Upper GI Tract Flashcards
(47 cards)
What marks the borders of upper GI
upper oesophageal sphincter to lower oesophageal sphincter
Anatomical contributions to lower oesophageal sphincter
3-4cm distal part of oesophagus is in abdomen
Diaphragm surrounds the sphincter (contracts against the sphincter)
Intact phreno-oesophageal ligament
Angle of His
How does the angle of His prevent reflux
The angle of His is an acute angle between the great curvature of the stomach and the oesophagus, and acts as an anti-reflux barrier by functioning like a valve
Why is an Intact phreno-oesphageal ligament important
ligament allows independent movement of the diaphragm and oesophagus during respiration and swallowing
4 stages of swallowing
Oral phase
Pharyngeal phase
Upper oesophageal phase
Lower oesophageal phase
Oral phase
Chewing + saliva prepare bolus
Both sphincter constricted
What is manometry
Way to record pressure of contractions of oesophagus + get an idea of its motility
what allows for relaxation of the sphincter - check this!
decreases LOS pressure - mediated by inhibitory noncholinergic noradrenergic neurons of myenteric plexus
What is absence of a stricture caused by
abnormal oesophageal contraction (hypermotility, hypomotility, disordered coordination)
Failure of protective mechanism for reflux (GORD)
Questions to ask about dysphagia
Location is important
Type of dyaphagia
Questions to ask abut dysphagia
Location is important (cricopharyngeal sphincter or distal)
Type of dysphagia (for solids fluids/ intermittent or progressive/ precise or vague)
Odynophagia
Pain on swallowing
what is oesophageal perforation?
hole in the oesophagus
3 areas of anatomical constriction (more vulnerable areas)
What is Boerhaave’s
sudden increase in intra-oesophageal pressure (vomit against closed glottis)
which foreign bodies cause a oesophageal perforation?
sharp objects
disk batteries (cause elctrical burns)
magnets
acid/ alkali
Trauma in the neck oesophageal perforation presentation?
dysphagia
haematemesis
surgical empysema
blood in saliva
what is GORD
acid from the stomach leaks up into the oesophagus
what does the antrum produce
gastrin
oesophageal perforation initial management?
IV fluids
Broad spectrum Antibiotics
Nil by mouth
oesophageal definitive management?
conservative management with covered metal stent
Protective mechanisms against reflux in the stomach
LOS usually closed as a barrier against reflux
what contributes to increasing LOS reflux
acetylcholine
hormones
protein-rich food
histamine
what contributes to decreasing LOS reflux
beta adrenergic agonists
dopamine
acid gastric juice
smoking
Protective mechanism following reflux
volume clearance - oesophageal peristalsis reflex
pH clearance - saliva
epithelium - barrier properties
