oesophagus and its disorders

Question 1

brief phsyiology of oesophagus

Answer 1

fibromuscular 25cm tube of striated squamous epithelium

Question 2

where is the oesophagus

Answer 2

posterior to the trachea

begins at end of laryngopharynx and joins stomach a few cm from diaphragm at the cardiac orifice

Question 3

what does the oesophagus do

Answer 3

transports food to the stomach and secretes mucus

Question 4

how is muscle type distributed in the oesophagus

Answer 4

skeletal muscles surround the upper third - smooth muscle in the lower 2/3

Question 5

action of the upper oesophageal sphincter

Answer 5

striated muscle - constricts to stop air entering oesophagus

Question 6

action of the lower oesophageal sphincter

Answer 6

smooth muscle - intra abdominal segment - acts as flap valve. it’s an area of high pressure, with intrinsic and extrinsic components

Question 7

what can malfunction of the intrinsic and extrinsic components of the LOS do

Answer 7

lead to GORD

Question 8

intrinsic components of the LOS

Answer 8

thick oesophageal smooth muscle
clasp-like semicircular smooth muscle fibres
myogenic activity - some resting tone, but less ACh-responsive

Question 9

extrinsic components of the LOS

Answer 9

crural diaphragm encircles LOS - forms channels where oes. enters abdomen.

Question 10

what makes up the extrinsic sphincter

Answer 10

fibres of the crural portion of the diaphragm which possess and pinchcock-like action - has myogenic tone

Question 11

in neural control of oes. sphincters, what happens when ach is released

Answer 11

contraction of intrinsic sphincters

Question 12

what cause relaxation of intrinsic sphincters

Answer 12

nitric oxide and vasoactive intestinal peptide release

Question 13

how is the upper part of the oes innervated

Answer 13

supplied by somatic motor neurons of the vagus nerve, w/o interruption

Question 14

how is the lower part of the oes innervated

Answer 14

visceral motor neruons of vagus nerve w/ interruptions - synapses w/ postganglionic neurons - cell bodies in oesophagus and splanchnic plexus

Question 15

what encircles the lower oes.

Answer 15

nerves of the oesophageal plexus

Question 16

functions of the oesophagus

Answer 16

swallowing - conveys food, fluid from the pharynx to the stomach

Question 17

what triggers swallowing

Answer 17

afferent impulses in the trigeminal, glossopharyngeal and vagus nerves

Question 18

what is swallowing coordinated with

Answer 18

opening and closing of the upper and lower oes. sphincters

Question 19

how is swallowing initiated

Answer 19

1. voluntary action - material on tongue collected, pushed back into pharynx
2. waves of INvol contractions push the material into the oesophagus

Question 20

what does #MOLO stand for

Answer 20

Mouth
Oropharynx
Laryngopharynx
Oesophagus

Question 21

how does inhibition of respiration occur

Answer 21

nasopharynx closed off
closure of glottis by epiglottis
prevents food entering trachea

Question 22

what is secondary peristalsis

Answer 22

peristalsis of oes. after stimulation of receptors on distension of the lumen by food.

Question 23

what prevents reflux of the gastric contents

Answer 23

LOS closes after material has passed
abd pressure acts on oes.
pinchcock effect of diaphragm of LO

Question 24

how do mucosal folds help prevent reflux of gastric contents

Answer 24

plug-like action of mucosal fold occludes the lumen of the gastro-oesophageal junction

Question 25

what is achalasia

Answer 25

loss of coordinated peristalsis/spasm of LOS - food fails to reach the stomach

Question 26

symptoms of achalasia

Answer 26

long period of sporadic dysphagia food regurgitation spasm disorders - chest pain, not of cardiac origin

Question 27

achalasia aetiology

Answer 27

damage to innervation of oesophagus | degenerative lesions to vagus nerve and loss of ganglionic cells in the oesophagus

