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AHP II > Oral cavity, salivary glands, and esophagus > Flashcards

Oral cavity, salivary glands, and esophagus Flashcards

1
Q

3 major functions of the oral cavity

A
  1. Digestion- receives food, preparing it for digestion in the stomach and small intestine. Beginning of lipid digestion (small amount) occurs here.
  2. Communication- modifies the sound produced in the larynx to create a range of sounds.
  3. Breathing- acts as an air inlet in addition to the nasal cavity.
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2
Q

Borders of the nasal cavity

A

Anteriorly: opening between the lips
Posterior: oropharyngeal isthmus

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3
Q

Regions of the oral cavity

A

2 regions created by the dental arches:

  1. Vestibule: Region between lip and teeth. Like pull down lower lip and the dip in there.
  2. Mouth/oral cavity proper. Enclosed by teeth.
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4
Q

The internal lining of the check is comprised of which type of epithelium?

A

SSNK. Mucous membrane.

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5
Q

Oral orifice/ oral fissure

A

Opening between lips.

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6
Q

Which muscle and touch receptors are found in the lips

A

Orbicularis oris muscle controlled by CN 7

Meissner’s corpuscles for fine touch.

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7
Q

Vermilion border skin

A

Most peripheral part of lips near skin. Does contain hair and glands.

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8
Q

Vermilion zone

  • Which epithelium type?
  • Contain hair or glands?
A
  • Red area of lips due to increased vascularization
  • Contains SSK epithelium that slightly thickens adjacent to the mucocutaneous junction.
  • Lacks hair or glands
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9
Q

Mucocutaneous junction

A

Transition area from lips to inside mouth. Lips contain SSK and inside mouth, a mucous membrane, contains SSNK.

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10
Q

Outer to inner 3 regions of the lips

A

Vermilion border of skin, vermillion zone, mucocutaneous junction

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11
Q

___ and __ make up the roof of the oral cavity

A

Hard and soft pallet.

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12
Q

Hard and soft pallet contain which epithelium type?

A

SSNK on the oral cavity side, psuedostratified ciliated columnar within the nasal cavity.

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13
Q

What causes a cleft palate?

A

Maxillary and palatine bones don’t fuse together. This should occur during the 8th-10th week of fetal development.

Linked more so to environmental factors such as diabetic mother or medications taken by mother during pregnancy rather than genetic factors.

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14
Q

What is the anterior and posterior hard pallet made of?

A

The hard pallet is more anterior than the soft pallet. Made of maxilla (most anterior) and palatine (posterior)

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15
Q

What is the role of the soft pallet and where is it located in relation to the hard pallet?

A

Soft pallet is important for swallowing. Closes oropharynx from nasopharynx.

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16
Q

Two major regions of the tongue

A
  1. Body (oral) Most visible. muscles here are involved with changing shapes.
  2. Root (pharyngeal). Muscles here are involved in protruding and retracting the tongue.
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17
Q

Arterial supply of the tongue

A

Lingual artery (brach off the facial, which is a branch off the external carotid)

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18
Q

Musculature of the tongue (2)

A

Intrinsic: Muscles not attached to bone and affect tongue shape

Extrinsic: Muscles attached to bone and move tongue as a whole.

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19
Q

Innervation of the tongue

  1. SVA (taste)
  2. SA (touch)
  3. GSE
A
  1. Facial for anterior 2/3 and glossopharyngeal for posterior 1/3
  2. Mandibular branch of trigeminal for anterior 2/3 and glossopharyngeal for posterior 1/3
  3. Hypoglossal primarily. CN XII. Main muscle is genioglossus. Other two are styloglossus and hyoglossus.
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20
Q

How to do CN testing for hypoglossal nerve

A

Stick out tongue

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21
Q

Palatoglossus is innervated by which CN?

A

X. The rest of the muscles are innervated by CN XII

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22
Q

Types of lingual papillae

A

Circumvallate- located in the back center.
Foliate- located in the back sides
Fungiform- located along the sides.

