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Flashcards in Oesophageal Function Deck (56):
1

What happens if accurate swallowing isn't achieved?

Choking
Aspiration (wrong hole)

2

What are the 3 phases of swallowing? Their sensory components are?

1) Oral (voluntary/striated muscle)
2) Pharyngeal (involuntary/stirated muscle)
3) Oesophageal (involuntary/ striated and smooth)

3

Swallowing centre

region in brainstem that receives sensory input from receptors in back of mouth and upper pharynx.
Also innervates swallowing muscles via cranial nerves

4

What is swallowing controlled by? What does that mean for stroke sufferers?

Cortex and brainstem. People who have had strokes in these areas can develop swallowing disorders

5

What are the phases of Oral Phase?

Preparatory phase ( formation of bolus)
Transfer Phase (bolus propelled into the pharynx)

6

Describe Preparation phase (oral phase)

Saliva= Lubrication and dissolving
Mastication = breaks down solids into smaller size, shape and consistency suitable for transport. Teeth grind, and tongue and cheeks position this to happen.

7

Describe Transfer phase (oral phase)

tip of tongue comes into contact with the hard palate.
close off anterior oral cavity
Bolus pushed to back off mouth

8

The Pharyngeal Phase #2

lasts

9

What are the 3 passages required to be closed in the pharyngeal phase?

1) mouth
2) upper airway/nasopharynx
3) Lower airway (to protect trachea from aspiration)

10

what is the UOS

upper oesophageal sphincter.
Acts as a barrier between the pharynx and oesophagus and is usually closed.
A complex of muscles often in a state of tonic contraction, that relaxes intermittently

11

What does UOS prevent?

air distending the stomach
reflux of contents into pharynx and larynx during oesophageal peristalsis

12

What muscles do UOS consist of?

Cricopharyngeus
Inferior Pharyngeal constrictor
cervical oesophagus

13

How is it that UOS opens how for how long?

-Cricopharyngeus relaxes
-suprahyoid and thyrohoid muscles contract
-pressure of descending bolus distendeds UOS

Opens for 0.5 s

14

Oesophagus Function and structure?

from UOS to LOS
~20-25cm long
mucosa= stratified squamous epithelium
upper 1/3 striated (voluntary)
lower 2/3 smooth (involuntary)

15

Oesophageal Phase?

UOS relaxes, bolus enters and is propelled down oesophagus via peristalsis
Primary: initiated by swallowing, cont of pharyngeal contraction wave but slower, 3-5cm/s
Secondary: initiated by distention, activated stretch receptors initiate local reflex response > peristalsis

lasts 5-6s

16

How does oesophageal peristalsis occur

ANS (para/sympathetic) and the Enteric NS

17

What are the nerve plexus of the GI tract

submucosal plexus
myenteric plexus (between circular longitudinal muscles)

18

Why is ES interesting?can operate independent/autonomously

can operate independent/ autonomously. Can also communicate with PS and S

19

The oesophagus is mostly covered in...

Adventitia

20

the circular layer contracts...

above and relaxes below bolus

21

the longitudinal layer

shortens during peristalsis

22

what is the LOS

a specialised segment of smooth muscle that is tonically contracted, close to the squamocolumnar junction (20-35 mmHg)

23

What causes LOS to relax

Swallowing: 1-2s after swallow, lasts 5-10s, followed by hypercontraction
Physiologically: intermittently relaxes to release air from stomach, only happens in an upright position, mediated via vagus nerve

24

Investigation of the Oesophagus

Gastroscopy: flexible telescope
Barium Swallow: xray test, asses function/motility
pH Study: may have reflux but unsure. involves cathater above gastro-oesophageal junction to test pH
Manometry: Like pH to test pressure/propagation of wave.

25

Structural diseases of the oesophagus

-inflammation
-ischemia/necrosis
-ulceration
-bleeding
-narrowing
-masses
-diverticulum

26

Dysmotility diseases of the oesophagus

abnormal contraction of the oesophageal muscles

27

Functional diseases of the oesophagus

disorders of motility, sensation and brain-gut dysfunction.

28

Gastro-oesophageal reflux disease

gastric contents into oesophagus. Occurs during transient LOS relaxation without the protective columnar epithelium, acidic contents damage.