Question 28

methods of diagnosis for achalasia

Answer 28

radiography - Ba swallow | oesophageal manometry

Question 29

what is oesoohageal manometry

Answer 29

test if oes if relaxing and contracting properly - diagnoses swallowing problems

Question 30

what are normal manometry results

Answer 30

normal LOS pressure | normal muscle contractions upon swallowing

Question 31

what does low LOS pressure suggest

Answer 31

GORD, although this can occur in individual with normal LOS pressure

Question 32

procedure for manomentry

Answer 32

``` local catheter: nostril > stomach deep inhale, swallow water measure strength and coord of muscle contractions, and LOS function slowly remove catheter ```

Question 33

methods of achalasia treatment

Answer 33

endoscopic balloon dilatation of LOS/surgery to weaken sphincter inhibtion of Ach release by injecting botox into LoS

Question 34

what causes GORD symptoms

Answer 34

irritation caused by gastric contents

Question 35

benefit of reflux stimulating salivation

Answer 35

saliva is an antacid - enhances, dilutes, neutralises refluxed gastric contents

Question 36

what are the consequences in GORD of a low salivation rate

Answer 36

lack of ability to swallow own saliva - prolonged contact of refluxed material with oesophagus > oesophageal irritation/damage

Question 37

cause of reflux in GORD patients

Answer 37

Transient spontaneous relaxation of LOS aka TSR

Question 38

what causes TSR

Answer 38

resting LOS pressure too weak to resist pressure within the stomach - sudden relaxation of LOS, not induced by swallowing

Question 39

what factors contribute to the severity of GORD

Answer 39

weak/uncoordinated oesophageal contractions - length of time in contact with gastric contents amount of pressure placed on the anti reflux barrier

Question 40

when does reflux occur

Answer 40

after eating, lying down, and when there is delayed gastric emptying - impaired gastric emptying alone can cause severe GORD

Question 41

use of secondary peristalsis in GORD

Answer 41

causes salivation - neutralises acid in oesophagus

Question 42

what causes GORD

Answer 42

reflux of gastric contents through the LOS - chronic oesophagitis

Question 43

RFs through GORD

Answer 43

pregnancy, obesity fat, chocolate, coffee, alcohol ingestion large meals, esp if high acid content - onions, tomatoes cigarettes drugs

Question 44

GORD complications

Answer 44

reflux causes desquamation of oesophageal cells - causing ulceration and basal cell hyperplasia barrett's oes. may form

Question 45

clinical features of GORD

Answer 45

low/absent resting LOS tone LOS tone fails to increase when lying flat poor oesophageal peristalsis - dec acid clearance delayed gastric emptying

Question 46

GORD symptoms

Answer 46

heartburn, acid regurgitation wake up at night due to laryngeal irritation by reflux dysphagia

Question 47

why does GORD occur in pregnancy

Answer 47

increased abdominal pressure from foetus - gastric contents forced into oesophagus

Question 48

what causes heartburn in the absence of pregnancy

Answer 48

large meals - less efficient LOS

Question 49

potential long term effects of GORD

Answer 49

oesophagitis, oesophageal strictures squamous cell carcinoma barrett's syndrome ulcer

Question 50

if a patient has heartburn/nausea after eating (GORD) or problems swallowing / achalasia what will get ordered

Answer 50

MANOMETRY

Question 51

how is GORD treated through lifestyle change

Answer 51

raise head of bed, dec intake of food that precipitates attacks, take antacids, lose weight

Question 52

what surgery treats GORD

Answer 52

anti - reflux surgery: fundoplication - wrap fundus around LOS

Question 53

what drugs can treat GORD

Answer 53

H2 receptor antagonists, Proton pump inhibitors | Metclopramide - may enhance peristalsis and aid acid clearance

Question 54

how do antacids work

Answer 54

neutralise gastric acif - inc pH of gastric lumen inhibit peptic activity stop acid secretion

Question 55

complication of using Mg salt antacid

Answer 55

can cause diarrhoea

Question 56

complication of Aluminium salts as antacid

Answer 56

constipation

Question 57

how does combination of alginic acid & saliva help protect from GORD

Answer 57

forms raft which floats on content of gastric lumen and protects oesophageal mucosa from reflux

Question 58

what is essential to stop ulcers returning

Answer 58

removal of H. pylori