Upper GI Tract Flashcards by Jessica Ebosele

What is the angle of His and what does it contribute to the LOS?

The angle between the abdominal stomach and the fundus of the stomach

It prevents reflux

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How does the diaphragm contribute to the efficacy of the LOS?

The left and right crux of the diaphragm contract against the sphincter to help its efficacy

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What ligament allows the diaphragm and LOS to move independently of each other?

Phrenoesophageal ligament

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What are the stages of swallowing?

Stage 0: Oral phase
Stage 1: Pharynx phase
Stage 2: Upper oesophageal phase
Stage 3: Lower oesophageal phase

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What is manometry and its units?

A test to measure the motility and muscle contractions of the oesophagus

in mmHg

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What is the usual manometry value for peristaltic waves?

around 40 mmHg

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What is the resting pressure of the LOS?

around 20 mmHg

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What is the role of the noncholinergic noradrenergic neurones (NCNA) of the myenteric plexus?

They mediate the decrease of LOS pressure (to <5 mmHg) during receptive relaxation
They are inhibitory neurones

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What is receptive relaxation?

The Vagus nerve is activated when food is swallowed and relaxes stomach muscle to prepare for bolus.

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What is the state of the oesophageal sphincters during stage 0 of swallowing?

Both oesophageal sphincters are constricted

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What is the state of the oesophageal sphincters during stage 1 of swallowing?

Upper oesophageal sphincter opens on reflex

LOS is opened by the receptive relaxation reflex

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What is the state of the oesophageal sphincters during stage 2 of swallowing?

Upper sphincter closes

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What is the state of the oesophageal sphincters during stage 3 of swallowing?

Lower sphincter closes as food passes through

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What happens to the muscles during stage 2 of swallowing?

Peristalsis:
Superior circular muscle rings contract
Inferior circular muscle rings dilate

Longitudinal muscles contract sequentially - (act antagonistically, contracting ahead of the bolus)

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What is the effect of cholinergic fibres on sphincters?

Increase contraction of sphincter - exciting shortening of fibres

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What causes Achalasia?

A loss of ganglionic cells in Aurebach’s myenteric plexus.
Decreased activity of inhibitory NCNA neurones
LOS remains constricted

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What is Achalasia?

Hypermotility of oesophageal muscles

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What are the causes of Achalasia?

Primary - aetiology unknown

Secondary -
Chagas’ Disease
Protozoa infection
Amyloid/Sarcoma/Eosinophilic Oesophagitis

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How does Achalasia affect oesophageal motility?

Increases resting pressure of the LOS (pressure in LOS much higher than in stomach)
Delay in receptive relaxation and decrease in effect
Increased pressure in oesophagus caused by collection of swallowed food
Propagation of peristaltic waves ceases

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What are the symptoms of Achalasia?

weight loss
dysphagia
regurgitation
retrostomach pain

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What is Chagas’ disease

Infection by a parasite (Trypanosoma cruzi) that causes damage to the heart, oesophagus and other digestive tracts

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What is Amyloid Oesophagitis?

Deposits of amyloid in the oesophagus (in the submucosa), puts pressure on and causes destruction of surrounding cells

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What is Sarcoma Oesophagitis?

A form of malignant neoplasm arising from the oesophagus

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What is the pathophysiology of Chagas’ disease?

The parasite damages the oesophageal myenteric plexus, causing:

loss of esophageal peristalsis
partial or absent lower esophageal sphincter relaxation
megaesophagus - secondary oesophageal achalasia

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What is the pathophysiology of Chagas' disease?

The parasite damages the oesophageal myenteric plexus, causing: - loss of oesophageal peristalsis - partial or absent lower oesophageal sphincter relaxation - megaoesophagus - secondary oesophageal achalasia

How is Achalasia treated?

Pneumatic Dilatation | Surgery

What is Pneumatic Dilatation?

An air-filled cylinder shaped balloon forcefully dilates the LOS and weakens it by circumferential stretching. Forceful dilation tears the muscle fibres but doesn't damage the mucosa

How effective is Pneumatic Dilatation?

71-90% respond initially but many relapse

What surgeries are given for Achalasia?

Heller's Myotomy with Dor fundoplication | Peroral endoscopic myotomy (POEM)

What is Heller's Myotomy?

