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Y1 Digestion and Renal Science > L2 The Mouth and Oesophagus > Flashcards

L2 The Mouth and Oesophagus Flashcards

1
Q

Define digestion

A

Conversion of dietary nutrients into a form that the small intestines can absorb – starts in the oral cavity

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2
Q

What is the mouth lined with?

A

Mucuos membranes that secrete oral mucus

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3
Q

What are the secretions of the mouth?

A

Saliva, salivary amylase, mucus and lysozyme

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4
Q

What is the function of the lysozyme in the mouth?

A

Lysozyme has anti-microbial action in the mouth to remove pathogens or harmful microbes from entering the body

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5
Q

What is oral mucosa composed of?

A

Stratified squamous epithelial cells – non-keratinised

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6
Q

What is the function of salivary amylase?

A

Digestion of proteins into amino acids

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7
Q

What is the main function of the teeth?

A

Mastication (chewing food)

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8
Q

How does mastication allow improved digestion?

A
  • Decrease the particle size (increase the surface area)
  • Means digestive enzymes have greater access and area over which to act on the food ingested
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9
Q

What is the primary function of the tongue? What structures do they have to allow this?

A

Taste - the papillae contain taste buds that has gustatory cells (taste receptors)

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10
Q

What is another function of the tongue?

A
  • Prepares food for swallowing meaning cohesive bolus produced can be controllably swallowed
  • Motility of food and ensures the food size is small enough to be digested properly and easily
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11
Q

What is saliva composed of?

A

Water (99.5%), electrolytes, mucus, amylase, lysozymes

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12
Q

What are the main functions of the saliva?

A
  • Motility
  • Taste
  • Cleaning the mouth (action of lysozymes)
  • Solubilises food in mastication
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13
Q

What are the 3 salivary glands?

A
  • Submandibular
  • Sublingual
  • Parotid
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14
Q

What nervous system innervates the salivary glands?

A

Parasympathetic

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15
Q

Where is the majority of slaiva produced?

A

Submandibular (70% of saliva produced here)

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16
Q

Why might a parasympathetic disease in the other two salivary glands and not the submandibular have a reduced effect?

A

Due to submandibular producing most of the saliva the effect is reduced

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17
Q

Why type of gland is a salivary gland?

A

Exocrine - contains branched ductal used to release secretory products (saliva)

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18
Q

What are acini?

A

Round secretory unit

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19
Q

What 2 types of secretions do salivary glands have?

A
  • Serous (protein)
  • Mucus (lubricant)
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20
Q

What do acinar cells produce?

A

Enzymes

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21
Q

What do ductal cell produce?

A

Mucus

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22
Q

What gland has many mucous acini?

A

Sublingual glands

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23
Q

What gland has many serous acini?

A

Parotid glands

24
Q

What gland has a mixture of both serous and mucous acini?

