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Semester 3 - Gastrointestinal > 6. Salivation and Swallowing > Flashcards

6. Salivation and Swallowing Flashcards

1
Q

What is the composition of saliva?

A

99% water and 1% various salts and solids

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2
Q

What is the ionic composition of saliva and why?

A

Hypotonic, tonicity depends on flow rate, Saliva produced at rapid rate so not enough time to chnage ionic composition

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3
Q

What 2 chemical compounds are rich in saliva?

A

Potassium and bicarbonate

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4
Q

What enzymes are found in saliva and what produces them?

A

Amylase (from salivary glands) and lipase (from lingual glands)

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5
Q

What different immune proteins are present in the saliva?

A

IgA, Lysozyme, lactoferrin

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6
Q

What is the function of the lactoferrin in saliva?

A

Sequesters iron, preventing it from being used by bacteria to prevent infections

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7
Q

What is the function of mucins in saliva?

A

lubrication

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8
Q

What are the different functions of saliva?

A
  • lubrication
  • protection
  • digestion
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9
Q

what does lubrication due to saliva help with?

A

swallowing

speach

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10
Q

how does saliva act as protection?

A
  • buffers acid
  • washes away debris stuck in teeth
  • antibacterial - lysozymes and lactoferrin
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11
Q

What in saliva helps to keep teeth healthy?

A

pH buffering of bicarbonates and immunological proteins

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12
Q

What is xerostomia?

A

Reduced flow of saliva in the oral cavity producing a dry mouth

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13
Q

What could possibly cause xerostomia?

A

Drugs, radiation treatment, salivary gland diseases (e.g. mumps)/removal, mouth breathing, autoimmune, dementia, dehydration

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14
Q

What drugs can cause xerostomia?

A

Antidepressants

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15
Q

What are the 3 different salivary glands?

A

parotid, submandibular, sublingual

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16
Q

Where is the parotid gland located?

A

Anterior to ear and SCM, between the zygomatic arch and inferior border of mandible

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17
Q

Where are the subamndibular and sublingual glands located?

A

In the floor of the mouth

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18
Q

What muscle separates the submandibular gland into its superficial and deep parts?

A

Mylohyoid muscle

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19
Q

how much saliva does each gland secrete?

A 
parotid = 25%, serous, + enzymes
submandibular = 70%, mixed
sublingual = 5%, mucous, - enzymes
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20
Q

what is the nerve supply to salivary secretion?

A

autonomic

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21
Q

What is the main neural control of the salivary glands?

A

Parasympathetic innervation (increases salivation)

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22
Q

What parasympathetic nerve innervates the parotid gland?

A

Glossopharyngeal nerve (CNIX)

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23
Q

What parasympathetic nerve innervates the submandibular and sublingual gland?

A

facial nerve

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24
Q

How does sympathetic innervation affect salivation?

A

Small sympathetic innervation causes small amounts of salivation, increases sympathetic innervation causes vasoconstriction and cessation of salivation

25
Q

describe how Saliva is hypotonic

A

• Initial saliva is isotonic and secreted by acinus
• Moved out of acinus into ducts by myoepithelial cells contraction
• Ductal cells are relatively impermeable to water
o However removes Na+ and Cl (water cannot follow)
o Secrete K+ and HCO3- ions
 More Na+ and Cl removed than K+ and HCO3- ions secreted
 Saliva ends up hypotonic

26
Q

describe effect of flow rate on saliva tonicty

A

• At low flow rates, increased contact time with ductal cells, most hypotonic
• At higher flow rates, less contact time with ductal cells, least modification
o Except for HCO3- ions which are selectively secreted at higher flow rates

27
Q

what can xerostamia lead to?

A

infections
tooth decay
halitosis

28
Q

What is mumps?

A

Viral infection of the salivary glands causing inflammation

29
Q

Why does mumps cause a lot of pain?

A

Parotid gland is enclosed in a tough fibrous capsule. This limits swelling of the gland, producing pain

30
Q

What nerve innervates the capsule of the parotid gland?

A

Trigeminal

31
Q

What do parotid stones in the duct cause?

A

Cause swelling of the parotid gland

32
Q

How might a parotid gland stone resolve itself?

