Physiology and Pathology: The Esophagus

Question 1

Where esophagus passes through the diaphragm?

Answer 1

Esophageal hiatus

Question 2

Esophageal Epithelium?

Answer 2

• Nonkeratinized stratified squamous epithelium
• Langerhans cells present

Question 3

Esophageal Lamina Propria? (2)

Answer 3

• Esophageal cardiac glands (2 clusters) - secrete mucous
• Lymphoid nodules

Question 4

Esophageal Muscularis Mucosa?

Answer 4

• Single layer of longitudinally smooth muscle

Question 5

Esophageal Submucosa?

Answer 5

• Dense, irregular fibroelastic CT
• Mucous and serous cells

Question 6

Esophageal Muscularis Externa?

Answer 6

• upper 1/3 mostly skeletal
• middle 1/3 mixed
• lower 1/3 mostly smooth muscle

Question 7

When does the esophagus go from adventitia to serosa?

Answer 7

Once it passes through the esophageal hiatus (diaphragm)

Question 8

Major arteries around esophagus? (2)

Answer 8

• Thoracic branches of aorta superiorly
• Branches of the left gastric artery inferiorly

Question 9

Major venous drainage of esophagus?

Answer 9

• Azygous vein
• Left gastric vein

Question 10

This interface is a pathologically important site of bleeding if the veins here rupture?

Answer 10

Where the portal circulation overlaps with systemic circulation
Esophageal branches => azygous vein

Question 11

What muscles compress the esophagus superiorly?

Answer 11

Muscles that move the larynx and hyoid upwards and anteriorly

Question 12

What are the major muscles for “pushing food down”?

Answer 12

• Cricopharyngeus muscle
• The rest of the inferior pharyngeal constrictor muscle

Question 13

What can happed in the “weak spot” just above the cricopharyngeus muscle?

Answer 13

Zencker Diverticulum = outpouching develops that food gets stuck in

Question 14

3 stages of swallowing?

Answer 14

1. Voluntary stage
2. Pharyngeal stage
3. Esophageal stage

Question 15

After the voluntary stage, swallowing becomes almost entirely _______

Answer 15

Automatic

Question 16

What type of stimulation is food in the larynx?

Answer 16

Tactile stimulation

Question 17

Why is it good that the soft palate is pulled upward in the pharyngeal stage of swallowing?

Answer 17

Blocks the nasal cavity

Question 18

Swallowing center?

Answer 18

Medulla

Question 19

What 2 nerves are mainly responsible for swallowing?

Answer 19

Vagus and Glossopharyngeal

Question 20

What does the swallowing center temporarily inhibit?

Answer 20

Respiratory center = halts respiration at any point in the cycle

Question 21

What results from distention of the esophagus by retained food, or by reflux of gastric contents into the esophagus?

Answer 21

Secondary peristalsis

Question 22

How long does secondary peristalsis happen for?

Answer 22

Until all the food has emptied into the stomach

Question 23

The lower esophageal sphincter normally remains _______ and _______

Answer 23

Tonic and constricted

Question 24

Is the resting pressure of the upper esophageal sphincter high or low?

Answer 24

High

Question 25

Is the resting pressure of the lower esophageal sphincter high or low?

Answer 25

Low

Question 26

When is the pressure in the lower esophageal sphincter higher?

Answer 26

After food has passed into the stomach

Question 27

What is relaxation of the lower esophageal sphincter mainly due to?

Answer 27

NO and VIP secreting branches of Vagus nerve

Question 28

Basic groups of esophageal pathologies? (4)

Answer 28

- Dysphagic/Motility disease - Inflammatory disease - Metaplastic/neoplastic disease - Vascular disease

Question 29

Visceral pain from the esophagus is well-localized, and excess distention cause relatively intense, brief chest pain

Answer 29

Nutcracker esophagus

Question 30

In nutcracker esophagus, outer longitudinal layer of smooth muscle ______ _______ inner circular layer

Answer 30

Contracts before

Question 31

What do the high-amplitude esophageal contractions of nutcracker esophagus cause?