A

Submandibular

25
How do the conditions of the glands change with production to secretion?
- Place where saliva produced is isotonic - Removal of ions and addition of water result means that saliva is hypotonic and alkaline
26
What do acinar cells do?
- Produce saliva by transporting ions (Na, K, Cl) – electrolytes across cell membranes. - They also secrete enzymes, proteins and other substances. Saliva is hypotonic and alkaline
27
Why is saliva alkaline?
Amylase works at its optimum in slightly alkaline conditions
28
What do goblet cells secrete mucus for?
- Lubrication - Hydration: Keeps the oral mucosa moist and prevents dehydration and cell death - Cytoprotection: Protects oral and oesophageal mucosa from damage
29
What is Sjögren's syndrome?
- Autoimmune condition that affects salivary and tear glands which results in dry mouth and eyes - Associated with rheumatoid arthritis - Causes xerostomia
30
What does a dry mouth cause?
- Reduction in lubrication - Reduced motility - Reduced cleaning as reduced lysozyme activity - Infection - Reduced taste sensations - Reduced mastication
31
What is Mumps Virus (parotitis)?
- Mumps is a viral infection that causes parotitis - The most common sign of mumps is the swelling of the parotid gland (bilateral) - MMR vaccine
32
What is the oesophagus?
A muscular tube that connects the pharynx to the stomach
33
What is the main secretion in the pharynx and oesophagus? Function?
Mucus Motility
34
What is the oesophagus composed of?
- The upper 1/3 of the oesophagus contains striated muscle - The lower 1/3 contains smooth muscle - The middle 1/3 contains a mixture of both
35
Why are there different types of muscle in the oesophagus?
Important because there are both involuntary and voluntary parts to swallowing
36
Describe the process of swallowing
1) Oral Preparatory Phase - food is manipulated in the mouth and masticated to reduce to a consistency which can be swallowed – larger surface area – voluntary 2) Oral Transport Phase - the tongue propels food posteriorly until the pharyngeal swallow is triggered – voluntary 3) Pharyngeal Phase - once the pharyngeal swallow is triggered, the bolus is transported through the pharynx with coordinated closure of the glottis via movement of the epiglottis and cessation of breathing and relaxation of the upper oesophageal sphincter (UOS) – voluntary - Uvula helps with closing off the respiratory passage - Tongue involved - Epiglottis involved - Upper sphincter involved - Stops food from entering the respiratory system and passing down the trachea by closing off the trachea using the above structures to help. 4) Oesophageal Phase - oesophageal peristalsis carries the bolus from the UOS through the oesophagus to the lower oesophageal sphincter – involuntary
37
What is Gastro-oesophageal Reflux Disease (GORD)?
A disorder where acid from the stomach leaks into the oesophagus
38
Causes of GORD?
Obesity Hiatus hernia Drugs that lower tone at LOS (anti cholinergic, beta agonist, benzodiazepines) Pregnancy Zollinger Ellison syndrome Gastrin secreting tumour
39
What is a sliding hernia?
(80%)– the GOJ, the abdominal part of the oesophagus, and frequently the cardia of the stomach (top part of the stomach) slides upwards through the diaphragmatic hiatus into the thorax
40
What is a rolling hernia?
(20%) – an upward movement of the gastric fundus occurs to lie alongside a normally positioned GOJ, which creates a ‘bubble’ of stomach in the thorax
41
Effects of GORD?
- Oesophagitis (inflammation) - Stricture (narrowing) - Barrett’s metaplasia (BM) - Oesophageal adenocarcinoma ((OAC) (cancer))
42
What is metaplasia?
Change of epithelial type in response to environmental stress
43
What % of GORD patients develop Barrett's Metaplasia?
10% of patients
44
What is Barrett’s Metaplasia considered as?
Pre-malignant condition for oesophageal adenocarcinoma
45
What % of patients with BM progress to oesophageal adenocarcinoma in a year?
0.5%
46
What characterises BM?
Squamous cell differentiation to columnar cells containing goblet cells in intestinal metaplasia
47
What is BM caused by?
- Acid/bile reflux - Inflammation - Ras - Hedgehog signalling
48
What is the conservative treatment for BM?
- Weight loss - Avoid food/alcohol close to bedtime - Decrease alcohol - Raise head of bed 20-30cm
49
What is the medical treatment for BM?
- Decrease acid - Proton pump inhibitors - H2 blockers - Antacids increase pH - Alginates (Gaviscon)
50
What is the surgical treatment for BM?
- Anti reflux surgery ‘fundoplication’ - Repair hiatus hernia - (historic note: Vagotomy – decreases acid production)
51
What is achalasia?
- Dramatic reduction in the number of neuronal cells in the lower oesophageal segment. - Makes it difficult for food to pass from the oesophagus into the stomach due to impaired oesophageal peristalsis
52
What happens in achalasia?
Progressive degeneration of myenteric neurons prevents the lower oesophageal sphincter from relaxing. This results in dilation of the oesophagus
53
Symptoms of achalasia?
- Difficulty swallowing (dysphagia) - Regurgitation of undigested food - Pain
54
% of achalasia with dysphagia to liquids?
75%
55
What is oesophageal manometry?
Measures strength and co-ordination of oesophageal contractions during swallowing
56
Diagnosis of achalasia?
Barium swallow test, endoscopy (rule out GE junction tumors, esp. age>60), oesophageal manometry (absent peristalsis,  LES relaxation, & resting LES >45 mmHg)
57
Treatment of achalasia?
Focus on relieving symptoms (medications: nitrates and calcium blockers), decrease pressure of LES (pneumatic dilation, botulinum toxin injections – forces relaxation of oesophagus)

Y1 Digestion and Renal Science (6 decks)

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