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?

<p>Relaxation (C)</p> Signup and view all the answers

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

<p>Segmental relaxation during swallowing (D)</p> Signup and view all the answers

What is the primary function of the upper intrinsic sphincter?

<p>To prevent the entry of air into the oesophagus. (B)</p> Signup and view all the answers

During swallowing, what happens to the upper intrinsic sphincter?

<p>It relaxes. (A)</p> Signup and view all the answers

What distinguishes primary peristalsis from secondary peristalsis?

<p>Primary peristalsis is triggered by the swallowing center in the brain stem. (B)</p> Signup and view all the answers

What role does secondary peristalsis play?

<p>Clearing the esophagus from retained bolus. (B)</p> Signup and view all the answers

What is the significance of the lower intrinsic sphincter?

<p>Prevents gastroesophageal regurgitation. (D)</p> Signup and view all the answers

How does the lower intrinsic sphincter respond during swallowing?

<p>It relaxes in response to the swallowing wave. (A)</p> Signup and view all the answers

What is a characteristic feature of tertiary peristalsis?

<p>Non-peristaltic contractions with no known physiological role. (A)</p> Signup and view all the answers

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

<p>The acute angle of insertion of the esophagus into the stomach. (B)</p> Signup and view all the answers

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

<p>Achalasia of the cardia (D)</p> Signup and view all the answers

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

<p>Loss of nerve ganglions along the esophageal wall (C)</p> Signup and view all the answers

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

<p>Manometry (C)</p> Signup and view all the answers

What is the primary goal of treating achalasia?

<p>Symptomatic relief from esophageal obstruction (D)</p> Signup and view all the answers

Which sign is associated with achalasia on imaging studies?

<p>Bird's beak or rat tail sign (D)</p> Signup and view all the answers

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

<p>Cause relaxation of LES smooth muscle (C)</p> Signup and view all the answers

What method involves injecting botulinum toxin to treat achalasia?

<p>Endoscopic injection in 4 quadrants (A)</p> Signup and view all the answers

What is a common complication associated with untreated achalasia?

<p>Esophageal cancer (A)</p> Signup and view all the answers

What is the standard therapy for patients with achalasia?

<p>Endoscopic balloon dilatation (B)</p> Signup and view all the answers

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

<p>70% (A)</p> 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?

<p>Sliding hiatus hernia (A)</p> Signup and view all the answers

Which of the following conditions can lead to gastroesophageal reflux?

<p>Higher intra-abdominal pressure (D)</p> Signup and view all the answers

What is Barrett's esophagus?

<p>A premalignant lesion with gastric-type epithelium (D)</p> Signup and view all the answers

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

<p>Division of the lower esophageal sphincter (A)</p> Signup and view all the answers

What is a common symptom of gastroesophageal reflux disorders?

<p>Superficial oesophagitis (C)</p> Signup and view all the answers

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

<p>80-100% (A)</p> Signup and view all the answers

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

<p>Oral Preparatory Phase (A)</p> Signup and view all the answers

What occurs during the pharyngeal phase of swallowing?

<p>The airway is closed to protect against aspiration. (B)</p> Signup and view all the answers

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

<p>Upper esophageal sphincter (C)</p> Signup and view all the answers

What initiates the swallowing reflex?

<p>Voluntary pushing of the bolus by the tongue (B)</p> Signup and view all the answers

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

<p>Upper part is striated while the lower is smooth. (A)</p> Signup and view all the answers

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

<p>To push food through the esophagus (B)</p> Signup and view all the answers

Which phases of swallowing can be stopped once initiated?

<p>Pharyngeal Phase (C)</p> Signup and view all the answers

What are the components of the two esophageal sphincters?

<p>Both intrinsic and extrinsic components (C)</p> Signup and view all the answers

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

<p>Guide and contain food (C)</p> Signup and view all the answers

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

<p>Uvula (D)</p> Signup and view all the answers

What role do taste buds play in oral physiology?

<p>Detect different flavors (B)</p> Signup and view all the answers

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

<p>Increasing food surface area (A)</p> Signup and view all the answers

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

<p>Amylase (D)</p> Signup and view all the answers

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

<p>Lysozyme (B)</p> Signup and view all the answers

Salivary secretion can be controlled by which type of reflex?

<p>Pavlovian conditioned reflexes (A)</p> Signup and view all the answers

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

<p>Parotid gland (D)</p> Signup and view all the answers

Flashcards

Lips

The opening of the mouth formed by the lips, used for acquiring and guiding food into the mouth, essential for speech, and sensitive to touch.

Palate

The roof of the mouth, separating the oral cavity from the nasal passage, preventing food from entering the nose during swallowing.

Uvula

A flap of tissue at the back of the mouth that closes off the nasal passages when you swallow.

Tongue

The floor of the mouth, made of skeletal muscle, crucial for chewing, swallowing, and speech.

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Pharynx

A passage at the back of the throat that connects the mouth and nose to the digestive and respiratory systems.

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Tonsils

Small masses of tissue in the side walls of the pharynx, important for immune function.

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Teeth

Hard structures in the mouth used for breaking down food into smaller pieces. Makes swallowing easier and increases the surface area for enzymes to work on.

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Saliva

A fluid produced by salivary glands, primarily composed of water, electrolytes, and proteins. It starts digestion of carbohydrates, moistens food, lubricates, and has antibacterial properties.

