Mouth + Esophagus Flashcards

1
Q

Components of the mouth

A
  • Upper/lower lips: closes off oral cavity
  • Frenulums (superior & inferior): attaches the lips to the gums to limit motion
  • Hard palate: bony structure of the maxilla
  • Soft palate: muscles running through it; able to raise it and close off nasopharynx so no food enters nasal cavity
  • Uvula: helps close off nasopharynx; irritant receptors = gag reflex
  • Tongue: keeps food up on teeth for grinding, initiates swallowing
  • Lingual frenulum: flap of tissue that restricts backward movement of tongue
  • Submandibular glands: saliva secretions
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2
Q

Gustation: taste buds

A
  • Vallate papillae: 12 each, V shaped
  • Fungiform papillae: scattered over tongue, mushroom shaped
  • Foliate papillae: in the sides of tongue, degenerate in childhood; this is why there are changes in taste while maturing
  • Filiform papillae: tactile sensation + friction
  • These tastebuds contain gustatory receptors = specialized episodes cells that secrete neurotransmitters onto neurons at the base of tongue (will constantly replenish)
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3
Q

Cranial nerves involved in gustation

A
  • Facial (7): anterior 2/3 of tongue, parasympathetic output to submandibular glands
  • Glossopharyngeal (9): posterior 1/3 of tongue
  • Vagus (10): taste sensations at throat and epiglottis

CNs –> brainstem –> thalamus –> primary gustatory area (parietal lobe)

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4
Q

Olfaction

A
  • CN 1
  • Olfactory glands produce mucus
    • Odourant molecules dissolved here for neural transduction
  • Conscious perception of smell occurs in the insular cortex (does NOT synapse in thalamus!!)
  • Olfactory cells are only found in the olfactory tract/bulb

Odourant molecules in mucus –> receptors sense these –> dump neurotransmitters onto sensory neurons –> primary olfactory area

NOTE: mammillary bodies = smell memories

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5
Q

Chewing: teeth!

A
  • Incisors: cutting, in front (4)
  • Canines: tearing, on side (2)
  • Premolars: crushing, front (4)
  • Molars: grinding, back (6)
  • Permanent teeth arise from ossification centres within the bone of maxilla/mandible
  • Supernumerary teeth = extra teeth
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6
Q

Components of a tooth

A
  • Enamel: hardest part of the body
  • Pulp: living portion of teeth, has a neuromuscular bundle (A,V,CN5)
  • Periodontal ligament: connects teeth to bone
    • Need Vit C to make sure this doesn’t get loose (scurvy)
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7
Q

Intrinsic muscles of the tongue

A

All innervated by the hypogloassal n. (CN 12)

  • Longitudinal muscles (x2, sup & inf): run from front –> back, shorten tongue when contracted
    • Sup long muscle contracted = tongue rolling
Transverse muscles (x2): right --> left
   - Causes tongue to get skinnier 

Vertical muscle: contracts to flatten tongue

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8
Q

Extrinsic muscles of the tongue

A

Innervated by CN 12 + attaches to the base of tongue to elevate/retract/depress

  • Styloglossus: attaches to tongue + styloid process, raises tongue to force food down.

Hyoglossus: attaches to tongue + hyoid bone (free floating bone)

Genioglossus: attaches to tongue & mandible
- Allows for protrusion of tongue from oral cavity (this is the only muscle that does this!)

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9
Q

Muscles of mastication

A

All inverted by somatic motor nerves (CN 5)

  • Tempolaris muscle: across temporal bone + sends tendon down to mandible
    • Forces mandible up against maxilla (chewing)

Masseter muscle: talking + chewing muscle, attaches maxilla to mandible

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10
Q

Muscles of facial expression

A

Innervated by CN 7

  • Buccinator: moves cheeks
  • Orbicularis oris: circles around the mouth, purses lips
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11
Q

Vascular supply of mastication

A

Vascular supply mainly comes from external carotid a.

  • Facial a: comes off early, supples mandible
  • Maxillary a: supplies maxilla
  • Superficial temporal a: runs underneath skin + supplies temporalis muscle
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12
Q

Mouth digestion

A

Three salivary glands

  • Parotid
  • Submandibular
  • Sublingual

Composition of saliva

  • Water
  • Amylase: breaks down complex carbs –> simple carbs
  • Mucin: makes saliva sticky
  • Lysozyme: breaks down bacteria
  • IgA
  • Defensins: target bacteria
  • Electrolytes: Na & Cl

Parasympathetic (CN 7&9) –> watery, enzyme-rich saliva

Sympathetic –> mucin-rich saliva, mainly from the sublingual gland

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13
Q

Salivary glands + composition

A

Parotid: only serous (watery, amylase) –> lots of tartar buildup *Target for mumps

Submandibular: mostly serous with amylase

Sublingual: mostly mucous with lipase, activated by low pH (only works in the stomach)

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14
Q

Three phases of swallowing

A
  1. Voluntary
    • Oral cavity + tongue, you choose to bring food –> oropharynx
  2. Pharyngeal
    • Deglutition reflex initiated by stretch of oropharynx (deglutition centre in brainstem - medulla + low pons)
    • Skeletal muscle: you can still stop it at this point
    • Closing off of nasal cavity (soft palate + uvula rise to protect upper airway)
    • Closing off of trachea (epiglottis + larynx rise)
    • Relaxation of upper esophageal sphincter (to allow bolus to pass)
  3. Esophageal
    • Peristalsis: first 1/3 is voluntary (skeletal), second 2/3 is not voluntary (smooth muscle)
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15
Q

Anatomy of esophagus

A
  • Glued into place by the adventitia (CT)
  • Two kinks and 1 hiatus
    • Kink 1: passing bifurcation of trachea
    • Kink 2: passing behind left atrium
    • Esophageal hiatus: in skeletal muscle of diaphragm
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16
Q

Esophagus histology

A
  • Mucosa: stratified squamous epi (needs lots of layers –> friction from food)
    • Lamina propria: CT that glues down the epithelium to underlying layers (this is where BVs + nerves are)
    • Muscularis mucosa: thin layer of SM, puts mucosa into folds
  • Submucosa: CT that glues down mucosa to underlying layers
  • Muscularis: 2 muscles that work together to cause peristalsis
    • Inner circular: sphincter-like motion
    • Outer longitudinal: shortening
  • Adventitia: CT that glues esophagus in place in cervical + thoracic regions
17
Q

Esophageal phase of swallowing

A

Controlled by the enteric NS

  • Circular muscles contract to constrict the pathway for bolus to go through
  • Longitudinal muscles contract to shorten the bolus’ pathway
  • LES only opens for bolus: so no stomach acid enters esophagus
18
Q

Reasons for GERD

A
  • LES pressure is too low
  • Gastric pouch = part of stomach goes through esophageal hiatus + ends up in thorax, results in the LES not getting enough help from diaphragm to close
19
Q

GERD

A
  • Acid in esophagus = heart burn, can even burn through muscularis layer
  • Effects are worsened by:
    • Smoking + alcohol (relaxing of LES)
    • Coffee, chocolate, peppermint + stress (increased acid production)
    • Obesity + pregnancy: more pressure = pushing on stomach = into esophagus

Treatment options

  • Smaller meals
  • Maintaining upright position
  • Antacids