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GIR Test 1 > B5.005 - GI Physiology 1 > Flashcards

B5.005 - GI Physiology 1 Flashcards

1
Q

parotid gland

A

salivary gland 20% of saliva largest, serous, releases saliva on the inside of the cheek across from the second upper molars

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2
Q

submandibular gland

A

70% of saliva mucous and serous, releases saliva through the floor of the mouth behind the bottom front teeth

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3
Q

sublingual gland

A

5% of saliva mucous and serous, release fluid from under the tongue

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4
Q

stimuli for salivary gland

A

cephalic activity, chewing, nausea inhibited during sleep. fear, fatigue

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5
Q

major control of salivary secretions

A

parasympathetic

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6
Q

what causes vasodilation in salivary glands

A

VIP ACh

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7
Q

acinar serous cells in salivary glands are stimulated by what

A

ACh, NE, substance P, VIP

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8
Q

duct cells in salivary glands are stimulated by

A

ACh and NE

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9
Q

describe saliva relative to plasma

A

hypotonic relative to plasma, help with tasting of foods, diluting of substances like keeping glucose concentration down

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10
Q

what are mucins

A

lubricate and modulate adhesions of microorganisms

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11
Q

what do amylases do

A

break down starch to oligosaccharides

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12
Q

what do proline rich proteins do

A

they are antimicrobials

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13
Q

what does bicarb do

A

protects erosion of teeth, neutralizes gastric secretions that reflux into the esophagus

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14
Q

how many muscles and nerves are involved in swallowing

A

50 muscles and 6 cranial nerves for sensory and motor functions

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15
Q

describe the initiation of swallowing

A

initiation is under voluntary control while the ensuing sequence of events occur as a pattern elicited response (under involuntary control) which is not a true reflex

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16
Q

how is the swallow divided

A

oral pharyngeal esophageal phases

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17
Q

oral stage of swallowing

A

mastication/chewing breaks cell wall of plan tmaterial to expose contents the tongue and cheeks facilitate chewing by moving the food between the teeth food is mixed with saliva and formed into a bolus of the correct size and consistency for swallowing

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18
Q

what does the tongue do in the oral stage of swallowing

A

facilitates formation, containment and propulsion of bolus

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19
Q

describe the propulsion of food

A

tip of tongue pressed against the palate lateral regions form seals with alveolar ridges and pharyngeal walls tongue moves in a wave motion along central groove pushing the bolus back towards pharynx anterior 2/3 of tongue and negative pressure in pharyngoesophageal segment are primarily responsible for the driving force propelling the bolus towards the pharynx which results in the temporary suppression of respiration

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20
Q

bolus transit is impaired in what scenarios

A

following a tongue injury or lanryngectomy

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21
Q

describe neural control of swallowing

A

signals are transmitted along afferent nerves to the swallowing center in the brainstem the pattern of incoming signals is identified and produces an appropriate set of signals to other neurons that in turn coordinate the muscles involved with swallowing, opening of the upper esophagus sphincter, cessation of breathing and peristalsis in the esophagus

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22
Q

what is the cricopharyngeus muscle

A

a horizontal striated sphincter muscle located a the top of the esophagus makes up the UES together with non-muscular components

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23
Q

what does the cricopharyngeus muscle do

A

controls the flow of material between the pharynx and esphagus tonically contracted at rest and relaxes during swallowing, vomiting and belching

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24
Q

describe relaxation of cricopharyngeus

A

not direct inhibitory signals acting on the muscle, rather inhibition of firing that causes tonic contraction

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25
Q

mechanisms involved in preventing aspiration

A

prevention of premature spill rapid and coordinated movement of the bolus through the oral cavity and pharynx laryngeal elevation to move out of the way, laryngeal closure, epiglottis inversion bolus that does enter trachea triggers a strong cough

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26
Q

what is dysphagia

A

difficulty/pain/discomfort in swallowing

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27
Q

consequences of dysphagia

A

asphyxiation, aspiration pneumonia, dehydration, starvation, weight loss

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28
Q

who commonly gets dysphagia

A

elderly

29
Q

symptoms in disorders of oropharyngeal dysmotility

A

drooling gagging trouble swallowing wet voice hoarseness slow eating coughing choking sore through weight loss dyspnea fever, sweats

30
Q

describe the functional changes in the oral phase with oropharyngeal dysmotility

A

abnormal bolus control impaired swallow initiation abnormal bolus transport

31
Q

describe the functional changes in the pharyngeal phase with oropharyngeal dysmotility

A

muscle weakness or incoordination pharyngeal outflow obstruction

32
Q

functional deficites of oropharyngeal dysmotility can be categorized by what

A

phase of swallowing affected 1. difficulty initiating swallow 2. nasopharyngeal regurgitation 3. pulmonary aspiration 4. residual in vallecula (space between post aspect of tongue and epiglottis)

33
Q

describe how aspiration occurs

A

during the swallow there is poor opening of the UES and substantial retention of bolus within the hypopharynx. During a subsequent dry swallow some of this material enters the airway

34
Q

failure of UES relaxation may be caused by what

A

neuro disorders like parkinsons amyotrophic lateral sclerosis

35
Q

impaired opening of UES may be caused by what

A

cricopharyngeal fibrosis, suboptimal pharyngeal propulsion, neural problem zenkers diverticulum

36
Q

what is zenkers diverticulum

A

a structural disorder due to fibrosis of cricopharyngeus muscle resulting in increased intrabolus pressure during swallow

