Clinical Correlations from Dr. Choudhury's saliva lecture

Question 1

Xerostomia

Answer 1

dry mouth due to absence of saliva production (drugs, radiation treatment, autoimmune disease).
buccal infections/dental caries
very common symptoms

Question 2

Sjorgen’s syndrome

Answer 2

autoimmune process-targets salivary and lacrimal glands
glandular atrophy and decreased saliva production (xerostomia), dry eyes (keratoconjuctivitis sicca)
difficulty in chewing, swallowing and speech.
dry oral mucosa, superficial ulceration, buccal infections/dental caries

Question 3

Drooling/ Ptyalism

Answer 3

excessive salivation due to increase nervous stimulation

treatment: anticholinergics and surgical removal of sublingual glands

Question 4

Parkinson’s, tumors of mouth/esophagus

Answer 4

increased saliva production due to unusual local reflexes and increase neurological stimulation

Question 5

cystic fibrosis

Answer 5

elevated Na+, Cl- and protein in saliva, sweat, pancreatic fluid & bronchial secretion
CF patients lacks CFTR or chloride transporter

Question 6

Addison’s

Answer 6

increase Na+ in saliva (↓ Na+ reabsorbed)

Question 7

Primary aldosteronism & Cushing’s Syndrome

Answer 7

decrease Na+ in saliva (↑ Na+ reabsorbed), salivary NaCl is zero, increase K+ levels

Question 8

digoxin therapy

Answer 8

increase Ca2+ & K+ in saliva

Question 9

vagotomy

Answer 9

(cutting of vagus nerve):

- inhibits gastric acid secretion 
- used to treat peptic ulcers
- side effects: delay in gastric emptying, diarrhea

Selective vagotomy:
-cutting vagal nerves supplying parietal cells only

Question 10

Peptic ulcer disease and aspirin

Answer 10

Aspirin (a weak acid) is easily
      absorbed in low pH of the stomach
Once absorbed it acts by acid 
      stimulating histamine release and
      disruption of local mucosa
Aspirin suppresses protective
      mucosal barrier production

Question 11

Peptic ulcer disease

Answer 11

Referred due to pathogenesis related to injurious
effects of gastric acid and pepsin
Common locations: esophagus, stomach, and duodenum
Both gastric ulcer disease and duodenal ulcer disease
Ratio of gastric ulcer to duodenal ulcer is 1:4

Question 12

gastric ulcer disease

Answer 12

Occurs in the gastric mucosa
Increased acid secretion (H. pylori increases gastrin secretion,
Pepsin remains active for too long
Failure in mucosal defense mechanisms (NSAIDS, H. pylori-70%)

Question 13

duodenal ulcer disease

Answer 13

Occurs in the duodenum
Increase acid secretion in the gastric region (H.pylori-100%)
Pepsin remains active for too long
Decrease bicarbonate secretion from pancreas (pancreatitis)

Question 14

Comparison of gastric, peptic and duodenal ulcers

Answer 14

Gastric ulcers: increased H+, pepsin; less mucosal protection
Peptic ulcers: increased H+, pepsin; less mucosal protection
Duodenal ulcers: increased H+ and pepsin, 2-3 X more parietal cells than normal

Question 15

ZES

Answer 15

Rare condition, one or more tumors form in pancreatic islet cells or duodenum.
These tumors are called gastrinomas that secrete large amounts of hormone gastrin.
gastrin secretion gastrin directly stimulates parietal cells HCl secretion.
gastrin secretion gastrin releases histamine from ECL, histamine HCl secretion.
gastric acid secretion both at rest and after meal.
Results in gastric and/or duodenal ulceration (common) due to acid and pepsin activity.

Question 16

Atrophic Gastritis: lack parietal cells

Answer 16

Chronic inflammation of gastric mucosa due to H.pylori gastric acid. Secretion of HCl, pepsin and intrinsic factor is impaired, leading to Vit B12 deficiency and anemia.

Question 17

pernicious anemia

Answer 17

autuimmune condition, antibodies against parietal cells and/or IF H+ and
somatostatin inhibition of gastrin, therefore gastrin but no H+
IF, therefore no Vit B12 absorbtion manifests as pernicious anemia-leads to neurological disorders

Question 18

proton pump inhibitors

Answer 18

Histamine potentiates effects of gastrin & ACh on parietal cells via H2 to release acid
Inhibiting H2 will decrease H+ release in the stomach
PPIs inhibits proton pump and decreases H+ release, increases gastric pH
Long term side effects of PPIs usage are:
Pneumonia
Clostridium difficle growth in gut
Osteoporosis