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GI-week 1 > Oral and esp PHYS-Prunske > Flashcards

Oral and esp PHYS-Prunske Flashcards

1
Q

Define Achalasia

A

failure of lower esophageal sphincter to relax

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2
Q

define Aspiration

A

inhalation of oropharnygeal or gastric contents into the respiratory track

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3
Q

Define Gastroesophageal Reflux Disease

A

heartburn due to inappropriate closure of lower esophageal sphincter allowing stomach contents to reflux into the esophagus

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4
Q

Define Deglutition

A

swallowing

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5
Q

DEfine Dysgeusia, results from?

A

distorted ability to taste, can be due to infection, aging, and nutritional deficiencies

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6
Q

Define Dysphagia

A

difficulty swallowing

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7
Q

Define Halitosis

A

bad breath

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8
Q

Define Manometry

A

test to measure pressure in GI tract

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9
Q

Define Mastication

A

chewing

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10
Q

Define Xerostomia

A

dry mouth-sign of sjorerns sydrome

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11
Q

Saliva is secreted by what?

A

Acinus

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12
Q

Saliva contains…

A
  1. Water
    2. Digestive Enzymes: salivary α-amylase (ptyalin), lingual lipase, RNAase, DNAase
    3. Mucins lubricate and protect oral mucosa
  2. Defense molecules: Lysozyme, IgA, lactoferrin, peroxidase, defensins
    5. Epidermal and nerve growth factors.
  3. Bicarbonate-BASIC PH!
    7. Sex steroids
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13
Q

Why do we think saliva may have endocrine (besides just exocrine) functions as well?

A

some salivary substances are also secreted into the blood

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14
Q

What controls the flow rate of saliva?

A

myoepithelial cells- they contract to control flow!

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15
Q

What is the salvia compostion of the parotid gland?

A

entirely serous (25% volume),

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16
Q

What is the salvia compostion of the Submandibular gland

A

mixed (70% volume)

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17
Q

What is the salvia composition of the sublinguial gland

A

mainly mucous (5% volume)

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18
Q

Where are the minor salivary glands?

A

in lips, cheek, and tongue

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19
Q

At fast flow rates what does the saliva represent?

A

saliva resembles plasma with higher HCO3 so Na high, CL high, K low

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20
Q

At slow flow rates what does saliva represent

A

the duct have time to make significant changes in ionic concentration but do not alter volume as ducts are impermeable to water.

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21
Q

Is the inhibitition of the salivary glands during sleep, fear, and fatigue due to sympathetics

A

No

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22
Q

What is the pathway of the parasympathetic pathway with the otic ganglion?

A

(distention, esophagitis, vomiting, or taste, smell ect)-salivary gland of the mediually-parasympathetics-otic ganglion releases ACH-parotid

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23
Q

What is the pathway of the parasympathetic pathway with the submandibular gland

A

(distention, esophagitis, vomiting, or taste, smell ect)-salivary gland of the mediually-parasympathetics-submandibular ganglion releases AcH-submandiulbar gland

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24
Q

Do you have secretions even with an empty mouth>

A

yes

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25
Q

Again whats the most important regulatory element of salivary secretion?

A

Parasypmathetics,

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26
Q

What does the paraysmpathetics NS act though?

A

through VIP and acetylcholine on muscarinic receptors to increase secretion of watery saliva.

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27
Q

What is the result of the parasympathetics

A

Increase volume of salivary secretion at the acinus
Increases secretion of enzymes and mucus
Increases the rate of bicarbonate secretion within the ducts
Stimulates glandular metabolism and growth
Increases blood flow to the gland (bradykinin)!!!

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28
Q

What does the sympathetic NS act though?

A

NE on B1 and alpha1 receptors to increase secretion of VISCOUS salivia

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29
Q

What are the actions of the SNS in regards to the

A

Stimulates secretion of enzymes and mucus
Stimulates glandular metabolism and growth
Stimulates contraction of myofibroblasts
Constricts blood vessels, decreases blood flow resulting in viscous saliva.

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30
Q

Where is salivary amylase found? what is it activated by?

A

oral cavity! CL in salvia and hydrolyzes -1,4 glycosidic linkages in starch. Active until acid penetrates the bolus in the stomach

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31
Q

Why is salvary amalyse important in neonates

A

they have decreased pancretic insufficiency

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32
Q

What does lingual lipase do?

A

breaks down triglycerides in the oral cavity

33
Q

Where do taste cells and support cells join?

A

Near apical surface by tight junctions

34
Q

What is the path of taste ligands?

A

They bind to receptor G protien, activate secondary messengers, release neurotransmitters onto primary sensory neurons

35
Q

Taste perception goes to what in the brain?

A

nucleus tractus solitarius leading to gastric acid secretion

36
Q

Whats important about Buccal and sublingual absorption of drugs

A

avoids first-pass metabolism, potential vaccine

37
Q

Reasons for too little salivia production aka Xerostoma?

A
  • SjÖgren syndrome- autoimmune disorder that destroys exocrine glands
  • Many medications: muscarinic antagonists, decongestants, and antihistamines
  • Secondary to head and neck radiation
  • Dehydration due to diarrhea, vomiting, fever, diuretics
  • Sialolithiasis (submandibular)
  • Nerve damage related to injury or diabetes
  • Postmenopausal hyposalivation
38
Q

What are some consequnces of dry mouth?

A

Increased likelihood of opportunistic infections (mumps parotid gland)
Halitosis due to production of hydrogen sulfide by bacteria and accumulation of dead cells
Decrease in oral pH leads to tooth decay
Decrease in taste
Problems with speech
Dysphagia>Poor nutrition

39
Q

Treat dry mouth?

