Case 11 SBA Flashcards
What are the three paired salivary glands?
Parotid, submandibular, sublingual
What percentage of saliva is secreted from the main three glands?
90%
Describe the parotid glands
side of face by ears. Parotid duct passes through buccinator muscle and opens into the oral cavity on the inner surface of the cheek opposite the maxillary second molar. Mumps can cause swelling of this gland
Describe the submandibular glands
under mandible. Submandibular duct (Wharton duct) travels between sublingual gland and genioglossus. Drains into the mouth through the sublingual caruncles located either side of the frenulum of the tongue
Describe the sublingual glands
under tongue. 8-20 ducts of Rivinus drain the sublingual glands. Some form the sublingual duct of Bartholin and join the submandibular duct. Others drain into the mouth separately at the sublingual folds either side of the frenulum of the tongue
Sialolithiasis
Salivary stones - calcified deposits that can block ducts causing pain and swelling of the affected gland. Can lead to inflammation and/or infection
Who and where do salivary stones affect most?
Male
30-60
Submandibular gland (less common in parotid, rare in sublingual and other smaller glands)
Treatments for sialolithiasis
hydration and stimulation of secretion to flush out smaller stones
massage to encourage stone expulsion
sialendoscopy
surgical removal of stones or gland
Functions of saliva
Lubrication to facilitate mastication, swallowing, and speech
Digestion and absorption
Protection, oral and dental health
Contents of saliva for lubrication
Fluid, mucus, proline-rich proteins
Contents of saliva for digestion and absorption
alpha amylase - initiation of starch digestion
lingual lipase - initiation of lipid digestion
r-protein - haptocorrin, role in b12 absorption
Contents of saliva for protection, oral and dental health
lysozyme breaks down bacteria walls
lactoferrin sequesters iron to stop bacterial growth and makes cell walls more permeable
slows down viral replication
IgA
thiocyanate
proline-rich proteins
mucus
fluid
HCO3-
Why do bacteria proliferate overnight in the mouth?
Low rate of saliva production
Xerostomia
dry mouth
What causes salivary gland hypofunction?
decreased blood supply, secretory function, stimuli
Sjögren’s syndrome
Nerve damage
Drugs
What can salivary gland hypofunction lead to?
dental caries, ulceration, infections, discomfort, speech difficulties, taste, chewing, swallowing
Treatments of xerostomia
stimulate residual saliva, artificial saliva, and sugar free gum
What are the secretory units in the salivary glands?
Acini - produce all the fluid
Pathway from acinus to main duct in salivary glands
Acinus → intercalated duct → striated duct → intralobular duct → interlobular duct → lobar duct → main duct
Histology of submandibular glands
acinar/serous cells and mucus secreting cells
Histology of parotid glands
lots of serous/acinar cells
Parotid saliva type and percentage secreted
Serous, 20-25%
Sublingual saliva type and percentage secreted
Mucus/serous, <5%
Submandibular saliva type and percentage secreted
Serous/mucus, 60-65%
Other smaller salivary glands saliva type and percentage secreted
Mucus, 10%
Functional unit of saliva glands and contents
Salivon
acinus, mucus cell, myoepithelial cells, serous cells
Phases of saliva secretion
primary secretion from acini and secondary ductular modification
Is saliva hypertonic, isotonic, or hypotonic compared to plasma?
Hypotonic
What is secreted in primary secretion of saliva?
Na, Cl, mucin glycoprotein, proline-rich protein, IgA
What is primary saliva secretion mainly driven by?
Na/K/2Cl transporter - the movement of chloride ions
How are chloride ions secreted in primary saliva secretion?
Down the concentration gradient through chloride channels that are mostly calcium controlled or ligand-gated. the opening of the channels is mostly controlled by ACh
What is secreted in secondary modification of saliva?
Lysozyme and potassium in intercalated duct
Potassium and HCO3 in striated and other ducts
What is reabsorbed in secondary modification of saliva?
