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GEM > 2.01 Swallowing and Motility > Flashcards

2.01 Swallowing and Motility Flashcards

1
Q

saliva helps to form a bolus with what key components?

A

water, electrolytes, enzymes (amylase), mucins

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2
Q

what do the lingual lipase and alpha amylase enzymes in saliva digest respectively?

A

initial triglycerides and starch

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3
Q

what kind of reflex is swallowing?

A

parasympathetic

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4
Q

what are the three main phases of swallowing?

A

oral, pharyngeal, and esophageal

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5
Q

what phases of swallowing are involuntary and controlled by the brainstem?

A

pharyngeal and esophageal

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6
Q

How is the upper 1/3 of esophagus innervated and muscle makeup?

A

striated (somatic), via CN IX and CNX

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7
Q

How is the lower 2/3 of esophagus innervated and muscle makeup?

A

smooth muscle (ENS & ANS) CNX

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8
Q

during esophageal peristalsis how is the process alternating and generating pressure to move bolus?

A

contract above generating positive pressure to push bolus into relaxed portion below with negative pressure

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9
Q

What is the LES doing under normal conditions?

A

contracted to maintain high pressure barrier (sympathetic innervation)

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10
Q

how is the peristalsis contraction wave triggered?

A

presence of bolus in UES decreasing the pressure + neuronal response leading to the LES relaxing a bit

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11
Q

What is the baseline pressure of the UES, esophageal body, and LES?

A

UES and LES = high to maintain contraction (closed sphincter)

esophageal body is relatively low

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12
Q

What happens once you swallow to the LES baseline pressure?

A

it falls (muscle relaxes) to pass bolus and steadily increases to high resting pressure

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13
Q

Why does the UES in particular have such a quick spike up in baseline pressure faster swallowing?

A

to prevent backflow of bolus/content to the pharynx

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14
Q

swallowing initiates what response from brainstem?

A

vagal CNX

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15
Q

Key NT needed to relax LES?

A

NO and VIP

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16
Q

what state does the sphincter muscle have to be in to allow LES relaxation?

A

hyperpolarization

17
Q

What is the neuronal pathways to relax the LES? (PARA)
extrinsic vagal response

A

(pregang vag) myenteric plexus synapse
Ach to N2 receptors on inhibit motor neurons (post gang) that release NO and VIP that bind to sGC and VAPC1 to hyperpolarize the PDGFR a+ cell to cause smooth muscles hyperpolarization (or directly)

18
Q

What are the neuronal pathways to relax the LES? (PARA)
ENS/INTRINSIC response

A

descending IPAN
Ach - N2
descending interneuron* (+/-)
Ach - N2 receptor
inhibit motor neuron
PDGFRa+ - NO and VIP release to sGC and VAPC
smooth muscle cell relax

19
Q

What is the neuronal tone pathway for normal tone of the LES?

A

thoracolumbar pre gang (T5-L2)
prevertebral celiac ganglia Ach to N2
post ganglionic NE to B2 (esophageal body relax) or a1 (LES contract) at myenteric plexus varicosities

20
Q

Failure for the LES to relax leading to dysphagia is called?

A

Achalasia

21
Q

What is a common cause/dysfunction found in achalasia?

A

dysfunction of post ganglionic inhibitory motor nuerons

22
Q

GERD is associated with what problem to the LES?

A

spontaneous relaxation of LES that leads to very low (<5) resting pressure and retrograde flow of gastric contents

23
Q

What common drug is known to relax smooth muscle and potentially lead to GERD symptoms? What condition?

A

CCB for HTN
blocks calcium needed in smooth muscle cells to relax

24
Q

What can cause a hypotensive LES?

A

inadequate barrier function, reflux trigger sensitivity, mucosal damage

25
Q

GI symptoms of chagas targets what part of LES that can lead to a megaesophagus?

A

destruction of neurons in the submucosal and myenteric plexus - LES cant relax and accumulates pressure

26
Q

Do ICCs create action potentials?

A

NO, they make slow wave potentials that move rhymical via ion channels that precede an AP and typically cannot trigger itself (smooth muscle contraction)

27
Q

Distention of the gut with a food bolus leads activates what via stretch?

A

IPAN (excitatory) nerves

28
Q

What is being release alongside ICC to raise the threshold to activate an AP to trigger smooth muscle contraction?

A

Ach and SubP

29
Q

What are the unique characteristics of slow wave membrane potentials when at rest, stimulated, or inhibited at the GI tract?

A

Rest = slow waves and some spikes = some muscle tone

stimulated = more slow waves, more spikes = more muscle tone

inhibited = less slow waves, no spikes = no muscle tone

30
Q

what are the frequency GI contractions of the stomach?

A

3-5 contract/min

31
Q

what are the frequency GI contractions of the small intestine?

A

12-20 contract/min

32
Q

what are the frequency GI contractions of the large intestine?

A

6-8 contract/min

33
Q

what generally can help depolarize membrane for GI contraction?

A

stretched muscle
parasympathetic stim
Ach

34
Q

what generally can help REpolarize membrane for GI contraction?

A

NE
sympathetic stim

GEM (28 decks)

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