A

muscarinic agonist
Gum, artificial saliva, switch medicines
Parasympathomimetics like pilocarpine
stimulate flow but also cause hypotension,
respiratory distress, and gastrointestinal disorder

40
Q

A small bolus can be swallowed involuntarily or voluntarily?

A

Both, involuntary reflex is initiated by mucosal mechanoreceptors but can be overridden voluntarily (swallow pill) but subsequent events are involuntary.

41
Q

What nerves transmit the mucosal mechanoreceprot signal? Where do they go?

A

glossopharyngeal (CN 9) and vagus nerves to the medullary swallowing center in the brain stem

42
Q

What regulates contraction in the upper 1/3 of the esophagus

A

Somatic nerves cause contraction (Ach- nicotinic) of striated muscles in the UES and top third of the esophagus

43
Q

What regulates contraction in the lower 2/3 of the esophagus

A

Autonomic nerves regulate smooth muscle- Ach on nicotinic and muscarinic

44
Q

Why are the spincters closed in the esophagus usually?

A

because of the low pressure environment, to prevent air and gastric contents from entering

45
Q

Whats the purpose of the nasopharynx?

A

prevent bolus from entering the nasal cavity

46
Q

Whats the purpose of the oropharynx?

A

contraction propels bolus into esophagus

47
Q

Whats the purpse of the Hypopharynx/Laryngopharynx

A

relax, segregate food and air

48
Q

How long does the Oral and pharyngeal phases take

A

less than 1 sec

49
Q

What action of the tongue triggers the swallowing reflex?

A

the tongue contacting the hard palate pushes the bolus against the soft palate-SWALLOW

50
Q

Is peristalsis necessary to move a liquid bolus?

A

yes

51
Q

what happens to breathing when you swallow?

A 
it stops 
also the Longitudinal muscles of
posterior pharynx contract 
Epiglottis folds down to prevent 
material fromentering the trachea.
Relaxation of cricopharyngeal muscle
leads to opening of distal pharynx and
upper esophageal sphincter.
52
Q

What is the most common kind of diverticulum>

A

Zenker

53
Q

What can lead to Dysphagi?/Odynophagia

A

structural abnormalities (esophageal cancer or diverticula) functional abnormalities (stroke leading to neural disorder)

54
Q

What bad things can happen from Dysphagia/Odynophagia

A

aspriration, malnutrition

55
Q

What happens to the pressure in the esophaus during swallowing?

A

Before swallowing, sphincter pressures are higher than atmospheric and fall during a swallow, ssophageal pressure increases as the peristaltic wave sweeps down the esophagus
about 10 sec

56
Q

distention or change in pH causes mechanorectoprs to do what?

A

either contract via ACh or relax via NO/VIP

57
Q

What is different about cold boluses moving through?

A

propelled with greater force but more slowly

58
Q

What controls esophageal peritstalsis?

A

long and short reflexes-para and enteric neuron

59
Q

The circular muscles in the esophagus constrict where in regards to the bolus? What binds and activates them?

A

UPSTREAM from the bolus ( AcH) and relax down steam (NO) Vagal efferents

60
Q

The relaxation and constriction of the longitudinal muscles is the same or different as the circular muscles in the esophagus?

A

Different-opposite of the circular muscles- constricts downstream and relaxes upstream

61
Q

What happens when a bolus gets stuck?

A

Secondary peristalsis

62
Q

What kind of muscle participates in secondary peristatlsis?

A

smooth muscle only

63
Q

What is the cause of secondary peristatlsis? What nerves respond?

A

elicited by distension of esophagus or acid in the esophagus, enteric neurons produce a very strong peristaltic wave starting just above the obstruction

64
Q

Retrograde movements require what to be relaxed?

A

UES and LES, but thats it!

65
Q

What are diffuse esophageal spasms

A

uncoordinated contractions can cause the regurgitation of food or liquids

66
Q

What is a nutcracker esophagus

A

painful contractions

67
Q

What does the control of LES depend on?

A

ENTERIC PLEXUS neurons, closed b/t swallows due to AcH, relaxed durign swallows due to NO and VIP

68
Q

What are some factors that increase tone in the LES?

A

protien, ACH, phenyephrine, 5HT, gastrin, substance P, motilin, neuropeptide Y, ect

69
Q

What is Gastro-Esophageal Reflux Disease (GERD)

A

reflux of acidic gastric contents into the esophagus due to relaxation of lower esophageal sphincter

70
Q

Whats the mild reflex of GERD feel like?

A

heartburn

71
Q

Whats severe reflux of GERD feel like?

A

REAL BAD- get epithelial erosion, Barrett’s esophagus

72
Q

TX of GERD?

A

Elevation of bed, change in diet?, Proton pump inhibitors and antacids

73
Q

What are some contributing factors to GERD

A

Obesity, Pregnancy (increased progesterone), Eructation, and Hiatal Hernia

74
Q

How does belching/eructation contribute to GERD?

A

swallowed air builds up in the stomach opens LES, larynx rises to prevent aspiration, diaphragm decends, increase abdominal pressure and decreased chest pressure, air moves from stomach to esophagus and opens up UES

75
Q

Excessive belching may be related to?

A

Unconsciously walling air=aerophagia

76
Q

What is Achalasia

A

failure of the LES to relax, get regurgitation, dysphagia of solids

77
Q

What cells are lost due to achalasia?

A

MYENTERIC gangilon cells- lack of NO synthase

78
Q

What would you see on an barium X-ray for a patient who had achalsia?

A

“birds beak”

GI-week 1 (11 decks)

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