Esophageal Disorders and Function

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Questions and Answers

What characterizes diffuse oesophageal spasm (DES)?

Loss of vagal nerve fibers

Simultaneous repetitive high pressure contractions (correct)

Thinning of the muscular wall

Distended lower esophageal sphincter

What is the predominant pathophysiology of achalasia?

Loss of Auerbach ganglion cells (correct)

Hypertrophy of the muscular wall

Fragmental degeneration of nerve fibers

Increased sensitivity to stretching

Which statement regarding achalasia is true?

It is characterized by simultaneous contraction of the esophagus.

It leads to increased relaxation of the lower esophageal sphincter.

It is the most common esophageal motility disorder.

The incidence is approximately 1-3 per 100,000 population per year. (correct)

What does the term 'chalasis' relate to in the context of achalasia?

Relaxation Signup and view all the answers

Which of the following features is NOT associated with diffuse oesophageal spasm?

Segmental relaxation during swallowing Signup and view all the answers

What is the primary function of the upper intrinsic sphincter?

To prevent the entry of air into the oesophagus. Signup and view all the answers

During swallowing, what happens to the upper intrinsic sphincter?

It relaxes. Signup and view all the answers

What distinguishes primary peristalsis from secondary peristalsis?

Primary peristalsis is triggered by the swallowing center in the brain stem. Signup and view all the answers

What role does secondary peristalsis play?

Clearing the esophagus from retained bolus. Signup and view all the answers

What is the significance of the lower intrinsic sphincter?

Prevents gastroesophageal regurgitation. Signup and view all the answers

How does the lower intrinsic sphincter respond during swallowing?

It relaxes in response to the swallowing wave. Signup and view all the answers

What is a characteristic feature of tertiary peristalsis?

Non-peristaltic contractions with no known physiological role. Signup and view all the answers

What anatomical feature helps prevent reflux from the stomach into the esophagus?

The acute angle of insertion of the esophagus into the stomach. Signup and view all the answers

What is characterized by failure of the lower esophageal sphincter (LES) to relax completely during swallowing?

Achalasia of the cardia Signup and view all the answers

What leads to the dilation of the body of the esophagus in achalasia?

Loss of nerve ganglions along the esophageal wall Signup and view all the answers

Which diagnostic method may reveal elevated LES pressure greater than 40 mmHg in patients with achalasia?

Manometry Signup and view all the answers

What is the primary goal of treating achalasia?

Symptomatic relief from esophageal obstruction Signup and view all the answers

Which sign is associated with achalasia on imaging studies?

Bird's beak or rat tail sign Signup and view all the answers

What effect do nitrate and calcium channel blockers have in the treatment of esophageal motility disorders?

Cause relaxation of LES smooth muscle Signup and view all the answers

What method involves injecting botulinum toxin to treat achalasia?

Endoscopic injection in 4 quadrants Signup and view all the answers

What is a common complication associated with untreated achalasia?

Esophageal cancer Signup and view all the answers

What is the standard therapy for patients with achalasia?

Endoscopic balloon dilatation Signup and view all the answers

What is the response rate for balloon dilatation in achalasia treatment?

70% Signup and view all the answers

What type of hernia is associated with the proximal stomach ascending into the chest through a lax diaphragmatic opening?

Sliding hiatus hernia Signup and view all the answers

Which of the following conditions can lead to gastroesophageal reflux?

Higher intra-abdominal pressure Signup and view all the answers

What is Barrett's esophagus?

A premalignant lesion with gastric-type epithelium Signup and view all the answers

What surgical method is used in Heller Myotomy to treat achalasia?

Division of the lower esophageal sphincter Signup and view all the answers

What is a common symptom of gastroesophageal reflux disorders?

Superficial oesophagitis Signup and view all the answers

What is the response rate for surgical treatment of achalasia using Heller Myotomy?

80-100% Signup and view all the answers

Which phase of swallowing involves chewing and formation of the bolus?

Oral Preparatory Phase Signup and view all the answers

What occurs during the pharyngeal phase of swallowing?

The airway is closed to protect against aspiration. Signup and view all the answers

Which structure is responsible for preventing the entry of air into the esophagus during breathing?

Upper esophageal sphincter Signup and view all the answers

What initiates the swallowing reflex?

Voluntary pushing of the bolus by the tongue Signup and view all the answers

How are the upper and lower parts of the esophagus differentiated in terms of musculature?

Upper part is striated while the lower is smooth. Signup and view all the answers

What is the main function of peristaltic waves in the esophagus?

