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Digestive System > Mouth and Oesophagus > Flashcards

Mouth and Oesophagus Flashcards

1
Q

Define the process of digestion

A
  • Conversion of dietary nutrients into a form that the small intestines can absorb
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2
Q

What are the 3 structures in the mouth that are important in digestion

A
  • Teeth
  • Tongue
  • Salivary glands
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3
Q

What are the functions of the tongue

A
  • Receptors on the tongue allow for taste and identifying what is in the mouth.
  • Facilitate movement of food
  • Assist in swallowing
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4
Q

What are the functions of the mouth

A
  • Mastication to increase SA for more efficient digestion
  • Initiation of metabolism of carbohydrates and fats
  • Lubrication - to cover the food bolus in saliva to allow for swallowing
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5
Q

What is the function of the oesophagus

A
  • Act as a conduit
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6
Q

What are the names of the glands that produce saliva

A
  • Parotid gland
  • Sublingual gland
  • Submandibular
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7
Q

How do salivary glands acts as exocrine glands

A
  • They produce lipase and amylase
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8
Q

What do salivary glands produce when acting as secretory organs

A
  • Mucous
  • Fluid
  • IgA
  • Lysozyme
  • Lactoferrin
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9
Q

What 2 types of cells make up the structure of the salivary glands

A
  • Acinar cells
  • Ductal cells
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10
Q

What is the function of acinar cells

A
  • Produce enzymes which enter the mouth
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11
Q

What is the function of ductal cells

A
  • Secrete water and electrolytes
  • Modifies secretions of acinar cells into the mouth
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12
Q

What is the total volume of saliva secreted every 24hrs

A
  • 1.5L
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13
Q

What is the histological type of saliva produced by each of the 3 salivary glands

A
  • Parotid = Serous
  • Submandibular = Mixed
  • Sublingual = Mucous
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14
Q

What is the secretion of each of the 3 salivary glands like

A
  • Parotid = Water
  • Submandibular = Viscous +
  • Sublingual = Viscous ++
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15
Q

What is the % of secretion by each of the 3 salivary glands

A
  • Parotid = 20
  • Submandibular = 70
  • Sublingual = 10
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16
Q

Why is hydration provided by the saliva important

A
  • Keeps the oral cavity moist to prevent dehydration of cells and eventually death
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17
Q

Why is cryoprotection provided by the saliva important

A
  • Protects the oral and oesophageal mucosa from damage
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18
Q

Describe the immune functions of some of the substances secreted by salivary glands

A
  • IgA - Antibodies that bind to pathogenic antigens
  • Lactoferrin - Binds to iron and is bactericidal
  • Lysozyme - Attacks bacterial cell walls causing cell lysis
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19
Q

Why is saliva hypotonic and alkaline

A
  • Salivary duct cells extract Na+ and Cl- and secrete K+ and HCO3-
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20
Q

What are the benefits of having alkaline saliva

A
  • Protects teeth from bacterial acid
  • Neutralises gastric acid that refluxes in the oesophagus
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21
Q

What is Sjogren’s syndrome

A
  • Autoimmune attack of salivary and tear glands which results in dry mouth (xerostomia) and eyes.
  • Commonly affects women, is associated with rheumatoid arthritis.
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22
Q

What is Mumps virus (Parotitis)

A
  • Swelling of the parotid glands
  • Associated with orchitis (inflamed testicles)
  • Early symptom of fever +headache
  • Can be prevented with MMR vaccine
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23
Q

What divisions of the nervous system control the secretion of the salivary glands

A
  • Autonomic nervous system mostly via parasympathetic nervous system
24
Q

What are the source and root ganglion of the nerve that innervates the submandibular and sublingual glands in the parasympathetic NS

A
  • Source - Cranial nerve VII (facial nerve)
  • Ganglion - Submandibular ganglion
25
Q

What are the source and root ganglion of the nerve that innervates the parotid gland in the parasympathetic NS

A
  • Source - Cranial nerve IX (Glossopharyngeal nerve)
  • Ganglion - Otic ganglion
26
Q

What is the source and root ganglion of the nerve that innervates the salivary glands in the sympathetic NS

A
  • Source - Thoracic sympathetic
  • Ganglion - Superior cervical ganglion
27
Q

What are the 4 stages of swallowing

A
  • Oral preparatory phase
  • Oral phase
  • Pharyngeal phase
  • Oesophageal phase
28
Q

What is the oral preparatory phase of swallowing

A
  • Manipulation and mastication of food in the mouth to turn it into a consistency that can be swallowed
29
Q

What is the oral phase of swallowing

A
  • The tongue pushes food posteriorly until the pharyngeal swallow is triggered
30
Q

