Upper GI Tract Flashcards
what vertrebal level does the oesophagus start and end?
c6-t10
What makes up the LOS (4)?
3-4cm of oesophagus
diaphragm
phrenoesophageal ligament
angle of his
Describe the stages of swallowing
Stage 0: chewing and saliva bolus
Stage 1: pharyngeal musculature guides bolus towards oesophageus UOS opens
Stage 2: UOS closes and LOS dilates more
Stage 3: LOS closes to prevent reflux
What neuron allows oesophageal relaxation? What neural structure do they stem from?
inhibitory noncholinergic nonadrenergic (NCNA) neurons from myenteric plexus
What is Achalasia (functional disorder) and what is its pathophysiology?
Hypermotility due to the loss of ganglion cells in myenteric plexus = decreased activity of NCNA neurones and LOS does not relax = muscles constantly contracted = food cannot pass through
What are some secondary causes of achalasia? what is the most common treatment line?
Chagas disease
Protozoa (infection)
Sarcoma/eosinophilic oesophagitis
Hellers myotomy
What is Scleroderma (functional disorder) and what is its pathophysiology? What condition is it normally associated with
Hypomotility and dilated LOS
increased reflux
associated with CREST syndrome: Calcinosis, Raynauds, Esophageal disturbance, Sclerodactyly (thickening of skin in hands) Telangiectasis (dilation of vessles causing red marks on skin)
What 3 areas are oesophageal perforations most common in?
Cricopharyngeal constriction
Aortic and bronchial constriction
Diaphragmatic constriction (narrowing)
What is the most common cause of oesophageal perforations? what other perforations are seen?
OGD- oesophagogastroduodenoscapy
Latrogenic
booerhaves
foreign body
trauma
intraoperative
What does the LOS protect us from? what are 3 mechanisms does the oesophagus have to also protect us from this?
Reflux
Peristalsis keeps food going down rather than up
saliva is slightly alkaline- coats oesophaus
epithelieum has barrier properties
What does failure of reflux mechanisms cause?
GORD-gastro-oesophageal reflux disease
Sliding Hiatus hernias and Rolling hiatus hernias
What do each parts of the stomach produce?
Cardia and Pylori: Mucus
Body and Fundus: Mucus HCL Pepsinogen
Antrum: Gastrin
What vertebral level does oesophagus enter the diaphragm?
What level does the vena cava and aorta pierce the diaphragm
T10
Vena C- T8
Aorta- T12
What ligament surrounds the oesophagus at the LOS?
What organ does It also bind it to?
Phrenooesophageal ligament
The diaphragm
What reflex opens the oesophageal sphincter?
Vasovagal reflex
What is the difference between reflux and regurgitation?
Reflux is when oesophageal contents return from above an obstruction
Regurgitation is when gastroduodenal contents return to mouth
How do you treat scleroderma?
What must you exclude?
Improve peristalsis with prokinetics
Exclude obstructions
What is an example of disordered coordination?
What muscle do you see hypertrophy in this condition?
What are its symptoms?
How do you treat it?
Corkscrew oesophagus- oesophageal spasms causing a corkscrew appearance
Smooth muscle
Dysphasia and chest pain
Pneumatic dilation of cardia
What type of hernia causes GORD?
Sliding hiatus hernia
What are the two types of hernias? What are their differences?
Rolling hernia: stomach rolls up with oesophagus to the chest
Sliding hernia: stomach and oesophagus move up and down
What are the medical and surgical treatments for GORD?
OGD- oesophageal gastro duodenoscopy
Manometry
Strictures
What are the 4 types of gastritis and what causes them each?
Erosive and haemorrhagic- E&H (acute ulcer)
Non erosive chronic- H.Pylori
Atrophic-autoantibodies
Reactive-Alcohol and steroids
What stimulates and inhibits gastric secretion?
Where do they stimulators come from?
Acetylcholine from brain
Gastrin from endocrine
Histamine from paracrine
Inhibit: Secretin, somatostatin, prostaglandin, TGF-alpha
What are the three mechanisms for repairing epithelial damage in ulcers?
Migration of epithelial cells, cell growth via TGF, acute wound healing
How do you test for H.Pylori?
CLO test: Clarythromycin Like Organism test