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Swallowing Reflex

A reflex triggered when food is pushed by the tongue to the back of the mouth.

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Oral Preparatory Phase

This phase involves chewing and forming the bolus of food.

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Oral Transit Phase

In this phase, the tongue pushes the bolus towards the back of the pharynx.

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Pharyngeal Phase

This phase focuses on protecting the airway during swallowing, closing the vocal cords and raising the larynx.

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Esophageal Phase

This phase involves the movement of the bolus through the esophagus to the stomach.

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All-or-None Reflex

An involuntary, programmed reflex that occurs in sequence, either completely or not at all, once initiated.

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Pharyngo-esophageal Sphincter

The upper sphincter of the esophagus, it helps prevent large amounts of air from entering the esophagus and stomach.

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Gastro-esophageal Sphincter

The lower sphincter of the esophagus, it prevents the reflux of stomach contents back into the esophagus.

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Upper Intrinsic Sphincter

A ring of muscle at the top of the esophagus that prevents air from entering the esophagus and works with the larynx to stop food from going into the airway during swallowing.

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Esophageal Peristalsis

The spontaneous, wave-like contractions of muscles in the esophagus that push food downwards.

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Primary Peristalsis

This type of peristalsis is triggered by the brain and starts at a speed of 2cm/s.

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Secondary Peristalsis

This type of peristalsis happens when something is left behind in the esophagus, such as food or stomach acid.

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Tertiary Peristalsis

These contractions in the esophagus are not related to normal swallowing, and they don't serve a clear purpose. They are more common in older people.

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Lower Intrinsic Sphincter

A strong ring of smooth muscle at the bottom of the esophagus that prevents stomach contents from flowing back up.

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Right Crus of the Diaphragm

The muscle that helps the lower sphincter to keep the stomach contents from going back up into the esophagus.

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Gastroesophageal Reflux (GER)

A condition where stomach acid flows back into the esophagus, often caused by a weak lower sphincter.

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Diffuse Esophageal Spasm (DES)

Characterized by simultaneous, repetitive strong contractions, often causing pain and difficulty swallowing. Occurs due to nerve damage and muscular thickening making the esophagus hypersensitive.

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Achalasia

A condition where the lower esophageal sphincter (LES) fails to relax, preventing food from moving into the stomach. It results from the loss of nerve cells (Auerbach's ganglion) in the esophageal wall.

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Lower Esophageal Sphincter (LES)

The lower esophageal sphincter (LES) is the muscular ring at the bottom of the esophagus that normally relaxes to allow food into the stomach.

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Dysphagia

A condition characterized by difficulty swallowing, pain, and sometimes regurgitation of food. It's often associated with the feeling of food getting stuck in the chest.

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Auerbach's Ganglion

The nerve cells responsible for controlling muscle movement in the esophagus and its sphincters.

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Cardia

The region of the lower esophageal sphincter and gastro-esophageal junction.

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Weak/ Absent Peristalsis

Weak or absent peristaltic waves in the esophagus, causing food to accumulate and leading to dilation. This is characteristic of achalasia.

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Hypertonic LES

An increase in the pressure of the LES, often exceeding 40 mmHg in achalasia, further contributing to the difficulty in swallowing.

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Botulinum Toxin Injection

A procedure used to treat achalasia by injecting botulinum toxin into the LES, temporarily paralyzing the muscles and improving relaxation.

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Nitrate and Ca Channel Blockers

The use of medications like nitrates and calcium channel blockers to relax the LES muscles in patients with achalasia.

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Surgical or Balloon Dilatation

Surgical or balloon dilatation procedures aimed at widening the LES to relieve the obstruction in achalasia.

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What is Achalasia?

A condition where the lower esophageal sphincter (LES) doesn't relax properly, preventing food from passing into the stomach, causing difficulty swallowing and chest pain.

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What is Endoscopic Balloon Dilatation?

Endoscopic balloon dilatation is a standard treatment for achalasia, where a balloon is inserted into the esophagus to stretch the LES, allowing for easier food passage.

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What is Heller Myotomy?

Heller Myotomy is a surgical procedure where the LES is cut to improve its ability to relax and allow food to pass into the stomach. Done laparoscopically (minimally invasive) or thoracoscopically (chest incision).

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What is POEM?

Per Oral Endoscopic Myotomy (POEM) is a minimally invasive endoscopic approach where the LES is cut from inside the esophagus. This is another way to improve food passage.

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What is Gastroesophageal Reflux Disorder (GERD)?

A condition where stomach acid or alkaline secretions reflux back into the esophagus, causing inflammation and other symptoms like heartburn.

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What is a Sliding Hiatus Hernia?

A type of hiatus hernia where the stomach protrudes into the chest through a widened opening in the diaphragm, but the junction between the esophagus and stomach remains in its normal location.

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What is a Paraesophageal Hiatus Hernia?

This is another type of hiatus hernia where a portion of the stomach pushes up through the diaphragm, but the junction between the esophagus and stomach remains below the diaphragm.

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What is Barrett's Esophagus?

A precancerous condition where the lining of the lower esophagus changes to resemble the lining of the stomach, increasing the risk of esophageal cancer.

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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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Related Documents

Chapter 16 The Digestive System PDF

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.

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