What is the pharyngeal phase of swallowing

A
  • Bolus is transported through pharynx, glottis closure via movement of the epiglottis, cessation of breathing and relaxation of upper oesophageal sphincter (UOS) must occur at the same time.
31
Q

What is the oesophageal phase of swallowing

A
  • Oesophageal peristalsis carries the bolus from the UOS through the oesophagus to the lower oesophageal sphincter
32
Q

What is the name of the structure that the oesophagus and vagus nerve pass through

A
  • Oesophageal hiatus
33
Q

Describe the structure of the oesophagus with regards to muscles

A
  • Top 1/3 is composed of striated muscle
  • Middle 1/3 is composed of a mixture of straited and smooth muscle
  • Bottom 1/3 is composed of smooth muscle
34
Q

What is the normal GI structure and does the oesophagus have this structure

A
  • Mucosa (stratifies squamous epithelium)
  • Inner circular muscle
  • Outer longitudinal muscle
    YES OESOPHAGUS HAS THIS STRUCTURE
35
Q

What is Gastro-oesophageal reflux disease (GORD)

A

Chronic symptoms or mucosal damage caused by the abnormal reflux in the oesophagus

36
Q

What are the risk factors of GORD

A
  • Anything that increases intraabdominal pressure (obesity, pregnancy)
  • Hiatus hernia (a portion of the stomach enters the thorax)
  • Some drugs that relax LOS
  • Zollinger Ellison’s syndrome (producing excess acid)
37
Q

What are the 2 types of Hiatus hernia and state there relative percentages of occurrence

A
  • Sliding, 80%
  • Rolling, 20%
38
Q

How does a sliding hiatus hernia occur

A
  • The abdominal part of the oesophagus slides upwards through the diaphragmatic hiatus into the thorax.
39
Q

How does a rolling hiatus hernia occur

A
  • The gastric fundus moves upwards and lies alongside a normally positioned Gastro oesophageal junction creating a ‘bubble’ in the thorax
40
Q

Name some symptoms of GORD and explain why they happen

A
  • Heartburn (retrosternal discomfort)
  • Dysphagia (Inflammation of stricture)
  • Laryngopharyngeal reflux (characterised by chronic cough)
41
Q

What are some of the outcome of GORD

A
  • Oesophagitis - damage to mucosal lining
  • Stricture - Narrowing of oesophageal lumen
  • Barret’s metaplasia - Change in mucosal layer due to damage
  • Oesophageal adenocarcinoma - Type of oesophageal cancer.
42
Q

How is GORD diagnosed

A
  • 24hr pH monitoring
  • Contrast swallowing
43
Q

what are the 3 stages of GORD treatment

A
  • Conservative -
  • Medical
  • Surgical
44
Q

Give examples of conservative treatments for GORD

A
  • Weight loss
  • Avoid food/ alcohol before bed
  • Decrease alcohol intake
  • Raise head of bed by 20-30cm
45
Q

Give examples of medical treatments for GORD

A
  • Decrease acid - proton pump inhibitors, H2 blockers
  • Antacids to increase pH
  • Alginates to neutralise acid (gaviscon)
46
Q

Give examples of surgical treatments for GORD

A
  • Anti reflux surgery ‘fundoplication’
  • Repair hiatus hernia
47
Q

What percentage of patients with GORD are diagnosed with Barrett’s metaplasia

A
  • 10%
48
Q

What percentage of patients with Barrett’s metaplasia are diagnosed with oesophageal adenocarcinoma

A

0.5%

49
Q

What is the change in the mucosa that occurs in Barrett’s metaplasia and why does this change occur

A
  • From stratified squamous epithelium to columnar single lined epithelium.
  • Protective mechanism
50
Q

How can the risk of a patient with Barret’s Metaplasia developing a malignant progression be measured

A
  • Surveillance endoscopy
51
Q

What makes surveillance endoscopy for patients with Barret’s Metaplasia controversial

A
  • Expensive
  • Labour intensive
  • Only 0.5% of BM patients progress to adenocarcinoma
52
Q

What are the two methods currently being discussed in research to identify biomarkers that identify BM patients at risk of adenocarcinoma

A
  • Capsule and abrasive sponge for oesophageal lining cells.
  • Breath test, test for biomarkers in breath of patient
53
Q

What are the two types of oesophageal cancers

A
  • Squamous cell carcinoma
  • Adenocarcinoma
54
Q

What is achalasia

A
  • Failure of the gastroesophageal sphincter to relax
55
Q

What are some symptoms of achalasia

A
  • Dysphagia of both solids and liquids
  • Regurgitation
  • Chest discomfort
  • Halitosis
56
Q

How can achalasia be treated

A
  • Botox to relax the GOS
  • Oesophageal dilation, use a balloon to open up the sphincter
  • Surgery, Heller’s myotomy

Digestive System (7 decks)

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