^^ All associated with tastebuds.

Filliform papillae are found in the center of the tongue and are not associated with tastebuds.

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23
Q

Features of a taste bud

A

Taste pore, supporting cells, basal and sensory cells

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24
Q

How many teeth and what kinds

A

Incisors- 8 total. 4 top, 4 bottom
Canines- 4 total. 2 top, 2 bottom
Premolars- 8 total. 4 top, 4 bottom.
Molar- 12 total. 6 top, 6 bottom.

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25
Q

3 divisions of a teeth from top to bottom

A

Top
Crown: Capped by enamel. Hardest substance in the body.

Cervix or neck: Where crown meets root

Root: Located in the alveolus (bony socket for tooth) below gingiva. Cementum surrounds the dentin. Cementum anchors tooth to bone. Holds/cements things in place. Bone and cementum are connectedly periodontal ligaments.

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26
Q

Cementum

A

Surrounds the dentin. Bony material where enamel stops. Calcified substance and anchors the tooth to bone by connecting periodontal ligaments.

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27
Q

Gingiva (gums)

A

Fibrous tissue covered by a mucous membrane. Hemidesmosomes bind teeth to gums.

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28
Q

What factors help hold teeth in place?

A

Cementum that anchors tooth to bone by periodontal ligaments

Hemi desmosomes between gingiva and teeth in basal lamina secreted by epithelium.

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29
Q

Gingival sulcus

A

Groove between gingiva and tooth. Sealed off by junctional epithelium which prevents infection of the periodontal ligament and loss of teeth from periodontal cavities.

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30
Q

Pulp:

A

Blood vessels and nerves.

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31
Q

What is dentin (dentine)?

A

Simular to bone, but avascular. Made by odontoblasts (not osteoblasts) and has dentinal tubules instead of boney canaliculi. Very sensitive, but no nerve endings.

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32
Q

How is the root of the tooth connected to alveolar bone of the maxilla or mandible?

A

By the periodontal ligament. Composed of collagen fibers that attach to the cementum of the tooth root and the alveolar bone. Contains fibroblasts, vessels and nerves.

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33
Q

Periodontium is composed of which 4 things

A

Ligament, cementum, gingiva, and bone. Considered a join or articulation.

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34
Q

Mandible role and anatomy

A

Single bone that makes up the lower jaw. Largest and strongest bone in the face.

Involved in mastication. Chewing.

Anatomy: Mandibular body is horizontal. Angle is 70 degrees. Ramus is almost vertical. At the top, there are two processes. One anterior is called the coronoid process. Attaches to the temporalis muscle. The posterior process is called the condylar process. articulation with mandibular fossa on the temporal bone to form the TMJ.

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35
Q

The coronoid process (anterior) attaches to which muscle

A

Temporalis.

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36
Q

The condylar process (posterior) attaches to what

A

Attaches to the mandibular fossa on the temporal bone to form the TMJ.

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37
Q

The TMJ is an articulation between which 3 surfaces?

The surfaces are split by what

A

Mandibular fossa
Articular tubercle (squamous portion of temporal bone)
Head of mandible (the condyle and the coronoid)

The surfaces are split by the articular disc. It splits the joint into two synovial joint cavities.

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38
Q

The articular surface of the TMJ is covered by what cartilage type?

A

Fibrocartilage. Tougher and more rare than hyaline cartilage.

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39
Q

Which 3 ligaments stabilize the TMJ

A

Lateral ligament (stabilizes mandible) and prevents posterior disloation.

Sphenomandibular ligament and stylomanidubular ligament support jaw weight and are both medial to the mandible.

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40
Q

Main muscles that move the TMJ

A

Muscles of mastication and hyoid muscles.

Muscles of mastication include the masseter, temporalis, and medial/lateral pterygoids. (all paired muscles)

Hyoid muscles include genioyoid, digastric, and mylohyoid.

