Upper GI Tract Flashcards
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
Causes of failure of protective mechanism
decreased vol clearance (abnormal peril-stasis)
Slowed ph clearance ( not producing enough saliva)
Smoking - decrease buffering capacity of saliva
Sliding hiatus hernia mechanism
gastro- oesophageal junction, and part of the stomach protrude into the chest
Rolling hiatus hernia
part of the stomach pushes up through the hole in the diaphragm next to the oesophagus (portion of stomach slips up the side)
Mechanism to repair epothelial defects
migration
gap closed by cell growth
acute wound healing
what do the body and fundus produce
mucus, HCl, pepsinogen
what is erosive + haemorrhagic gastritis
acute ulcer - gastric bleeding + perforation
what is nonerosive, chronic active gastritis
variety of histologic abnormalities that are mainly the result of Helicobacter pylori infection
what is atrophic gastritis
chronic inflammation of the gastric mucosa with loss of the gastric glandular cells and replacement by intestinal-type epithelium, pyloric-type glands, and fibrous tissue
reactive gastritis
long-term contact with substances that irritate the stomach lining
Cause of erosive gastritis
NSAIDS
multi-organ failure
trauma
ischaemia
what is reflux
passive return of gastroduodenal contents to the mouth
Mechanism to repair epithelial defects
migration - adjacent epithelial cells flatten to close gap
gap closed by cell growth
acute wound healing - epithelial closure by restitution + cell division
Why do you get ulcers
increased chemical aggression (anything that increases gastric juice secretion)
barrier function disturbed (h. pylori)
what causes secondary hypermotility
chagas’ disease
protozoa infection
amyloid/ sarcoma/ eosinophilic oesophagitis
what is the onset of hypermotility
insidious onset - symptoms for years prior to seeking help/ risk of oesophageal cancer increased 28 fold
how is hypermotility treated
PD - pneumatic dilatation (balloon inserted + inflated to resume flow)
90% of patients respond initially but many relapse
how is hyper-motility treated
PD - pneumatic dilatation (balloon inserted + inflated to resume flow)
90% of patients respond initially but many relapse
what is heller’s myotomy
continuous myotomy performed for 6cm on oesophagus + 3cm onto stomach
dor fundoplication
anterior fundus folded over oesophagus + sutured to right side of myotomy
what is scleroderma
autoimmune hypomotility disease
what is the cause of scleroderma
early stages - due to neuronal defects + atrophy of smooth muscle of oesophagus
what is disordered coordination
incoordinate contractions which lead to dysphagia + chest pain
marked hypertrophy of circular muscle
what are the causes of oesophageal perforation
cancer, foreign body, physiological dysfunction