29

When does Transient LOS relaxation become pathological?

When too much gastric juice refluxes into the oesophagus causing symptoms/disease

30

Causes of G-O reflux

Hypotensive LOS (caffiene, alcohol, fats or certain meds eg) beta-blockers, nitrates)
Hiatus Hernia
Impaired oesophageal peristalsis (less clearance)

31

Hiatus Hernia

Hiatus = diaphragm opening
diaphragm = additional support to the sphincter
stomach passes through hiatus into the chest, due to a diaphragmatic weakening, now you have an area that can freely reflux

32

pH of oesphagus and stomach

oesophagus= 6-7
stomach= 1-2

33

Symptoms of acid reflux

Heartburn
regurgitation
sour/bitter taste in mouth (worse after eating/lying down)

34

Why to the symptoms of gastric acids occur?

The gastric acid (pH 1-2) comes into contact with the oesophageal mucosa (pH6-7) which is sensitive to it, and nerve fibres give the sensation of burning. Chronic acid causes damage

35

Structural complication of GORD

Reflux oesophagitis (inflammation, ulceration and bleeding)
Peptic Stricture (narrowing from prolonged inflammation leading to fibrosis and scarring)
Barretts oesophagus
cancer

36

Whats Barrett's oesophagus

Oesophageal epithelium (squamous) transforms to become like gastric (columnar + goblet) in an attempt to adapt to damage.
"intestinal metaplasia"
loss of z line

37

Evolution of Barrets oesophagus to cancer?

Squamous oesophagus > chronic inflammation > Barrets metaplasia > Low-grade dysplasia > High-grade dysplasia > cancer (adenocarcinoma)

38

2 types of oesophageal cancer the the risk factors

Adenocarcinoma (adenoCa): GORD, Barret's
more in distal oesp/GO junction

Squamous cell carcinoma (SqCC): smoking, alcohol, diet
SqCC usually higher up

39

Ring/web

found distally, thin mucosal memmbrane, associated with hiatus hernia. Can obstruct passage of food, difficulty swallowing (dysphasia)

40

Zenker's Diverticulum

Excessive pressure cause weakest part of pharynx to balloon out
Leads to poor swallowing and impair relaxation of cricopharyngeus, more common in eldery

41

Stricture

Peptic: reflux related
Caustic: custic injury
post-radiotherapy/surgical
malignant

Narrowing of oesophagus

42

Reflux oesophagitis

inflammation due to GORD. Bleeding, ulceration, perforation
1) bleeding - haematemesis (vomiting blood)
2) Dysphagia

can lead to peptic strictures

43

Oesophageal Candidiasis

Thrush, with white plaques coating oesophagus

44

Ulceration

Herpes simple virus. Pill induced (doxycycline)
or bisphosphates

45

Eosinophilic oesophagitis

Eosinophils infiltrate the epithelium of oesophagus = circular appearance
-allergy mediated

46

Motility Disorders of the oesophagus

Dysphasia present (difficult swallowing). Likely intermittent/variable symptoms.
Liquids just as affected

47

Achlasia (motility disorder)

neuro-degenration of oesophageal nerves
-myenteric plexus and LOS inhibitory nerves
-loss of peristalsis and failure of LOS to relax, birds beak of dilation occurs

48

Diffuse oesophageal spasm

"corkscrew oesophagus"
non-peristaltic onset of contraction
-dysphasia and chest pain

49

Nutcracker Oesophagus

Normal but extremely strong peristaltic contractions

50

Sclerodema

CT disease, hardening (fibrosis) of skin and CT
Damage occurs to submucosa (nerves/BV) =rubbery hose-pipe
No peristalsis, weak contraction, LOS has no tone
-dysphagia and reflux

51

What can you use to diagnose motility disorders

manometry

52

Four landmarks that indent the oesophagus

cricoid
Aortic arch
left main bronchus
diaphragm

53

Sup border of mouth

hard & soft palate

54

Ant/Lat border of the mouth

Cheeks, lips, tongue body

55

Inferior border of the mouth

glenohyoid and thyrahyoid

56

Posterior border of the mouth

ulva (soft palate)
Palantine tounsils
root of tongue
Linguinal tonsil