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41
Q

Which muscles are responsible for

  1. Protrusion
  2. Retraction
  3. Elevation
  4. Depression
A
  1. Lateral and medial pterygoid
  2. More complex. Temporalis mainly.
  3. Temporalis, masseter, and medial pterygoid
  4. Gravity*** and hyoid muscles
42
Q

Masseter

  1. Superficial to?
  2. Attached to?
  3. Actions?
  4. Innervation?
A

*Strongest of the muscles of mastication
1. Superficial to the medial pterygoid and temporalis
2. Superficially originates from maxillary process of zygomatic bone.
Deep originates from zygomatic arch of temporal bone
Both insert on to the ramus of the mandible

  1. Actions: Elevates the mandible (primary) and can cause protrusion (secondary)
  2. CN V3 (anterior division of mandibular branch)
43
Q 
Temporalis 
Originates from ? 
Inserts onto? 
Actions?
Innervation?
A

Originates from the temporal fossa
Inserts onto the coronoid process of the mandible. Passes under zygomatic arch.
Primary action elevates. Secondary action retracts.
Innervated by CN V3

44
Q

Medial pterygoid
Actions?
Innervation?

A

Two heads- deep and superficial
Elevates the mandible
Innervated by mandibular nerve

45
Q

Lateral pterygoid
Action?
Innervation
attachments?

A

Two heads- superior and inferior
Major protractor of the mandible
Innervated by the mandibular nerve
Attached superiorly to the greater wing of sphenoid. Inferiorly to the lateral pterygoid plate of the sphenoid.

46
Q

What are the three pairs of salivary glands and where are they located?

A

Parotid- below ear and external to masseter.
Submandibular- Under lower edge of mandible
Sublingual- Deep to the tongue in the floor of the mouth.

47
Q

Regulation of what controls salivary gland secretion?

A

Blood flow.

Secretion stimulated by parasympathetic. Sight, smell, chewing, pressure.

Secretion inhibited by sympathetic. Sleep, fright, disease, dehydration.

48
Q

Which salivary glands are the largest?

A

Parotid

49
Q

What are on the borders of the parotid gland?

A

Superior is the zygomatic arch
Inferior is the inferior border of the mandible
Anterior is the masseter muscle
Posterior is the external ear

50
Q

What are the two lobes of the parotid gland? What nerve passes between them?

A

Deep and superficial lobes. Facial nerve passes between the lobes. As the facial nerve passes into the gland, it splits to form the 5 nerves of facial expression while still in the gland.

To zanzibar by motor car
Temporal 
Zygomatic
Buccal
Mandibular 
Cervical
51
Q

What GV/SVA nerve passes through the parotid gland along with the facial nerve?

A

Chorda tympani.
GVE: Sends parasympathetics to submandibular and sublingual.
SVA: Taste for anterior 2/3 of tongue

52
Q

Course of parotid duct

A

Passes over masseter, through buccinators and opens into the oral cavity near the upper second molar. Elevated, very posterior.

accessible to pathogens, which is why lymph nodes and immunological protection in the saliva, such as lysozyme, are necessary

53
Q

Does the facial nerve innervate the parotid?

A

NO. It only passes through and gives rise to the 5 terminal motor branches that innervate the muscles of facial expression.

54
Q

parotid gland innervation

  1. Sensory
  2. Parasympathetic
  3. sympathetic
A
  1. Mandibular branch of trigeminal
  2. Glossopharyngeal CN 9. Increases saliva production.
  3. Fibers from superior cervical ganglion. Inhibit saliva secretion.
55
Q

Second largest gland

A

Submandibular

56
Q

Shape of the submandibular

A

U shape gland that hooks around the mylohyoid muscle.

57
Q

Vascular supply of the submandibular gland

A

Submental artery and vein

58
Q

Sensory and autonomic innervation of the submandibular glands

A

Sensory- Mandibular branch of the trigeminal
Parasympathetic- Facial
Sympathetic- fibers from superior cervical ganglion

59
Q

Smallest salivary glands

A

Sublingual

60
Q

Shape of the sublingual glands

A

Almond shape glands that unite anteriorly to form single horseshoe shaped structure around frenulum.