A

Swelling of the parotid gland causes increase in pressure which may force the stone out of the duct into the mouth

33
Q

what is sjogrens syndrome?

A

Autoimmune disease —> dry mouth, swollen/painful salivary glands.

34
Q

What are SIALOLITHS? Hint : think of gallbladder

A

Salivary stones

–> calcified –> pain when salivating –> associated with eating

35
Q

what is the most common location of sialoliths?

A

WHARTONS DUCT

36
Q

What is the importance of WHARTONS DUCT?

A

It’s the duct connnecting glands to mouth esp the SUBMANDIBULAR gland.

37
Q

Which palate protects the oropharynx and nasopharynx respectively?

A

Hard palate protects OROPHARYNX

Soft palate protects NASOPHARYNX

38
Q

What are the 3 phases of swallowing?

A

Oral preparatory phase, Pharyngeal, Oesophageal

39
Q

Which of the swallowing phases are voluntary?

A

Oral phase

40
Q

What occurs the oral phase?

A

preparing bolus

Pushes bolus towards the oropharynx.

41
Q

When does the pharyngeal phase begin?

A

Once bolus touches the pharyngeal wall

42
Q

What occurs in the pharyngeal phase?

A
  • Soft palate elevates and seals off nasopharynx
  • Pharyngeal constrictors push bolus downwards
  • Larynx elevates, closing epiglottis
  • Vocal cords adduct (protecting airway) and breathing temporarily ceases
  • Opening of the upper oesophageal sphincter by relaxing
43
Q

What causes the larynx to elevate and what does this cause?

A

Elevates due to action of the suprahyoid muscles, which causes closing of the epiglottis.

44
Q

What happens in the oesophageal phase?

A
  • Closure of the upper oesophageal sphincter

* Peristaltic wave carries bolus downwards into oesophagus

45
Q

Where does the epiglottis sit in a baby?

A

Epiglottis sits higher up, causes liquids to flow laterally around it and into the oesophagus while still allowing the larynx to remain open.

46
Q

Which nerve has sensory fibres to the pharyngeal wall?

A

Glossopharyngeal nerve CNIX

47
Q

Which nerve has motor fibres to the pharngeal constrictor muscles?

A

Vagus nerve

48
Q

Describe the swallowing/gag reflex?

A

Mechanoreceptors in pharyngeal wall → glossopharyngeal nerve → medulla → vagus nerve → pharyngeal constrictors

49
Q

Define dysphagia.

A

Difficulty swallowing

50
Q

What are the 4 narrowings of the oesophagus?

A
  1. junction of oesophagus with pharynx
  2. where oesophagus is crossed by aortic arch
  3. where oesophagus is crossed by left main bronchus
  4. at the oesophageal hiatus (in diaphragm)
51
Q

What are the two different types of dysphagia?

A

Liquid - problems coordinating swallowing

Solid - blockage problems

52
Q

How would liquid dysphagia present?

A

ineffective swallowing - Dribbling

material entering resp tract - Coughing + Choking when attempt to swallow

53
Q

If caused by neurological problems, what is more difficult to swallow?

A

• Usually harder to swallow fluids (than solids) as these are more difficult to coordinate and
move as a unit into the GI tract
• Can more easily get into respiratory tract than solids

54
Q

If caused by physical obstruction to lumen, what is more difficult to swallow?

A

• Solids typically harder to swallow than fluids

55
Q

Causes of coordination problems w swallowing?

A

cerebrovascular accident
Parkinson’s disease
multiple sclerosis

56
Q

What causes blockages to swallowing/solid dysphagia?

A
  • Fibrous rings
  • Tumours
  • Achalasia-failure of LOS to relax
57
Q

Describe a suitable investigation for Dysphagia to solid foods

A

Barium swallow
OGD (oesophageal/gastro/duodenoscopy)
CXR to check for external compression of oesophagus

58
Q

What are some red flag signs for oesophageal cancer?

A

+55 years old
Cancer-like weight loss
Progressive dysphagia

59
Q

Why is dysphagia progressive in oesophageal cancer?

A

Tumour slowly grows bigger, blocking off more of the oesphagus so whereas small foods and liquids can get past, eventually they’ll be a complete blockage

Semester 3 - Gastrointestinal (17 decks)

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