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ANAT + PHYS (9610) > UNIT 6: Esophagus and Gastro Tract > Flashcards

UNIT 6: Esophagus and Gastro Tract Flashcards

1
Q

what is the goal of the digestive system

A

obtain nutrients to support energy needs, growth, and cell repair

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2
Q

what are the 5 functions of the digestive system

A

ingestion
propulsion
digestion
absorption
defecation

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3
Q

ingestion

A

brought into the body

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4
Q

propulsion

A

moved along the digestive tract

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5
Q

digestion (2 types)

A

broken down into simpler forms

mechanical and chemical

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6
Q

absorption

A

nutrients pass into blood stream

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7
Q

defecation

A

waste is removed from the body

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8
Q

6 organs of the digestive sys

A

mouth and pharynx
esophagus
stomach
small intestine
large intestine
anus

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9
Q

4 accessory organs of the digestive sys

A

salivary glands
liver
gallbladder
pancreas

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10
Q

mouth has 4 functions

A

ingestion - food brought into oral cavity
propulsion - tongue propels bolus into pharynx
mechanical digestion
chemical digestion

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11
Q

mechanical digestion in the mouth ….

A

mastication by teeth and mixing movements by tongue (voluntary)

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12
Q

chemical digestion in the mouth…

A

salivary amylase and lipase begins breakdown of starches and fats

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13
Q

parotid contributes…

A

the most saliva during chewing and swallowing

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14
Q

pharynx propulsion is….

A

peristaltic wave like - positive pressure on bolus tail moves bolus from pharynx to esophagus

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15
Q

esophagus propulsion is…

A

true peristaltic wave moves bolus (pos pressure on bolus tail) from pharyngoesophageal segment (PES) to the gastoesophageal junction

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16
Q

describe the esophagus

A

collapsible, muscular tube of approx 25cm in length

posterior to trachea, anterior to vert column

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17
Q

the esophagus runs from the _____ and passes through the _______ and pierces the _____ through the _______

A

laryngopharynx
mediastinum
diaphragm
esophageal hiatus

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18
Q

hiatal hernia

A

when a portion of the stomach protrudes into the thoracic cavity

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19
Q

the pharyngoesophageal segment (PES) contains the

A

upper esophageal sphincter (UES)

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20
Q

PES is comprised of ____ and ____ tissues, the UES is comprised of the _______ muscle

A

pharyngeal and esophageal tissues
cricopharyngeus muscle

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21
Q

UES is ______ at rest due to contraction of the CP muscle

A

closed

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22
Q

UES opens by

A

tissue compliance

relaxation of CP muscle

traction of the ascending larynx (hyolaryngeal complex)

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23
Q

traction of the ascending larynx (hyolaryngeal complex) works to open the UES by

A

cricoid cartilage is pulled anterosuperiorly and thus pulls the anterior esophageal wall away from the posterior esophageal wall

aka when this structure moves up when we swallow it pulls open the UES

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24
Q

inferior border of the esophagus forms the

A

lower esophageal sphincter - LES

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25
Q

LES is a

A

muscular junction bw esophagus and stomach at level of the diaphragm

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26
Q

how is the LES a physiological sphincter

A

physiological sphincter bc no sphincteric muscle present

smooth muscle of esophagus and crura of diaphragm maintain closure

prevents gastroesophageal reflux

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27
Q

along the length of the esophagus, transitions from ____ muscle to ____ muscle

A

striated to smooth

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28
Q

upper 1/3 of esophagus is

A

cervical esophagus
skeletal muscle

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29
Q

intermediate 1/3 of the esophagus is

A

skeletal and smooth muscle

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30
Q

lower 1/3 of esophagus is

A

smooth muscle

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31
Q

cervical esophagus is

A

a muscular wall comprised on 2 muscle groups w fibres perpendicular to each other

circular muscle fibres and longitudinal muscle fibres

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32
Q

what is primary peristalsis

A

muscle contraction triggered by arrival of bolus at UES; contraction wave propagates the length of the esophagus

