Upper GI

Question 1

esophagus journey to stomach

Answer 1

Starts at cricoid cartilage

Runs anterior to the vertebrae down through the posterior mediastinum beside descending aorta
passing through esophageal hiatus of diaphragm
into stomach

Question 2

anatomical markers on esophgus frrom incisor (4)

Answer 2

1. Cricopharyngeal sphincter (15cm)
2. Arch of aorta (22cm)
3. Left main bronchus (27cm)
4. Esophageal junction (OG) (40cm)

Question 3

Normal constrictions of esopgus

Answer 3

cricoid cartilage
aortic arch
diaphram

Question 4

importance of esophageal constrictions (4)

Answer 4

• Swallowed objects are more likely to get stuck in these areas
• Corrosive fluids swallowed pass slower at these areas than others and can thus cause more damage that at other points in the esophagus
• Difficult to pass surgical instruments through these areas for investigations or interventions
• Food may become lodged in the piriform fossae (two channels on either side of the epiglottis which normally allow liquids into the esophagus)

Question 5

esophgeal layers

Answer 5

mucosa
submucosa
muscularis externa
adventitia

Question 6

blood supply of esophagus (3)

Answer 6

• Inferior Thyroid Artery
• Aortic Esophageal Branches
• Left Gastric Esophageal Branches

Question 7

venous drainage of esophagus

Answer 7

inferior thyroid vein/ aortic branches drain to left gastric vein then hepatic portal system

rest drains through azygous/ brachiocephallic to systemic circulation

portosystemic anastamosis

Question 8

lumen epithelium of esophagus

Answer 8

non kertitinzed stratified squamous epithleium

Question 9

what do parietal cells do

Answer 9

HCL and intrinsic factor

Question 10

cheif cells

Answer 10

pepsinogen, gastric lipase and renin

Question 11

g cell

Answer 11

gastrin

Question 12

what does gastrin do

Answer 12

stimulate release of HCL and pepsinogen, increase gastric motility and relaxes pyloric sphincter

Question 13

diagnosis of barretts

Answer 13

• Endoscopy (OGD)
• Biopsy to confirm metaplasia
• Endoscopic Grading system (prague critera)- measuring length of barretts

Question 14

management of barretts

Answer 14

• PPI
• Surveillance
• Anti-reflux surgery (if not controlled medically)
• Resection
• Ablation

Question 15

Normal function of the lower esophageal sphincter (LES)

Answer 15

• Food is transported from the mouth to the stomach by peristaltic contractions of the esophagus muscle
• The LES relaxed as you swallow and this allows food to enter the stomach
• LES contracts and closes to prevent reflux into the esophagus

Question 16

Multiple mechanisms in place to prevent stomach contents from entering the esophagus:

Answer 16

• LES which only opens during swallowing
• Oblique angle of abdominal esophagus which acts as a valve
• Rosette of mucosal folds from the gastric mucosa at the gastro-esophageal junction which acts like a plug
• Muscle of diaphragm constrict around esophagus to prevent backflow

Question 17

esopheal offenses

Answer 17

1. Gastric secretion

2. Pyloric competence

Question 18

Protective factors that prevent peptic ulcers:

Answer 18

• Bicarbonate- buffers acid
• Prostaglandins- gets rid of pathogens
• Mucus production- creates a layer between epithelium and acid
• Blood flow to mucosa

Question 19

Risk factors for peptic ulcers:

Answer 19

• H-pylori (pan gastritis- reduces acid secretion/ pylorus)
• Gastric acid
• Pepsin
• NSAIDs
• Genetics
• Diet
• Smoking