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DIG > L03 - Functions of the mouth/ oesoph and ass diseases > Flashcards

L03 - Functions of the mouth/ oesoph and ass diseases Flashcards

1
Q

What are the function of acinar cells?

A

Exocrine glands producing enzymes

e.g. a amylase

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2
Q

What are the function of ductal cells?

A
  • Produces mucous (goblet cells)
  • Secrete water and electrolytes
  • Stimulated by hormone secretin
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3
Q

What is the total approx vol of liquid secreted from mouth per 24 hours?

A

1.5L

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4
Q

What is the histological type/ type of secretion/ % of total secretion from the parotid gland?

A
  • Serous
  • Water
  • 20%
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5
Q

What is the histological type/ type of secretion/ % of total secretion from the submandibular gland?

A
  • Mixed
  • Viscous
  • 70% (majority)
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6
Q

What is the histological type/ type of secretion/ % of total secretion from the sublingual gland?

A
  • Mucous
  • More viscous than submandibular secretion
  • 10%
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7
Q

Why is saliva needed?

A
  1. Lubrication
  2. Hydration
    - Keeps the oral mucosa moist and prevents dehydration and cell death
  3. Cytoprotection
    - Protects oral and oesophageal mucosa from damage
  4. Immune function
    - Antibacterial properties
    - Salivary secretions play an important role in protection from pathogens
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8
Q

Which enzymes can be found in saliva have serve an immune function?

A
  1. IgA
    - IgA antibodies bind to pathogenic antigens
  2. Lactoferrin
    - Binds iron and is bactericidal
  3. Lysozyme
    - Attacks bacterial cell wall (cell lysis)
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9
Q

Why does saliva need to be alkaline?

A
  1. Protects teeth from bacterial acid

2. Neutralises gastric acid that refluxes into the oesophagus

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10
Q

How do salivary duct cells affect secretions of acinar cells?

A

Salivary duct cells modify the secretion of acinar cells:
- Extracts Na+ amd Cl-
- Secretes K+ and HCO3-
=> Therefore saliva is hypotonic and alkaline

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11
Q

What is Sjogrens syndrome?

A
  • AI attack of salivary and tear glands which results in dry mouth and eyes (xerostomia - dry mouth)
  • Commonly affects women, assoc with RA
  • ANA (anti-nuclear antibody) and rheumatoid factor
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12
Q

What is mumps virus (patotitis)?

A
  • Prodrome of headache and fever
  • Assoc with orchitis (inflammation of testicles)
  • MMR vaccine available
  • Swelling of parotid glands
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13
Q

What is the innervation of the salivary glands (general)

A

ANS controls secretion

- Predominantly via the parasympathetic NS

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14
Q

Which glands does the parasympathetic NS innervate? (and which ganglion)

A

CN VII –> Submandibular and sublingual [submandibular ganglion]
CN 1X –> Parotid [otic ganglion]
Effect of stimulus –> secretion

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15
Q

Which glands does the sympathetic NS innervate? (and which ganglion)

A

Thoracic sympathetics –> ALL salivary glands [superior cervical ganglion]
Effect of stimulus –> vasoconstriction
–> thick mucous secretion

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16
Q

What are the 4 phases to swallowing?

A
  1. Oral preparatory phase
  2. Oral phase
  3. Pharyngeal phase
  4. Oesophageal phase
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17
Q

What happens in the oral preparatory phase of swallowing?

A

Food is manipulated in the mouth and masticated to reduce to a consistency which can be swallowed

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18
Q

What happens in the oral phase of swallowing?

A

The tongue propels food posteriorly until the phrayngeal swallow (reflex) is triggered

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19
Q

What happens in the pharyngeal phase of swallowing?

A

Once the pharyngeal swallow is triggered, the bolus is transported through the pharynx

  • WITH co-ordinated closure of the glottis via movement of the epiglottis
  • AND cessation of breathing
  • AND relaxation of the upper oesophageal sphincter (UOS)`
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20
Q

What happens in the oesophageal phase of swallowing?

A
  • Oesophageal peristalsis carries the bolus from the cricopharyngeal juncture (the UOS)` through the oesophagus to the LOS
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21
Q

What is the pharyngeal swallow?

A
  • A reflex
  • Coordinated by the swallowing centre on the medulla oblongata and pons (CN V, IX, X, XII)
  • Initiated by touch receptors in the pharynx as bolus is pushed to the back of the mouth by the tongue
  • OR by stimulation of palate (palatal reflex)
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22
Q

What is pseudobulbar palsy?

A
  • Inability to control facial movements (such as chewing and speaking)
  • Upper motor neurone (i.e. pre ganglionic)
23
Q

What is bulbar palsy?

A
  • Impairment of function of the CN IX, X, XI and XII
  • Lower motor neurone (i.e. post ganglionic)
  • Lesion in the medulla oblongata or from lesions of the lower CN outside the brain stem
24
Q

Where is the anatomical site for pseudobulbar palsy?

A
  • Cerebral cortex fibres pass to the medulla via corticobulbar pathway in pyramidal tract
25
Q

Where is the anatomical site for bulbar palsy?