Answer 31

Short-lived esophageal obstruction

Question 32

What is Diffuse Esophageal Spasm caused by?

Answer 32

Dysfunction in inhibitory nerves

Question 33

Is diffuse esophageal spasm common?

Answer 33

Yes

Question 34

What is characterized by incomplete LES relaxation, increased LES tone, and aperistalsis of the esophagus?

Answer 34

Achalasia

Question 35

Primary achalasia?

Answer 35

- Idiopathic - Caused by failure of distal esophageal inhibitory neurons

Question 36

If inhibitory neurons do not release NO or VIP after swallowing, what happens?

Answer 36

The lower esophageal sphincter won't relax

Question 37

Secondary achalasia? (2)

Answer 37

- Diabetic autonomic neuropathy - Malignancy

Question 38

What can the tropical infection Trypanosoma cruzi cause?

Answer 38

Secondary achalasia

Question 39

Clinical features of Achalasia? (3)

Answer 39

- Dyspepsia - Chest pain - Regurgitation

Question 40

Treatment for Achalasia?

Answer 40

- Botox - Myotomy

Question 41

What can iron-deficiency anemia or chronic reflux disease sometimes cause?

Answer 41

Fibrosis or non-malignant growths that obstruct the esophagus

Question 42

What can cause Infectious Esophagitis? (3)

Answer 42

- HSV (small “punched-out” lesions) - Cytomegalovirus (CMV) - Fungal organisms

Question 43

Autoimmune esophagitis causes? (3)

Answer 43

- Crohn's (rare) - Scleroderma - Eosinophilic esophagitis

Question 44

What are the more common findings of scleroderma?

Answer 44

Mostly obstructive and regurgitation (vs inflammatory findings)

Question 45

Population that Eosiniphilic esophagitis typically affects?

Answer 45

Children and Adults

Question 46

Esophagitis that is usually distributed throughout the length of the esophagus, with primarily esosinophilic inflammation

Answer 46

Eosinophilic Esophagitis

Question 47

Eosinophilic esophagitis has marked _____ cell hyperplasia and ________ of the submucosal papillae

Answer 47

Basal; Elongation

Question 48

In eosinophilic esophagitis, Th2 cells are responsible for an abundance of what in the serum of effected tissue?

Answer 48

IL-4, IL-5, IL-13

Question 49

Patients often have a Hx of what before GI Sx of Eosinophilic eso.?

Answer 49

Atopic illness

Question 50

Clinical features for children with eosinophilic eso.? (3)

Answer 50

- Nausea and vomiting - Small for age - Weight loss if severe

Question 51

Clinical features for adults with eosinophilic eso.? (3)

Answer 51

- Dysphagia - Food impaction - Chest pain

Question 52

Diagnosis of eosinophilic eso.? (2)

Answer 52

- Endoscopy - IgE levels often elevated

Question 53

What is the most common cause of esophagitis?

Answer 53

Reflux of gastric contents into lower esophagus

Question 54

Decreased LES tone or increased abdominal pressure likely contribute to ______

Answer 54

GERD

Question 55

Common findings of Reflux Esophagitis? (4)

Answer 55

- Hyperemia - Mild eosinophilic infiltration - Basal zone hyperplasia - Barrett's Esophagus

Question 56

Patches of red, velvety mucosa extending upward from the gastroesophageal junction that alternate with the smooth, pale normal esophageal mucosa

Answer 56

Barrett's esophagus

Question 57

In Barrett's Esophagus, metaplasia looks similar to _______ ________ _______– goblet cells are present – with time many will progress to dysplasia

Answer 57

Intestinal glandular epithelium

Question 58

Clinical features of Reflux esophagitis? (3)

Answer 58

- Dysphagia - Heartburn - Regurgitation (sometimes)

Question 59

Treatment for Reflux esophagitis?

Answer 59

PPIs or H2 Histamine receptor antagonists