37
Q

hypopharyngeal intrabolus pressure is an indirect measure of what

A

UES compliance

38
Q

what is intrabolus pressure

A

the obstruction (resistance) to flow across the pharyngo-esophageal junction during swallowing

39
Q

what is nadir UES

A

the lowest pressure during relaxation; higher than normal can indicate diminished UES relaxation or diminished opening of UES

40
Q
A

zenkers diverticulum

herniation between inferior pharyngeal constrictor and cricopharyngeus

41
Q

presentation of zenkers diverticulum

A

disphagia

aspiration

regurgitation

halitosis

noisy deglutition

changes in voice

42
Q
A

normal cricopharyngeus muscle

43
Q
A

muscle dropout due to necrosis, variability in fiber size, increase in fibroadepose tissu

zenkers diverticulum

results in restricted opening of UES

44
Q
A

cricopharyngeal bar

associated with failure of teh cricopharyngeus to relax

when suprahyoid muscles contract the lumen of the open UES is obstructed by the contracted circopharyngeus that appears as a bar

45
Q

what types of muscle make up the esophagus

A

striated and smooth

46
Q

describe the layers of the esophageal muscle from superficial to deep

A

longitudinal muscle

circular muscle

esophagel glands

submucosa

muscularis mucosae

tunica propria

stratified squamus epithelium

lumen

47
Q

how long does a swallow last

A

8-10 s

48
Q

what is primary peristalsis

A

continued peristaltic wave from that started in pharynx aka stripping wave

49
Q

what is secondary peristalsis

A

if residual food in esophagus, initiated by intrsinsic nervous system and vago-vagal responses. Can have the same strenght and speed as primary peristalsis and is generated in absesce of a swallow

50
Q

in striated esophagus peristalsis is under what control

A

central control

51
Q

in the smooth muscle peristalsis is under what control

A

intrinsic

52
Q

describe the biochemical signaling happening to produce a swallow

A

upon swallowing the inhibitory pathway nuerons in the cuadal DMN are activated first, which acuses simultaneous inhibition of all parts of the esophagus. This inhibition lasts longer in the lower parts than the upper parts. As the inhibition ends, sequential activation of excitatory (cholinergic) neruons in the rostarl DMN elicits a contraction wave that is peristaltic in nature.

53
Q

describe the excitatory pathway in a swallow

A

includes vagal preganglionic neruons that are locatd in the rostral part of ht eDMN in the brainstem. Thes fiber project inot the excitatory postganglionic neruons that conatin ACh and substance P.

54
Q

describe the inhibitory pathway in a swallow

A

includes preganglionic vagal fibers that are located in the caudal part of teh DMN. The fibers project onto the postganglionic inhibitory neurons that contain NO, VIP and ATP and substance P.

55
Q

what happens when swallows are performed in rapid succession

A

the pharynx and UES respond on a one to one basis and the LES remains relaxed. peristalsis in the esophagus is inhibited until after the last swallow.

56
Q

localized esophageal motor disorders

A
  1. achalasia like syndromes
  2. diffues esophageal spansm
  3. nutcracker esophagus
  4. hypertensive LES
57
Q

diffuse esophageal motor disorders

A

GERD

scleroderma

myopathies

diabetes

parkinsons

idiopathic pseudo obstruction

58
Q

hypotensive peristalsis

A

contractions have a decreased strength leading to impaired esophageal transit

also can have impaired clearance of refluxed contents

main symptom is dysphagia although reflux symptoms may be present or predominate

59
Q

what labs would demonstrate hypotensive peristaltic contractions

A

espac eof barium bolus in proximal esophagus due to a weak peristaltic contractionw ave. shows a simultatnesou monometry nd fluoroscopy of a barium swallow

60
Q
A

scleroderma esophagus

61
Q

what is scleroderman esophagus

A

thought to have autoimmune origin

chronic disorder characterized by diffuse fibrosis of skin and internal organs. Damae to smallblood vessesl are often among earliest signs

62
Q

what is raynauds phenomenon

A

reducton of blood flow in response to cold or stress resultin gin idscoloration; white can turn to blue followed by flushing resulting in red appearance

63
Q

what is telangiectasia

A

dilated blood vessels near the surface of the skin

64
Q

what is hypertensive peristalsis

A

nutcracker esophagus

normal sequence of peristalsis on barium swallow, normal appearance on esophagoscophy, but smooth muslce contractions have excessive amplitude or duration as detected by manometry

symptoms include chest pain, dysphagia

65
Q

what is diffuse esophageal spasm

A

inhibitory nerves are disrupted leadin to simultaneous contraction in the smooth muslce of esophagus. contractions occur following swallowing or spontaneously. Deglutitive inhibition is also impaired.

66
Q

symptoms of diffuse esophageal spasm

A

chest pain, dysphagia, possible regurgitation

67
Q

what does a barium swallow of diffuse esophageal spasm look like

A

simultaneous contractions that appear corkscres, multiple ripples or sacculations

68
Q

what part of the esophagus is affected by esophageal spasm

A

the lower part (smooth muscle)

69
Q

what is deglutitive inhibition

A

A wave of inhibition precedes a swallow-induced peristaltic contraction in the smooth muscle part of the human oesophagus involving both circular and longitudinal muscles in a peristaltic fashion. Deglutitive inhibition is necessary for drinking liquids which requires multiple rapid swallows

GIR Test 1 (15 decks)

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