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33
Q

what is secondary peristalsis

A

if residue remains in esophagus, second peristaltic wave is triggered

34
Q

esophagus is innervated/controlled by

A

esophageal branch of CN X

35
Q

UES =

A

a muscular sphincter (cricopharyngeus m) w/i the PES

tonic contraction of the CP muscle keeps the UES closed at rest …. prevents gastric contents from re-entering pharynx (i.e. prevents retrograde flow)

36
Q

LES =

A

An anatomical sphincter (where esophagus passes thru crura of diaphragm)

37
Q

resting pressure of LES is ____ of the UES resting pressure … created by….prevents…

A

1/3

circular muscle layer and the crura of the diaphragm

prevents gastric contents from re-entering esophagus (i.e. prevents retrograde flow)

38
Q

as bolus approaches LES releases _____ posture and bolus enters stomach…. ______ on tail of bolus, brief supra-resting level of contraction

A

resting

closure

39
Q

what are the 3 functions of the stomach

A

mechanical digestion and propulsion

chemical digestion

absorption

40
Q

mechanical digestion and propulsion in the stomach

A

peristaltic waves mix food w gastric juice and propel it into the duodenum (small intestine)

41
Q

chemical digestion in the stomach

A

pepsin in gastric acid begins digestion of proteins, produces chyme

proteins –> large polypeptides –> small polypeptides –> aminoacids

42
Q

absoprtion in the stomach

A

few fat soluble substances absorded (ex. aspirin, alcohol, some drugs)

43
Q

part of the stomach that often causes hiatal hernias

A

fundus

44
Q

what is gastroesophageal reflux GER

A

spontaneous movement of gastric contents into the esophagus

45
Q

what is GERD

A

Gastroesophageal reflux disease

chronic symptoms or mucosal damage due to the reflux of gastric contents

46
Q

GER is ______ in western society …. caused by…. estimated at ___% symptoms daily, ___% symptoms monthly

A

extremely common

dietary habits, stress, obesity

10%, 20-30%

47
Q

clinical symptoms of GER include

A

heart burn, regurgitation, chest pain

48
Q

less typical symptoms of GER related to acid damage

A

sore throat, globus sensation, chronic cough, vocal changes (Hoarseness), poor dentition, persistent throat clearning, asthma, aspiration

laryngopharyngeal reflex LPR

49
Q

what is the common mechanism behind GER

A

Transient lower esophageal sphincter relaxation (TLESR)

LES relaxes inappropriately, creating backflow into esophagus

50
Q

other than the common mechanism behind GER, what are the two other mechanisms

A

hypotensive LES = weak tonic contractile state

hiatal hernia = stomach herniates thru diaphragmatic hiatus, LES no longer receives structural support from the diaphragm

51
Q

Gastric reflux is _____ to the esophagus and other structures in the upper digestive tract because of -____

A

destructive
pepsin aka stomach acid

52
Q

patients w GER are often prescribed …. alternatively could use ….

A

proton pump inhibitors - typically proton pump (in stomach) pulls protons into cells to create HCI - PPIs inhibit creation of HCI

H2 blockers, histamine 2 receptor agonists, gastric acids suppressors raises pH of stomach after acid has already been produced

53
Q

3 parts of small intestine and the order of them

A

duodenum
jejunum
ileum

54
Q

mechanical digestion and propulsion in the small intestine

A

smooth muscle segmentation mixes contents w digestive juices, produces short distance peristaltic waves

55
Q

chemical digestion in small intestine

A

enzymes delivered from pancreas and gallbladder complete digestion of all food classes

56
Q

absorption in small intestine

A

products of carbohydrate, protein, fat, and nuclei acid digestions, plus vitamins, electrolytes, and water are absorbed

57
Q

segmentation vs peristalsis

A

peristalsis = adjacent segments of alimentary tract organs alternately contract an relax which move food along the tract distally

segmentation = nonadjacent segments of alimentary tract organs alternately contract and relax, moving the food forward then backward - food mixing and slow food propulsion occurs

58
Q

chemical digestion in large intestine

A

remaining food residues digested by enteric bacteria

59
Q

absorption in large intestine

A

remaining water, electrolytes (NaCl), and vitamins produced by bacteria (organic compounds)

