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13. Gastrointestinal > 2. Salivation and Swallowing > Flashcards

2. Salivation and Swallowing Flashcards

1
Q

What is the purpose of the mouth?

A

It is the entrance to the GI tract and serves to disrupt foodstuffs and mix them with saliva to form boluses to swallow.

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2
Q

What do the teeth do?

A

Cut - incisors, and crush - molars, and mix food with saliva.

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3
Q

What are the powerful muscles of mastication?

A

The Masseter.

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4
Q

What nerve innervates the Masseter?

A

A branch of the trigeminal nerve.

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5
Q

What is the tongue?

A

A collection of 8 muscles.

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6
Q

What is the purpose of the tongue?

A

It manipulates food for mastication and forms it into a bolus. Aids in swallowing by pushing the bolus to the back of the mouth.

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7
Q

Where is the oropharynx?

A

Behind the oral cavity, below the nasopharynx but above the laryngopharynx. From the uvula to the level of the hyoid bone.

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8
Q

What is the purpose of the epiglottis?

A

To close over the glottis to prevent aspiration as both food and air pass through the oropharynx.

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9
Q

What is the oesophagus?

A

A muscular tube that passes food from the pharynx to the stomach.

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10
Q

What are the layers of the oesophagus?

A

From inside to out: mucosa, submucosa, and muscularis externa.

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11
Q

What makes up the mucosa layer of the oesophagus?

A

Non-keratinised stratified squamous epithelium, lamina propria and a layer of smooth muscle.

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12
Q

What makes up the submucosa layer of the oesophagus?

A

Mucous secreting glands.

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13
Q

What makes up the muscularis externa layer of the oesophagus?

A

Upper third is striated, skeletal muscle under conscious control for swallowing. The lower two thirds are smooth muscle under autonomic control for peristalsis.

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14
Q

What are the functions of saliva?

A

Lubricates and wets food, starts the digestion of carbohydrates, protects oral environment.

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15
Q

How does saliva protect the oral environment?

A

Keeps mucosa moist, washes teeth, maintains alkaline environment by neutralising acid produced by bacteria, and has a high Ca2+ concentration.

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16
Q

What is zerostomia?

A

Insufficient saliva production.

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17
Q

What are the consequences of zerostomia?

A

Can still eat food if it is moist, but teeth and mucosa degrade very quickly.

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18
Q

What are the constituents of saliva?

A

Water, electrolytes, alkali, bacteriostats, mucus, and enzymes.

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19
Q

What are the features of the three salivary glands?

A

Ducted, exocrine glands made up of blind-ended tubes lined with acinar cells.

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20
Q

What is the structure of exocrine glands?

A

Made up of blind-ended tubes lined with acinar cells. Te acini are connected via a system of ducts to a single outlet, lined by duct cells.

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21
Q

What are the three salivary glands?

A

Parotid glands, sub-lingual glands, and sub-maxillary glands.

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22
Q

What are the secretions from parotid glands?

A

Serous saliva, watery secretion rich in enzymes but little mucus.

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23
Q

What are the secretions from sub-lingual glands?

A

Mucous saliva, viscous secretion with no enzymes but lots of mucus.

24
Q

What are the secretions from the sub-maxillary glands?

A

Mixed serous and mucus secretions. Mixture of serous and mucus acini leading to a common duct.

25
Q

What is the percentage breakdown of where saliva comes from?

A

70% from sub-maxillary glands.
25% from parotid glands.
5% from sub-lingual glands.

26
Q

What is the mechanism of acinar secretions?

A

Cl- ions are actively secreted from acinar cells into the lumen of the duct. Water and other ions, like Na+, will then follow in passively.

27
Q

What is the role of Na/K ATPase in ductal modification?

A

In the basolateral membrane, it lowers the concentration of Na+ inside the cell. This means there is a concentration gradient, when the concentration of Na+ is high in the duct lumen and low in the duct cells. Na+ diffuses passively back into the duct cell. It also increases the concentration of K+ inside the cell so there is a gradient to drive the expulsion of Cl0 from the duct cells into the extracellular fluid. HCO3- is also driven into the duct lumen.