To push food through the esophagus Signup and view all the answers

Which phases of swallowing can be stopped once initiated?

Pharyngeal Phase Signup and view all the answers

What are the components of the two esophageal sphincters?

Both intrinsic and extrinsic components Signup and view all the answers

What is the primary function of the lips in the mouth?

Guide and contain food Signup and view all the answers

Which structure is responsible for sealing off the nasal passages during swallowing?

Uvula Signup and view all the answers

What role do taste buds play in oral physiology?

Detect different flavors Signup and view all the answers

What purpose does chewing (mastication) serve in the digestive process?

Increasing food surface area Signup and view all the answers

Which of the following components primarily begins the digestion of carbohydrates in saliva?

Amylase Signup and view all the answers

What substance in saliva helps to keep the mouth and teeth clean?

Lysozyme Signup and view all the answers

Salivary secretion can be controlled by which type of reflex?

Pavlovian conditioned reflexes Signup and view all the answers

Which major salivary gland is located in front of the ear?

Parotid gland Signup and view all the answers

Study Notes

The Digestive System

The digestive system is a complex system with several stages and components
The mouth initiates the digestion process
Involved are lips, palate, tongue, and teeth
Saliva is vital with a composition of mostly water, electrolytes, and enzymes like amylase
Functions of the mouth are chewing, mixing with saliva, and stimulating taste buds
Saliva contains amylase to start carbohydrate digestion, mucus for lubrication and lysozyme to help fight bacteria
Salivary secretion is regulated via simple and conditioned reflexes
The swallowing process is divided into four phases: oral preparatory, oral transit, pharyngeal, and esophageal
The pharynx and esophagus are responsible for transporting the bolus.
The esophagus is a muscular tube that moves food down to the stomach.
The esophagus has sphincters at each end to prevent air or reflux
Motility, particularly peristalsis, plays a critical role in esophageal function

Swallowing

Swallowing is a sequential, all-or-none reflex that moves food from the mouth into the esophagus
The process is initiated voluntarily but cannot be stopped once it starts
Oropharyngeal stage, moving the bolus from the mouth through the pharynx and into the esophagus
Airway protection is critical in this stage
Epiglottis covers the trachea
Oesophageal stage, pushing the bolus down the esophagus

The Esophagus

The esophagus is a muscular tube connecting the pharynx and stomach
It's primarily involved in transporting food to the stomach
The upper two-thirds of the esophagus are striated muscle, while the lower third is smooth muscle
Sphincters control the flow of food
Two main sphincters are pharyngo-esophageal and gastroesophageal
Peristalsis propels food through the esophagus
The esophagus also secretes mucus to protect its lining

Oesophageal Motility Disorders

Diffuse esophageal spasm (DES) features simultaneous, repetitive high-pressure contractions within the esophagus. It's related to vagal nerve fiber degeneration. The esophageal wall is thick, hypertrophied, and hypersensitive to stretching
Achalasia is the failure of the lower esophageal sphincter (LES) to relax during swallowing. This can lead to food stasis and esophageal dilation and shows a "bird's beak" or "rat tail" sign. The loss of nerve ganglions is the main pathophysiology. Incidence is 1–3 per 100,000 population/year
Treatments consist in balloon dilatation, Botox injections, surgery (Heller Myotomy) or Per Oral Endoscopic Myotomy (POEM)

Gastroesophageal Reflux Disorders (GERD)

Reflux is a symptom of abnormalities involving the diaphragmatic hiatus
Features of reflux can occur with various esophageal conditions, often including motility disturbances
The main forms are hiatus hernia with reflux and reflux without abnormal anatomy
Sliding hiatal hernia occurs when a portion of the stomach enters the chest through a widened esophageal hiatus
Risk factors include intra-abdominal pressure and aging
Contribute to GERD by reducing the acute angle of the esophagus insertion into the stomach.

Pathophysiology of Reflux

Acid or alkaline secretions reaching the lower esophagus can cause mucosal inflammation (oesophagitis)
Structural changes, such as strictures (narrowing of the esophagus) or metaplastic changes (development of gastric tissue in the esophagus; Barrett's esophagus). This is a precancerous condition.

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Description

Test your knowledge on esophageal disorders such as diffuse oesophageal spasm and achalasia, as well as the physiological functions of intrinsic sphincters. This quiz covers key concepts in gastrointestinal physiology, helping you understand the mechanisms behind peristalsis and sphincter function.