A continuous myotomy for 6cm on oesophagus and 3cm of stomach Remove muscles and leave only mucosa

What are the risks for Achalasia surgery?

``` Oesophageal perforation (10-16%) Division of vagus nerve (rare) Splenic injury (1-5%) ```

What is Dor fundoplication?

attach anterior fundus to right side of myotomy on oesophagus

What is Peroral endoscopic myotomy?

minimally invasive procedure to divide the inner muscle layer of the LOS through a submucosal tunnel.

What is the disease course of Achalasia

insidious onset progressively dilates oesophagus without treatment increases risk of oesophageal cancer 28 fold

What is the annual incidence of oesophageal cancer?

0.34%

What is Scleroderma?

An autoimmune disease causing hardening and tightening of skin and connective tissues.

How does early stage hypomotility affect the oesophagus?

Atrophy of smooth muscle of oesophagus

How does Scleroderma affect the oesophagus?

No peristalsis in distal oesophagus | Decrease resting pressure of LOS (can cause GORD)

What is CREST syndrome?

``` C - Calcinosis R - Raynaud's phenomenon E - Oesophageal dysmotility S - Sclerodactyly T - Telangiectasias ```

What is Calcinosis?

Calcium deposits in the skin (hard nodules under skin)

What is Raynaud's phenomenon?

Spasms of blood vessels in response to cold or stress

What is Oesophageal dysmotility?

Acid reflux and decreased motility of oesophagus

What is Sclerodactyly?

Thickening and tightening of skin on hands and fingers

What is Telangiectasias?

Dilatation of capillaries causing red marks on the skin

How is Hypomotility treated?

Exclude organic obstruction Cisapride (prokinetic to improve force of peristalsis) Once peristaltic failure occurs its usually irreversible

What is Corkscrew Oesophagus?

A type of disordered contraction | Diffuse oesophageal spams with incoordinate contractions

What are the symptoms of Corkscrew Oesophagus?

Dysphagia | Chest pain

What manometric changes are seen in Corkscrew Oesophagus?

Pressures of 400-500 mmHg

What cellular changes occur in Corkscrew Oesophagus?

Marked hypertrophy of circular muscle

What is the treatment for Corkscrew oesophagus?

Pneumatic Dilatation may be effective | Results are unpredictable

What vascular anomalies can cause dysphagia?

Dysphagia Lusoria | Double Aortic arch

What is Dysphagia Lusoria?

An aberrant right subclavian artery compresses the oesophagus

What are the 3 areas of oesophageal constriction?

Cricopharyngeal Aortic and bronchial Diaphragmatic and sphincter

What are they 3 types of pathological narrowing of the oesophagus?

Cancer Foreign body Physiological dysfunction

What are the different causes of Oesophageal perforation?

``` Iatrogenic - >50% Spontaneous (Boerhaave's) - 15% Foreign body - 12% Trauma - 9% Intraoperative - 2% Malignant - 1% ```

What is Iatrogenic Oesophageal Perforation?

Perforation of the oesophagus as a result of endoscopy and other investigations More common if diverticula or cancer are found

What investigations can cause Iatrogenic Oesophageal Perforation?

Endoscopy - 0.03% Stricture dilatation - 0.1-2% Sclerotherapy - 1-5% Achalasia dilatation - 2-6% (more interventions increase likelihood of perforation)

What is Boerhaave's syndrome?

Sudden increase in intra-oesophageal pressure with negative intra-thoracic pressure Rupture of oesophagus due to forceful vomiting against a closed epiglottis

What part of the oesophagus is Boerhaave's syndrome likely to affect?

Left posterolateral aspect of the distal oesophagus

What foreign objects are likely to cause oesophageal perforation?

``` Disk batteries - electrical burns if in contact with mucosa Magnets Sharp objects Dishwasher tablets Acid/Alkali ```

What differentiates penetrating trauma from blunt force trauma?

Neck - penetrating | Thorax - blunt force

What are the symptoms of trauma causing oesophageal perforation?

Dysphagia Blood in saliva Haematemesis Surgical emphysema

What operations may cause Oesophageal perforation?

Hiatus hernia repair Heller's Cardiomyotomy Pulmonary surgery Thyroid surgery

What is dysphagia?

difficulty swallowing

Upper GI Tract Flashcards

(64 cards)