Oesophageal function

Question 1

Three phases of swallowing

Answer 1

Oral (voluntary, striated muscle)
Pharyngeal (involuntary, striated)
Oesophageal (involuntary, striated and smooth muscle)

Question 2

Swallowing control centres

Answer 2

Swallowing centre in brainstem

Cortex

Question 3

Describe pathways of the swallowing centre

Answer 3

Receives sensory input from receptors in the posterior mouth and upper pharynx and innervates swallowing muscles through cranial nerves

Question 4

Part one: Two phases of oral phase

Answer 4

Preparatory phase and transfer phase

Question 5

Preparatory phase

Answer 5

Mastication, wetting food, forming bolus

Question 6

Transfer phase

Answer 6

Bolus propelled into pharynx

Question 7

Part two: Pharyngeal phase

Answer 7

• Less than 1 sec, involuntary.
• Upper and lower airways closed by soft palate and the larynx moves up and epiglottis closes over vocal cords. Also tongue closes off oral cavity.
• UES relaxes.
• Bolus exits

Question 8

UES functions

Answer 8

In a state of tonic contraction
Stops air moving freely into stomach.
Prevents reflux of contents of stomach.

Question 9

Three muscles making up UES and if they contract or relax during swallowing

Answer 9

Cricopharyngeas (relax)
Inferior pharyngeal constrictor (contract)
Cervical oesophagus (contract)

Question 10

Oesophageal phase (two phase and what initiates them)

Answer 10

Primary peristalsis, initiated by swallowing

Secondary peristalsis, initiated by distention from the bolus

Question 11

Nervous control of oesophageal peristalsis

Answer 11

Autonomic nerves

Enteric nerves

Question 12

Lower oesophageal sphincter

Answer 12

Located at the junction to stomach.
Z line- squamocolumnar junction
Normally contracted
Relaxes 1-2 seconds after swallowing and stays relaxed for 5-10 seconds then hyper contraction.
Intermittent physiological opening when upright to let air out of stomach

Question 13

Barium test

Answer 13

Xray test allows us to examine the oesophagus in motion as a person swallows, function and motility. Can’t take biopsies

Question 14

Endoscopy

Answer 14

Useful for structural pathologies e.g. damage to the mucosa. Can take biopsies

Question 15

24 pH study

Answer 15

? reflux. Thin catheter in the oesophagus for 24 hours sits just above LOS measures a drop in pH in distal oesophgus.

Question 16

Manometry

Answer 16

Catheter in oesophagus between UES and LES contraction measured to determine if peristaltic wave is normal.

Question 17

Structural disorders

Answer 17

Ulceration
Diverticulum
Bleeding
Stricture
Inflammation
Stricture
Masses

Question 18

Dysmotility

Answer 18

Abnormal contraction of oesophageal muscles

Question 19

Gastro oesophageal reflux disease

Answer 19

Occurs when gastric acid enters the oesophagus during physiological opening of the LES. Becomes pathological when pt symptomatic.
Eitiology- relaxed sphincter (foods caffiene, alcohol, fatty food). Hiatus hernia (LES loses support of diaphragm), disorderd peristalis.

Question 20

Symptoms of GORD

Answer 20

Burning over chest
Regurgitation
Sour bitter taste in mouth
Symptoms worsen when lying down or after eating

Question 21

Complications of GORD

Answer 21

Reflux oesophagitis
Peptic sticture
Barrets oesophagus
Cancer

Question 22

Haemotemisis

Answer 22

Vomiting up blood

Question 23

Barrets oesophagus population at risk

Answer 23

Males over 50 with high BMI, smokers, chronic GORD. Increased risk of adenocarcinoma.

Question 24

Transition from Barrets to adenocarcinoma

Answer 24

Squamous oesophagus, chronic inflammation, barrets metaplasia, low grade dysplasia, high grade dysplasia, invasive adenocarcinoma

Question 25

Two types of oesophageal cancer

Answer 25

Adenocarcinoma and squamous cell carcinoma. | Seeing less of adenocarcinoma as treatment for reflux improving. Squamous cell carcinoma a lifestyle cancer.

Question 26

Ring/ web

Answer 26

Thin membrane formed around inner edge of oesophagus. Can obstruct passage of food. Associated with hiatus hernia.

Question 27

Zenkers diverticulum

Answer 27

Pouch at back of pharynx. People with impaired swallowing. Pressure in pharynx excessive forming diverticulum in weakest part. Present with dysphagia.

Question 28

Stricture

Answer 28

Causes: Peptic, caustic (swallowing poisons), post radiotherapy, surgery to oesophagus (enastamosis stricture), cancer.

Question 29

Infections of oesophagus

Answer 29

``` Oesophageal candidiasis (immunosupressed) Herpes, CMV (cause ulcerations) ```

Question 30

Drugs causing ulceration

Answer 30

Doxycyclin

Question 31

Eosinophilic oesophagitis

Answer 31

Eosinophils infiltrate the oesophagus- allergy mediated

Question 32

Motility disorder:

Answer 32

Present with dysphagia, liquids and solids (structural usually just solids).

Question 33

Achalasia

Answer 33

Myenteric plexus nerves disfunction. Loss of peristalsis in distal oesophagus, failure of distal oesophageal sphincter to relax.

Question 34

Diffuse oesophageal spasm

Answer 34

When peristalsis occurs in random order (spasm). Corkscrew oesophagus.

Question 35

Nutcracker oesophagus

Answer 35

Normal wave but high amplitude

Question 36

Scleroderma

Answer 36

Connective tissue disease causing fibrosis of skin and connective tissue. Oesophagus turns into a rubbery hose pipe! Severe reflux.