Oesophagus and Swallowing Flashcards

(55 cards)

1
Q

Which cells is the oesophagus composed of?

A

Fibromuscular tube (25cm) of striated squamous epithelium

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2
Q

Where in the body is the oesophagus located?

A

Lies posterior to the trachea

Begins at end of laryngopharynx and joins stomach a few cm from diaphragm (at the cardiac orifice of the stomach)

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3
Q

What is the role of the oesophagus?

A

Transports food to stomach (eating gullet)

Secretes mucus

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4
Q

What promotes the transport of ingested food into the stomach?

A

Highly coordinated muscular process;
contraction & relaxation of oesophagus to move food through GIT
Relaxation of the sphincters (UOS and LOS)

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5
Q

Describe the muscular structure of the oesophagus

A

Skeletal muscles surround the oesophagus below the pharynx (the upper third)
Smooth muscles surround the lower ⅔

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6
Q

Name the 2 oesophagul sphincters?

A

Upper oesophageal sphincter (UOS): striated muscle;

Lower oesophageal sphincter (LOS): smooth muscle;

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7
Q

Describe the features of UOS

A

Musculo-cartilaginous structure

Constricted to avoid air entering the oesophagus

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8
Q

Describe the features of LOS

A

acts as a flap valve
LOS = area of high pressure zone where it merges with the stomach
LOS has intrinsic and extrinsic components

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9
Q

What are the intrinsic components of the LOS?

A

Intrinsic component: oesophageal muscles; under neurohormonal influence;

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10
Q

What are the extrinsic LOS components?

A

Extrinsic component: diaphragm muscle (adjunctive external sphincter)

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11
Q

What is the consequence of malfunctioning of the intrinsic/extrinsic LOS components?

A

Malfunction of intrinsic and extrinsic components of lower oesophagul sphincter → GORD

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12
Q

What is GORD?

A

GORD - gastro-oesophagul reflux disease

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13
Q

What are the 3 components of the LOS?

A
  1. Thick circular smooth muscle layers and longitudinal muscles
  2. Clasp-like semi-circular smooth muscle fibres on the
    right side
  3. Sling-like oblique gastric (angle of His) muscle fibres
    on the left side
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14
Q

How are the semi circular smooth muscle fibres activated in the oesophagus?

A

Myogenic activity (some resting tone), but less ACh-responsive

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15
Q

Describe the functional features of the oblique gastric muscle fibres

A

Work in concert with clasp like-semi-circular smooth muscle fibres, help prevent regurgitation- responsive to cholinergic innervation

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16
Q

Explain how the Angle of His (oblique fibres) in infants may cause reflux

A

Angle of His is poorly developed in infants as it makes a vertical junction with stomach, hence why reflux is common in infants

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17
Q

What is the Angle of His (oblique angles)?

A

The acute angle created between stomach entrance (cardia), and oesophagus. It forms a valve, preventing reflux entering the oesophagus

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18
Q

What is the consequence of reflux into the oesophagus?

A

Reflux of duodenal bile, enzymes, gastric acid cause irritation of the oesophageal lining, inflammation and in extreme cases Barrett’s oesophagus

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19
Q

What are the components of the extrinsic LOS?

A
  1. Crural diaphragm

2. Pinchcock action of crural fibres

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20
Q

Describe the role of the crural diaphragm in the extrinsic LOS

A

Crural diaphragm encircles the LOS

Forms channel through which oesophagus enters the abdomen

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21
Q

Explain how the crural fibres produce the pinchcock action

A

Fibres of the crural portion of the diaphragm possess a “pinchcock-like” action => (extrinsic sphincter; diaphragmatic sphincter) - myogenic tone

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22
Q

What is the oesophagul innervation?

A

Involvement of cholinergic (i.e. via ACh) and non-cholinergic, NANC innervation in the control of tone of the lower oesophageal sphincter

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23
Q

Outline the neural control of the oesophagul sphincters

A

Acetylcholine, SP: contraction of intrinsic sphincters
NO and VIP: relax the intrinsic sphincters
Extrinsic / intrinsic sphincters work in concert to push food → stomach

24
Q

Describe the muscular and neural structure of the upper part of the oesophagus

A

Striated muscle; supplied by somatic motor neurons of vagus nerve without interruption
- Vagus nerve
- Splanchnic nerves (thoracic sympathetic
trunks)