Chloride and sodium ions in striated and other ducts
How are Na and Cl reabsorbed in secondary modification of saliva?
Na through ENaC, Cl through paracellular route
How does cystic fibrosis impact on saliva secretion and compositon?
CFTR involvement so cystic fibrosis would reduce the concentration of HCO3 in saliva but does not affect volume of saliva
Parasympathetic control of saliva production (which nerves and neurotransmitters)
CNVII (facial) controls sublingual and submandibular, CNIX (glossopharyngeal) controls parotid. Profuse secretion of watery saliva. ACh and VIP (vasoactive intestinal peptide) used.
Sympathetic control of saliva production
small volume of saliva rich in proteins and mucus. Norepinephrine
Cephalic control of saliva production
unconditioned and conditioned. Food or irritating substance in the mouth (reflex) or thought, sight, and smell of food (Pavlov)
Sympathetic and parasympathetic control of blood supply to salivary glands
parasympathetic vasodilation via ACh and VIP,
sympathetic vasoconstriction via norepinephrine, vasodilation via bradykinin
Intrinsic pacemaker in the stomach
Interstitial cells of Cajal generate a sub-threshold oscillating membrane potential (need stimuli to get contraction)
Gastro-gastric reflexes (antrum and reservoir)
enteric nervous system.
distention of reservoir stimulates antral contraction, distension of antrum leads to prolonged relaxation of reservoir
Major excitatory neurotransmitters in gastric emptying
ACh and gastrin
Major inhibitory neurotransmitters in gastric emptying
NO, VIP, and ATP
Intestinal brake mechanism
gastric emptying inhibited by stomach contents entering small intestine. controlled by release of intestinal hormones and entero-gastric reflexes.
Hormones involved in intestinal brake mechanism
Increased secretin from acid, increased CCK from fats, decreased gastrin from acid
Increase and decrease of which nervous systems leads to delayed gastric emptying?
Increased sympathetic activity and decreased parasympathetic activity leads to decreased gastric emptying. Enteric and vagus involvement.
Motility functions of the stomach
reservoir for ingested foodstuffs (upper stomach), initial breakdown/digestion of foodstuffs, controlled emptying of contents into intestines (lower stomach)
Mechanisms involved in stomach acting as a reservoir
Receptive relaxation and gastric accommodation. Both involve relaxation of fundus and proximal corpus
Receptive relaxation mechanism
LOS and proximal stomach relax in anticipation of contents. Vagovagal reflex.
Where is the vagovagal reflex and what does it control ?
afferent and efferent fibres of vagus nerve coordinate responses to gut stimuli via dorsal vagal complex in brain. Controls contraction of GI muscle layers in response to distension of the tract by food and allows for accommodation of large amounts of food in tract
Stages of mixing and emptying of stomach contents
Propulsion, grinding, retropulsion and then repeat
Stomach propulsion
peristaltic contraction propels material towards antrum and occlusion of pylorus
Stomach grinding
churning of trapped material in antrum, only particles <2mm can pass through
Retropulsion of stomach
most of the bolus is returned to gastric body to be broken down
Which type of meal leads to a feeling of satiety for longer and why?
Fat-rich as fatty acids trigger a strong intestinal brake response
Peristalsis
movement of contents along the oesophagus caused by a wave of relaxation followed by contraction of smooth muscle
Triggers of primary and secondary peristalsis
Primary = swallowing, secondary = presence of luminal contents
Voluntary swallowing reflex
voluntarily forming bolus in the mouth –> move tongue back and up –> tips bolus into the pharynx
Involuntary swallowing reflex
triggered by bolus exerting pressure on pharyngeal wall –> soft palate elevation –> inhibition of respiration as larynx raised and glottis closed –> upper oesophageal sphincter relaxes/opens –> oesophageal peristalsis –> lower oesophageal sphincter opens, and bolus enters stomach