60
Q

propulsion in the large intestine

A

feces propelled toward rectum by haustral churning and mass movements

61
Q

defecation of large intestine

A

reflex triggered by rectal distension; eliminates feces from body

62
Q

2 functions of swallowing

A

supportive function = transports ingested material from mouth to stomach

protective function = protects respiratory sys from entry of foreign material

63
Q

why is swallowing necessary: in the adult human the upper respiratory and digestive paths are _____, crossroads is called the _____

A

crossed

upper aerodigestive tract

64
Q

4 phases of swallowing

A

oral preparatory
oral (transport)
pharyngeal
esophageal

65
Q

describe the oral preparatory phase of swallowing… voluntary or involuntary?

A

ingested material is broken down mechanically and chemically, forming a bolus

a voluntary phase - actions vary w the properties of the food/liquid

66
Q

describe the oral (transport) phase of swallowing

A

bolus is moved posteriorly over the tongue surface

67
Q

describe the pharyngeal phase of swallowing… voluntary or involuntary?

A

phase is triggered when a moving bolus excites oropharyngeal sensory receptors

bolus transported from mouth to esophagus

involuntary -patterned motor response

68
Q

describe the esophageal phase of swallowing

A

bolus is transported to stomach

69
Q

swallowing events tend to occur in a _____ patter, although there is _____ subject and ____ subject variability

A

predictable
intra
inter

70
Q

how is the epiglottis deflecting during swallowing?

A

in 2 stages

first = upright, once the bolus comes along the hyolaryngeal complex moves up, base of epi comes up becoming a horizontal structure

second = to get it to tip the rest of the way the tongue base, pharyngeal wall, and bolus itself push the epi down to flip it the rest of the way

71
Q

describe the path of the bolus

A

bolus flows lateral to the larynx w/i the pyriform sinuses

1 pyriform sinus on each side - bw larynx and the pharyngeal wall

72
Q

during the esophageal phase, the ____ of the esophagus is relaxed in basal state; ____ and ____ are normally contracted, _____ on demand

A

body

UES and LES

Relaxed

73
Q

UES opens during the esophageal phase bc of

A

CP m relaxes, traction from HLAE, compliant segment, intrabolus pressure

74
Q

describe the peristalsis of the esophagus

A

progressive, normal/constant amplitude, non-repetitive, non-spontaneous = motility

75
Q

3 parts of esophagus contraction

A

primary peristalsis = distally progressive wave initiated by the act of swallowing

secondary peristalsis = distally progressive wave initiated by esophageal distension

tertiary contraction = non peristaltic (non-progressive) contraction of the body of the esophagus

76
Q

what causes residue/material in the pharynx?

A

weakness in pharyngeal constrictor muscles

inability to open UES sufficiently

gastroesophaeal reflux - incomplete closure of LES/UES at rest

77
Q

cervical osteophytes is….

A

bone spurs that grow on the cervical spine

narrow the pharynx and esophagus making it more difficult to get a bolus through

leads to residue

78
Q

what is hypertonicity in inferior pharyngeal constrictor

A

incomplete/inadequate relaxation during swallowing

leads to herniation of pharyngeal wall - at level of UES, this is called a zenker’s diverticulum … at triangle of killian

79
Q

what is triangle of killian …. what is pharyngoesophageal diverticulum … what does it result from?

A

triangle of killian = area of weakness bw oblique fibres of thyropharyngeus m and transverse fibres of CP

posterior hypopharyngeal mucosa protrudes bw two components of inferior pharyngeal constrictor

results from repetitive high hypopharyngeal pressures due to poor compliance of the UES

80
Q

clinical symptoms of zenker’s diverticulum

A

dysphagia with both solids and liquids

reguritation of undigested foods

coughing/aspiration

halitosis (bad breath bc of food stuck)

81
Q

how is zenker’s diverticulum diagnosed

A

use barium swallow

can use endoscopy but risk a perforation of the esophagus

82
Q

treatment of zenker’s diverticulum

A

diverticulectomy and or CP myotomy

ANAT + PHYS (9610) (19 decks)

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