25
Describe the muscular and neural structure of the lower part of the oesophagus
smooth muscles; Innervated by visceral motor neurons of vagus nerve with interruptions (-synapse with postganglionic neurons; cell bodies in oesophagus and splanchnic plexus)
26
Which nerves encircle the oesophagus>
encircled by nerves of the oesophageal plexus
27
What is the Dorsal vagal nucleus
cranial nerve nucleus for the vagus nerve in the medulla
28
Where is the DVN located?
It lies under the floor of the 4th ventricle
29
What is the role of the DVN?
Mostly serves parasympathetic vagal functions in the GIT, lungs and other thoracic and abdominal vagal innervations
30
What is the nucleus Ambiguus?
where the cell bodies for the preganglionic parasympathetic vagal neurons that innervate the heart reside
31
What is the role of the phrenic nerve?
Innervates the external & internal intercostal muscles and the diaphragm, it passing motor information to the diaphragm and receiving sensory information from it
32
Where is the phrenic nerve located?
originates in the neck (C3-C5) and passes down between the lung and heart to the diaphragm
33
How many phrenic nerves are there?
2, left and right
34
What innervates the phrenic nerve ?
The phrenic nerve receives innervation from parts of both the cervical plexus and the brachial plexus of nerves
35
What is the significance of the phrenic nerves?
Provide the only motor supply to the diaphragm as well as sensation to the central tendon. In the thorax, each phrenic nerve supplies the mediastinal pleura and pericardium
36
What controls the contraction of the crural diaphragm?
Contraction of the crural diaphragm is controlled by the inspiratory centre in the brain stem and the nucleus of the phrenic nerve
37
What innervates the crural diaphragm?
right and left phrenic nerves through ACh
38
What causes the swallow reflex?
Excitation of receptors in pharynx (oesophageal peristalsis and relaxation)
39
What is swallowing?
Swallowing is the coordinated opening and closing of the upper and lower oesophageal sphincters
40
Outline how the swallowing reflex takes place
1. The afferent stimulus travels to the sensory nucleus (nucleus solitarius, smaller upper inset). 2. Programmed events from DVN + nucleus ambiguus mediate oesophageal peristalsis and sphincter relaxation via NO /VIP 3. Efferent impulses pass to pharyngeal musculature and tongue 4. Vagal efferent fibres communicate with myenteric neurons that mediate relaxation of LOS (larger lower inset).
41
What are the functions of the oesophagus?
Swallowing (deglutition) | Conveys food and fluids from pharynx to stomach
42
How is swallowing initiated?
Swallowing is triggered by afferent impulses in the trigeminal, glossopharyngeal and vagus nerves
43
What causes swallowing to take place?
Efferent impulses pass to the pharyngeal musculature and the tongue - trigeminal, facial and hypoglossal nerves (tongue muscles)
44
Which impulses are required to integrate for swallowing to occur?
DVN, NTS and NA
45
Describe how swallowing is voluntarily initiated?
Voluntary action – collect material on tongue and push it backwards into pharynx (skeletal muscle, mucus membrane)
46
Describe how swallowing is involuntarily initiated?
Waves of involuntary contractions push the material into oesophagus Food moves from Mouth→oropharynx→laryngopharynx→oesophagus + stomach
47
What reflex responses occur during swallowing?
Inhibition of respiration - nasopharynx closed off Closure of glottis (around the vocal cords) by epiglottis Prevents food from entering the trachea Ring of peristaltic waves (4cm/sec) behind the material moves it towards the stomach
48
What causes food to move along the GI tract?
Progressive muscular contractions and relaxations move the food towards the stomach and along the GIT
49
What is swallowing difficulty caused by?
Swallowing difficulty (oropharyngeal dysphagia) is caused by: - UOS inability to open - Timing discoordination between UOS opening and pharyngeal push of ingested bolus
50
What is the purpose of secondary peristalsis?
allows any remnants of food to be moved on
51
Explain how secondary peristalsis occurs
Relaxation of upper oesophageal sphincter (UOS) – food passes UOS closes as soon as food passes Glottis opens Breathing resumes
52
Explain how primary and secondary peristalsis occur to aid swallowing
Lower oesophageal sphincter opens + stays open throughout swallowing LOS closes after material passed A large food material does not reach the stomach after the first peristaltic wave Stimulation of receptors upon distension of oesophagus lumen by the food → repeated waves of peristalsis (secondary peristalsis)
53
How is gastric reflex prevented ?
LOS – closes after material has passed “Pinchcock” effect of the diaphragmatic sphincter on the lower oesophagus Plug-like action of the mucosal folds in the cardia
54
What is the effect of the plug-like action of the mucosal folds?
Abdominal pressure acting on the intra-abdominal parts of the oesophagus Valve-like effect of oblique entry of oesophagus into stomach – in adults only
55
Explain how the UOS and LOS prevent gastric reflux?
form an opening when relaxed and closing completely when contracted there is an anti-reflux barrier in the region of gastro-oesophageal junction