does the esophagus go from adventitia to serosa?

A

Once it passes through the esophageal hiatus (diaphragm)

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8
Q

Major arteries around esophagus? (2)

A
  • Thoracic branches of aorta superiorly
  • Branches of the left gastric artery inferiorly
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9
Q

Major venous drainage of esophagus?

A
  • Azygous vein
  • Left gastric vein
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10
Q

This interface is a pathologically important site of bleeding if the veins here rupture?

A

Where the portal circulation overlaps with systemic circulation
Esophageal branches => azygous vein

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11
Q

What muscles compress the esophagus superiorly?

A

Muscles that move the larynx and hyoid upwards and anteriorly

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12
Q

What are the major muscles for “pushing food down”?

A
  • Cricopharyngeus muscle
  • The rest of the inferior pharyngeal constrictor muscle
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13
Q

What can happed in the “weak spot” just above the cricopharyngeus muscle?

A

Zencker Diverticulum = outpouching develops that food gets stuck in

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14
Q

3 stages of swallowing?

A
  1. Voluntary stage
  2. Pharyngeal stage
  3. Esophageal stage
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15
Q

After the voluntary stage, swallowing becomes almost entirely _______

A

Automatic

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16
Q

What type of stimulation is food in the larynx?

A

Tactile stimulation

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17
Q

Why is it good that the soft palate is pulled upward in the pharyngeal stage of swallowing?

A

Blocks the nasal cavity

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18
Q

Swallowing center?

A

Medulla

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19
Q

What 2 nerves are mainly responsible for swallowing?

A

Vagus and Glossopharyngeal

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20
Q

What does the swallowing center temporarily inhibit?

A

Respiratory center = halts respiration at any point in the cycle

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21
Q

What results from distention of the esophagus by retained food, or by reflux of gastric contents into the esophagus?

A

Secondary peristalsis

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22
Q

How long does secondary peristalsis happen for?

A

Until all the food has emptied into the stomach

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23
Q

The lower esophageal sphincter normally remains _______ and _______

A

Tonic and constricted

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24
Q

Is the resting pressure of the upper esophageal sphincter high or low?

A

High

25
Q

Is the resting pressure of the lower esophageal sphincter high or low?

A

Low

26
Q

When is the pressure in the lower esophageal sphincter higher?

A

After food has passed into the stomach

27
Q

What is relaxation of the lower esophageal sphincter mainly due to?

A

NO and VIP secreting branches of Vagus nerve

28
Q

Basic groups of esophageal pathologies? (4)

A
  • Dysphagic/Motility disease
  • Inflammatory disease
  • Metaplastic/neoplastic disease
  • Vascular disease
29
Q

Visceral pain from the esophagus is well-localized, and excess distention cause relatively intense, brief chest pain

A

Nutcracker esophagus

30
Q

In nutcracker esophagus, outer longitudinal layer of smooth muscle ______ _______ inner circular layer

A

Contracts before

31
Q

What do the high-amplitude esophageal contractions of nutcracker esophagus cause?

A

Short-lived esophageal obstruction

32
Q

What is Diffuse Esophageal Spasm caused by?

A

Dysfunction in inhibitory nerves

33
Q

Is diffuse esophageal spasm common?

A

Yes

34
Q

What is characterized by incomplete LES relaxation, increased LES tone, and aperistalsis of the esophagus?

A

Achalasia

35
Q

Primary achalasia?

A
  • Idiopathic
  • Caused by failure of distal esophageal inhibitory neurons
36
Q

If inhibitory neurons do not release NO or VIP after swallowing, what happens?

A

The lower esophageal sphincter won’t relax

37
Q

Secondary achalasia? (2)

A
  • Diabetic autonomic neuropathy
  • Malignancy
38
Q

What can the tropical infection Trypanosoma cruzi cause?

A

Secondary achalasia

39
Q

Clinical features of Achalasia? (3)

A
  • Dyspepsia
  • Chest pain
  • Regurgitation
40
Q

Treatment for Achalasia?

A
  • Botox
  • Myotomy
41
Q

What can iron-deficiency anemia or chronic reflux disease sometimes cause?

A

Fibrosis or non-malignant growths that obstruct the esophagus

42
Q

What can cause Infectious Esophagitis? (3)

A
  • HSV (small “punched-out” lesions)
  • Cytomegalovirus (CMV)
  • Fungal organisms
43
Q

Autoimmune esophagitis causes? (3)

A
  • Crohn’s (rare)
  • Scleroderma
  • Eosinophilic esophagitis
44
Q

What are the more common findings of scleroderma?

A

Mostly obstructive and regurgitation (vs inflammatory findings)

45
Q

Population that Eosiniphilic esophagitis typically affects?

A

Children and Adults

46
Q

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

A

Eosinophilic Esophagitis

47
Q

Eosinophilic esophagitis has marked _____ cell hyperplasia and ________ of the submucosal papillae

A

Basal; Elongation

48
Q

In eosinophilic esophagitis, Th2 cells are responsible for an abundance of what in the serum of effected tissue?

A

IL-4, IL-5, IL-13

49
Q

Patients often have a Hx of what before GI Sx of Eosinophilic eso.?

A

Atopic illness

50
Q

Clinical features for children with eosinophilic eso.? (3)

A
  • Nausea and vomiting
  • Small for age
  • Weight loss if severe
51
Q

Clinical features for adults with eosinophilic eso.? (3)

A
  • Dysphagia
  • Food impaction
  • Chest pain
52
Q

Diagnosis of eosinophilic eso.? (2)

A
  • Endoscopy
  • IgE levels often elevated
53
Q

What is the most common cause of esophagitis?

A

Reflux of gastric contents into lower esophagus

54
Q

Decreased LES tone or increased abdominal pressure likely contribute to ______

A

GERD

55
Q

Common findings of Reflux Esophagitis? (4)

A
  • Hyperemia
  • Mild eosinophilic infiltration
  • Basal zone hyperplasia
  • Barrett’s Esophagus
56
Q

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

A

Barrett’s esophagus

57
Q

In Barrett’s Esophagus, metaplasia looks similar to _______ ________ _______– goblet cells are present – with time many will progress to dysplasia

A

Intestinal glandular epithelium

58
Q

Clinical features of Reflux esophagitis? (3)

A
  • Dysphagia
  • Heartburn
  • Regurgitation (sometimes)
59
Q

Treatment for Reflux esophagitis?

A

PPIs or H2 Histamine receptor antagonists

BMS150 Post-MT2 (17 decks)

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