28
Q

What predominantly controls salivary secretion?

A

The autonomic nervous system.

29
Q

What is the overall effect of the parasympathetic nervous system in control of salivary secretion?

A

It increases the production of primary secretion and addition of HCO3-.

30
Q

How does the parasympathetic nervous system affect the parotid gland?

A

Glossopharyngeal nerve, 9th cranial, and otic ganglion.

31
Q

How does the parasympathetic nervous system affect the submandibular and sublingual glands?

A

Facial nerve, 7th cranial, and submandibular ganglion.

32
Q

What can block parasympathetic stimulation of the salivary glands?

A

Drugs like atropine that block the muscarinic receptors.

33
Q

What is outflow of the parasympathetic nervous system mediated by?

A

From centres in the medullar, afferent information from the mouth and tongue - taste receptors, especially acid, nose, and conditioned reflexes.

34
Q

What is the overall effect of the sympathetic nervous system in control of salivary secretion?

A

It reduces blood flow to the salivary glands, limiting salivary flow and producing the ‘dry mouth of anxiety’, signals through superior cervical ganglion.

35
Q

How does aldosterone affect salivary secretions?

A

It increases the rate of ductal recovery of Na+ so saliva is more hypotonic.

36
Q

What are the three phases of swallowing?

A

Voluntary phase, pharyngeal phase, and oesophageal phase.

37
Q

What is the voluntary phase of swallowing?

A

The tongue moves the bolus back onto the pharynx.

38
Q

What is the pharyngeal phase of swallowing?

A

Afferent information from pressure receptors in the palate and anterior pharynx reaches the swallowing centre in the brain stem. There is inhibition of breathing, raising of the larynx, closure of the glottis, opening of the upper oesophageal sphincter.

39
Q

What is the oesophageal phase of swallowing?

A

A wave of peristalsis sweeps down the oesophagus and propels the bolus to the stomach in 9 seconds. This is coordinated by extrinsic nerves from the swallowing centre of the brain and the lower oesophageal sphincter opens.

40
Q

What is dysphagia?

A

Difficulty swallowing.

41
Q

What is odynophagia?

A

Pain whilst swallowing.

42
Q

What might cause dysphagia?

A

The result of primary oesophageal disorder like motility problems of the smooth muscle preventing peristalsis - achalasia. Or secondary consequence of another issue like obstruction of the oesophagus from a tumour.

43
Q

What are the two categories for dysphagia?

A

Dysphagia for solids, and dysphagia for liquids.

44
Q

What is oesophageal dysphagia?

A

Dysphagia for solids.

45
Q

How is dysphagia for solids investigated?

A

With a barium swallow or endoscopy.

46
Q

What is oropharyngeal dysphagia?

A

Dysphagia for liquids.

47
Q

How is dysphagia for liquids investigated?

A

With a flexible endoscopy evaluation of swallowing, allows you to view the entire trachea/ oesophagus.

48
Q

What is a common cause of oropharyngeal dysphagia?

A

A stroke.

49
Q

How is the stomach protected against the strong acids and enzymes it makes?

A

The mucosa provides protection.

50
Q

Why is reflux of the stomach contents into the oesophagus a problem?

A

The mucosa of the oesophagus is not adapted to cope with the strong acids and enzymes of the stomach.

51
Q

What protects the oesophagus from the contents of the stomach?

A

The lower oesophageal sphincter that acts as a one way valve and the angle of His.

52
Q

What is Barrett’s oesophagus?

A

An abnormal change of the epithelial cells of the oesophagus. Metaplasia from non-keratinised stratified squamous epithelia to columnar epithelium and goblet cells.

53
Q

What is a risk of Barrett’s oesophagus?

A

Adenocarcinoma.

54
Q

What is gastro-oesophageal reflux disease?

A

The reflux of the stomach’s contents into the oesophagus and pharynx.

55
Q

What are some symptoms of gastro-oesophageal reflux disease?

A

Cough, hoarseness, and asthma.

13. Gastrointestinal (17 decks)

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