Functional and Diagnostic Aspects of Upper Digestive Tract

Hunger & Appetite

Disturbances of Hunger & Appetite

                       Hyperorexia: Hypermetabolic state, Diabetes mellitus, Psychic Emotional state
                            Parirexia:      Specific nutritional deficiency or need ( Ca, salt etc),  Pregnancy
                            Anorexia:     Anorexia nervosa, Pharmacologic effect, Excess smoking, Fever,
                                           Vitamin def., GI disorder ( Hepatitis, Ulcerative colitis ),                                                                Dehydration, Hypometabolic state, Neurogenic, Radiation therapy

Salivation, Mastication, Deglutition ( 3 stage: oral, pharyngeal and esophagus )

                            Swallowing & Deglutition of the Esophagus ( Stage of oral & Pharynx 省略不談)

                                   Essential physiologic requirement:

1. a suitable size & consistency of food
2. prevent of dispersal
3. creat a differential pressure
4. prevent chocking
5. rapid passage of food to shorten the respiration suspended time
6. prevent gastric reflux
7. final clearance

Motility
                   Oropharynx : peristalic wave is concentric
                        Laryngopharynx : "suck" the food into laryngopharynx,
                        Epiglotis : closing the air conduit → the distal travel of the stripping wave
                        Cricopharynx: co-ordination of the food vs air to GI and Ventilatory tract
                        Hypopharnx: starting peristalic wave continues without interrption into

                        The body of Esophagus : at the rate of 2 to 3 cm. per second

                        Terminal portion of the Esophagus ( 1 or 2 cm. above the hiatus esophagus )
                   "high-pressure zone" plays a significant role in the swallowing mechanism.
                        In the resting state: HPZ keep higher pressured than the body of esophagus.
                        As swallowing onset, HPZ ( physiologic valve ) prevent gastric reflux ( constriction)
                        and impulse the food to stomach ( relax) may monitor by motility test unit as well
                        as PH measurement.

PH manometry
 

Anatomic       : esophagogram, rigid or fiber-esophagoscopy, esophago-endoscopic-ultrasound,
                          CT image study etc.   surrouding check: bronchofiberscopy, mediastinoscopy,

                          Thoracoscopy, Caval system angiography etc.

Physiologic    : Static esophago-motility & PH manomery; vs Dynamic studies,  Continuous
                          24 hrs PH manometry and motility record; → computerized portable 24 hrs record .

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