A
  • LMN of CN XI, X, XI and XII

- From medulla to mouth/ pharynx

26
Q

What are some of the possible causes of pseudobulbar palsy?

A 
Vascular - CVA of cerebral cortex
Trauma - Head injury
Inflammatory - Multiple sclerosis
Malignant - High brain stem tumour 
- Any condition which affects the corticobulbar tracts bilaterally will result in pseudobulbar palsy
27
Q

What are some of the possible causes of bulbar palsy?

A

Vascular - CVA of medulla (infarction of medulla)
Degenerative - MN disease
Infective - Guillain-Barre, Polio
Malignant - Glioma of braim stem

28
Q

What are some symptoms/ signs of diseases assoc with swallowing?

A
  • Difficulty in swallowing
  • Altered speech
  • Loss of gag reflex = aspiration of food/ fluid into trachea (common mechanism of death following stroke)
29
Q

What are some possible causes of GORD?

A
  1. Obesity
  2. Hiatus hernia
  3. Drugs that lower tone at LOS
    - Anti-cholinergic
    - Beta agonist
    - Benzodiazapenes
  4. Pregnancy
  5. Zollinger Ellison syndrome
    - Gastrin secreting tumour
30
Q

What is GORD?

A

Acid from stomach leaks up into the oesophagus

- Chronic symptoms or mucosal damage produced by the abnormal reflux in the oesophagus

31
Q

What are the symptoms of GORD?

A
  • Heartburn
  • Regurgitation
  • Dysphagia
  • Cough
  • Hoarsness
  • Chronic ear ache
32
Q

What are the possible effects (outcomes) of GORD?

A
  1. Oesophagitis
  2. Stricture
  3. Barrett’s metaplasia
  4. Oseophageal adenocarcinoma
33
Q

How could you define GORD?

A
  1. 24 hour pH monitoring
    - Defines reflux
    - Especially useful if endoscopy is normal
    - Characterises other conditions with abnormal
  2. Contrast swallow
    - Surpassed by endoscopy
    - Demonstrates reflux
34
Q

What are the different possible conservative treatments for GORD?

A
  1. Weight loss
  2. Avoid food/ alcohol close to bedtime
  3. Decrease alcohol
  4. Raise head of bed 20-30 cm
    - As more likely to get heart burn when lying down than standing or sitting up
35
Q

What are the different possible medical treatments for GORD?

A
  1. Decrease acid
    - Proton pump inhibitors (PPI)
    - H2 blockers
  2. Antacids
    - To increase pH
  3. Alginates coat mucosa
    - e.g. Gaviscon
36
Q

What are the different possible surgical treatments for GORD?

A
  1. Anti reflux surgery (fundoplication)

2. Repair hiatus hernia

37
Q

What is metaplasia?

A

Change of epithelial type in response to environmental stress

38
Q

What is the normal histology of cells lining the oesophagus?

A

Stratified squamous epithelial cells

39
Q

What happens to the epithelial cells of the oesophagus in Barrett’s metaplasia?

A

Stratified squamous –> simple columnar

40
Q

What are the different types of oesophageal cancers?

A
  1. Squamous cell carcinoma

2. Adenocarcinoma

41
Q

What is achalasia?

A
  • Failure to relax

- Motor disorder of the oesophagus - loss of myenteric plexus at the LOS (therefore poorly relaxing LOS)

42
Q

What are the symptoms of achalasia?

A
  • Dysphagia- solids and liquids
  • Regurgitation
  • Chest discomfort
  • Halitosis
43
Q

What are some possible treatment options for achalasia?

A
  1. Botox injection at LOS to relax the muscle
  2. Oesophageal dilation
  3. Surgery - Hellers myotomy
44
Q

What is pharyngeal pouch?

A

A posterior defect between cricopharygus and inferior constrictor - Killians dehisence

45
Q

What are the symptoms of pharyngeal pouch?

A
  • Dysphagia
  • Regurgitation
  • Halitosis
46
Q

What are the different possible causes of pharyngeal pouch?

A
  1. Traction diverticulum
  2. Affects men> women
  3. Trumpet players
47
Q

What is a possible treatment option for pharyngeal pouch?

A

Surgical excision

48
Q

Why might an oesophageal rupture occur?

A

Due to trauma

  • Endoscopy of a stricture
  • Blunt trauma
  • Penetrating trauma
  • During vomiting
  • Boerhaave’s syndrome
49
Q

Why are the pre-hepatic causes of oesophageal varices?

A
  • Portal vein thrombosis

- External compression of portal vein by tumours

50
Q

Why are the post-hepatic causes of oesophageal varices?

A
  • Right heart failure

- Budd-Chiari syndrome

51
Q

Why are the hepatic causes of oesophageal varices?

A
  • Cirrhosis
  • Alcoholic liver disease
  • Viral hepatitis
  • Schiostosomiasis
52
Q

What are the complications of portal hypertension?

A
  • Variceal bleeding
  • Ascites
  • Encephalopathy
53
Q

What medical therapy is available for oesophageal varices?

A
  • Beta blockers
  • Nitrates
  • -> Decreases portal pressure
54
Q

What surgical therapy is available for oesophageal varices?

A
  • Liver transplant

- Spleno-renal anastomosis

DIG (31 decks)

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