Digestive System Prac Notes: Pharynx

Structure and function:

- A fibromuscular tube, forming part of
the upper alimentary canal (GI tract).
- Lies behind the tongue and soft palate.
- Somewhat conical in shape with the
narrow end terminating at the
oesophagus.
- Important for swallowing - allows
passage of bolus from the mouth into
the oesophagus.

Divided into 3 main sections:
- Nasopharynx behind the soft palate.
- Oropharynx extends from soft palate to hyoid bone - food and air from the mouth
passes through here.
- Laryngopharynx hyoid bone to the cricoid cartilage.

Walls of the pharynx consist of mucosal, submucosal and muscular layers.
The muscular layers:
- Constrictors upper, middle and lower consisting of circular smooth muscle.
- Stylopharyngeus long, thin strips of muscle which run longitudinally either side of the
pharynx, in front of and between the constrictores.
- Salpingopharyngeus
- Palatopharyngeus
Cell types:
- Non-keratinized stratified squamous epithelial cells (laryngopharynx and oropharynx)
- Smooth muscle cells
- Neural branching from the pharyngeal plexus, the external laryngeal and recurrent nerves
and the glossopharyngeal nerve.
- Ciliated epithelial cells (nasopharynx)
What will happen?
When the bolus of food reaches the back of the mouth, mechanoreceptors in the pharynx are
stimulated. This causes:
- the nasopharynx to be closed off by the soft palate.
- epiglottis to close off entry to the larynx.
- relaxation of the upper oesophageal sphincter.

Meanwhile: The stylopharyngei contract, which lifts the pharynx upwards and dilates it outwards.
This allows the bolus to be received as it is pushed into the pharynx by the tongue. The constrictors
then contract and relax in an alternating manner (upper, followed by middle and lower), causing the
diameter of the pharynx to narrow. The bolus is propelled into the oesophagus via the previously
relaxed upper oesophageal sphincter. This propelling mechanism is referred to as peristalsis.

Gastroesophageal reflux disease
GORD is caused by acid from the stomach travelling
backwards, up past the lower oesophageal
sphincter (LOS) and entering the oesophagus. This is
due to a lack of tone, or the absence of tone in the
LOS. When in the oesophagus, the stomach acid
and enzymes damage the lining, causing chemical
burns, which usually present as heart burn,
regurgitation or pain when swallowing. Chronic
exposure of the oesophagus to stomach contents
can lead to necrosis (cell death leading to ulcers) or strictures (narrowing) caused by constant
inflammation.
Causes
There is no definitive cause of GORD. However, there are multiple weak correlations between
lifestyle factors such as smoking and alcohol consumption. If the patient is obese, they may see
improvement in their symptoms with weight loss.
Treatment
While there is no cure for GORD there are treatments to can reduce/eliminate symptoms.
- Sleeping Position: If patients sleep with their head and torso elevated on their side this helps
to relieve symptoms by reducing acid in contact with the sphincter.
- Weight Loss leading to reduced pressure on the stomach
- Alkalising agents To reduce stomach pH
- Proton Pump inhibitors- Reduces proton formation in the stomach
- Gastric H
2
antagonists Reduces proton formation in the stomach
- Alginic Acid ( Gaviscon) Coats the oesophagus working as a physical barrier
- GABA
B
Agonist Reduces the lower oesophageal
sphincter relaxation strength
- Gastro prokinetic agent: Increases ACh concentrations
leading to increased peristaltic contractions and
stomach emptying. Prokinetic agents such as
metoclopramide increases contraction strength of the
lower esophageal sphincter.
Surgery
- Nissen fundoplication involves the stapling of the top
segment of the fundus around the lower oesophageal
sphincter, reinforcing its ability to close.
This condition does not affect digestion of food but may reduce intake due to pain of swallowing or a
perceived attack.

References
- Gray, H, 2000, Anatomy of the Human Body, 20
th
ed., Lea & Febiger, Philadelphia. [Electronic
book] from: www.bartleby.com/107/ (accessed September 6, 2011)
- Elaine N. Marieb and Katja Hoehn, 2006, Human Anatomy and Physiology , Seventh Edition.
- DeVault KR, Castell DO (1999). "Updated guidelines for the diagnosis and treatment of
gastroesophageal reflux disease. The Practice Parameters Committee of the American
College of Gastroenterology".
- Kahrilas, PJ (2008). "Clinical practice. Gastroesophageal reflux disease.". New England
Journal of Medicine. 359 (16): 17007
- Paul Moayyedi, and Nicholas J Talley. 2006. Gastro-oesophageal reflux disease. The Lancet
367, no. 9528, (June 24): 2086-100. http://www.proquest.com.ezproxy.lib.monash.edu.au/
- http://www.cortexity.com:8080/nicksblog/images/pharynx.jpg
- http://www.webmd.boots.com/heartburn-gord/guide/treating-with-
surgery&docid=TeNMUiEX5yDGhM&w=280&h=300&ei=6YVlTpDwB8zxmAXrvbysCg&zoom=
1&iact=hc&vpx=407&vpy=206&dur=4524&hovh=232&hovw=217&tx=123&ty=123&page=1
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