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GINME > Week 2: Esophageal motility > Flashcards

Week 2: Esophageal motility Flashcards

1
Q

What is the main function of the esophagus?

A

transit of food to the stomach

Trick is

  • dont choke
  • dont aspirate food into the trachea
  • don’t aspirate air into the gut
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2
Q

Describe esophageal manometry

A

UES - upper esophageal sphincter

LES - lower esophageal sphincter

At the UES you are above atmospheric pressure
as you go lower the pressure decreases but at the diaphragm above atmo pressure

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3
Q

esophageal manometry during a swallow

A

initially open and then snap shut

Pressure wave going down but the bottom is open and gravity can take bolus down before even the pressure wave gets there depending on the viscosity of what is being swallowed, this is why liquids can be swallowed faster than solids

stomach relaxes to prepare for the bolus to enter

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4
Q

Functions of the esophagus

4 listed

A
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5
Q

Reflexes involved in the initiation of swallowing

2 listed

A
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6
Q

Describe the oral or voluntary phase of swallowing

A

Moves food into the pharynx

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7
Q

Describe the pharyngeal phase of swallowing

A
  • Larynx moves forward, epiglottis prevents entry into trachea and helps open UES
  • soft palate prevents reflux into nasopharynx, provides passage into pharynx
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8
Q

Pharyngeal phase of swallowing

A

involuntarily and neuronally mediated through Vagal efferents

brain also turns of respiration which picks back up as soon as the UES closes

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9
Q

Describe UES regulation

A
  • tonically contracted between swallows
  • relaxes during swallows
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10
Q

Muscle types in the esophagus

A
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11
Q

Describe the muscles and nerves of the pharynx and upper esophagus

A
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12
Q

What drives peristalsis

A

entirely done by neurons contained in the wall of the gut in between the longitudinal and circular muscle fibers

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13
Q

IDentify structure and components

A
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14
Q

Locations of the principal networks of enteric neurons

A
  • Myenteric plexus
  • Submucous plexus
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15
Q

Identify structures and components

A
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16
Q

Describe peristalsis mechanism

A

You get a peristaltic contraction behind the bolus and a relaxation in front of the bolus which is in tune with the size, shape and chemistry of the bolus without any input from the brain through the combination of sensory neurons and efferent neurons of the enteric nervous system

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17
Q

Describe the peristaltic reflex

A

sensory neurons sense the bolus and interneurons to coordinate contraction and relaxation of motor neurons to move the bolus as needed

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18
Q

Regulation of GI smooth muscle peristalsis

A

bolus hits villi activating sensory neurons and data is transmitted through the interneurons to get a coordinated contraction and relaxation behind and in front of the bolus respectively

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19
Q

Muscles and nerves of the pharynx and upper esophagus

A
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20
Q

Peristalsis transmissions speeds

A
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21
Q

M2 receptor second messenger

A

inhibition of adenylate cyclase

Activation of K+ channels

22
Q

M2 receptor targets

A

Heart

23
Q

M2 receptor effects

A

Inhibition

24
Q

M3 receptor second messenger

A

Stimulation of phospholipase C

25
Q

M3 receptor targets

2 listed

A
  • smooth muscle
  • secretory glands
26
Q

M3 receptor effects

2 listed

A
  • Contraction (smooth muscle)
  • secretion (secretory glands)
27
Q

Cardiac muscle stimulation

A

increase adenylate cyclase

28
Q

Cardiac muscle inhibition

A

decrease adenylate cyclase

29
Q

Smooth muscle stimulation

A

Increase phospholipase C

30
Q

Smooth muscle inhibition

A

Increase adenylate cyclase

31
Q

Glandular stimulation

A

Increase phospholipase C

32
Q

Inhibition of adenylate cyclase

A

M2 Gi coupled receptor

33
Q

Activation of phospholipse C pathway

A
34
Q

Excitatory neurotransmission to GI smooth muscle

A
35
Q

Inhibitory neurotransmission to GI smooth muscle

A
36
Q

LES regulation

A
37
Q

Describe the overall mechanism of primary peristalsis

A
38
Q

Describe the overall mechanism of secondary peristalsis

A
39
Q

Question

A

C. Activation of M3 and M2 receptors on smooth muscle cells

40
Q

Disorders of esophageal motility

3 listed

A
  • Stroke
  • Achalasia
  • Reflux
41
Q

Summary of esophageal motility

A
42
Q

How common is induced dysphagia from stroke?

A

common - up to 65% of stroke patients

43
Q

Swallowing phase effected by stroke-induced dysphagia

A

Loss of coordination of pharyngeal phase

44
Q

Complications of stroke-induced dysphagia

A
  • Pneumonia
  • poor nutrition
45
Q

Treatment of Stroke-induced dysphagia

A
  • Physical therapy
  • Modify texture of foods
46
Q

What is Achalasia?

A

Loss of coordination of smooth muscle peristalsis

47
Q

Swallowing phase effected by Achalasia

A

Lack of complete opening of LES so food remains in the esophagus leading to pain and regurgitation

48
Q

Treatment of Achalasia

A
  • Smooth muscle relaxants
  • Surgery
49
Q

Cause of loss of esophageal motility due to Reflux

A

Low resting pressure in LES

50
Q

Phase of swallowing effected by reflux

A

Poor secondary peristalsis

51
Q

Treatment of reflux induced loss of esophageal motility

A
  • Symptomatic treatment - acid reduction
  • Surgical treatment - Strengthen LES

GINME (63 decks)

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