61
Q

What is unique about the sublingual ducts.

A

Sublingual has many ducts per gland. Parotid and submandibular have 1 duct per gland.

62
Q

Vasculature of the sublingual gland

A

Sublingual artery and vein (branch off lingual, which is a branch off external carotid)

Submental artery and vein (branch of facial, which is a branch of external carotid)

63
Q

Functional gland tissue of the salivary gland

A

Parenchyma. Divided into secretory end pieces (serous and mucous) and a branching duct system.

64
Q

Where are myoepithelial cells found in the salivary gland?

A

Found between the basal lamina and membranes of cells that form that secretory end pieces and intercalated ducts.

65
Q

What do serous end pieces secrete?

A

Watery secretions containing enzymes, ions, and small amounts of mucin.

66
Q

Structure of serous end pieces and cell shape?

A

Contained within a spherical capsule called an ancinus.

Cells are pyramidal shape with large, central nuclei. Contains granules with amylase.

67
Q

What do mucous end pieces secrete?

A

Thick secretion of mucous.

68
Q

Structure of mucous end pieces and cell shape?

A

Contained within a cylindrical capsule.
The cells are cuboidal or columnar in morphology with their nucleus pushed to the periphery due to the thick mucous they contain.

69
Q

What cap-like structure is found on mucous end pieces?

A

Serous demilunes.

These are serous producing cells distal to the mucous producing cells in the secretory end pieces.

70
Q

By which method do serous and mucous end pieces secrete their substances?

A

By exocytosis. Merocrine method. Least damaging to the cell.

71
Q

Pathway from acinus to main collecting duct

A

Acinus- site of primary secretion
Intercalated duct- site of primary secretion
Striated/intralobular duct- site of Na reabsorption and K secretion
Excretory duct
Main collecting duct (parotid, submandibular, or sublingual)
Empties into oral cavity

72
Q

Parotid gland has which acini present and what would you see if looking at histology slide

A

Only serous present, meaning it has the thinnest secretions.
High secretion of amylase and IgA.
Granules may even be present.
Stains pink/red with H&E.
No serous demilunes as those are only present on the mucous acini.
Adipose cells can also be spotted.

73
Q

Submandibular gland has which acini present and what would you see if looking at histology slide

A

Contains mostly serous (90%) and mucous (10%) acini.
Can also see serous demilunes on mucous acini.
Secretes a mixture of both serous and mucinous secretions with lysozyme (from serous demilunes) and lactoferrin.

74
Q

Sublingual gland has which acini present and what would you see if looking at histology slide?

A

Only mucous acini are present, along with serous demilunes.
The cytoplasm stains poorly due to its mucous components.
Secretion is mucous with lysozyme from the demilunes.

75
Q

What gland tumors are the most common but usually benign?

A

Parotid.

If needs to be removed, can be complex since CN 7 travels through and releases the 5 muscles of facial expression.

76
Q

What gland tumors are less common but more likely to be malignant?

A

Submandibular and sublingual.

Treatment usually involves surgical excision and removal. Complex because nerve pathways travel through and near glands.

77
Q

How does Sjogren’s syndrome affect the salivary glands?

A

Autoimmune disease that attacks and destroys the glands that produce tears and saliva.

Can cause dry eye symptoms, issues while swallowing, mouth infections (due to decreased level of lysozymes, lactoferrin, pH changes)

Mostly affects females.

Can be associated with lymphoma.

78
Q

Ranulas

A

Fluid filled cyst usually secondary to gland trauma. Painless, but can rupture and leak fluids into surrounding tissues.

79
Q

Mechanical digestion

A

Mastication, chewing. Teeth break food into pieces. Pieces mix with saliva to form a bolus (rounded mass of chewed food)

80
Q

Chemical digestion occurs due to which two enzymes

A

Amylase- secreted by salivary glands. Begins starch digestion in the oral cavity at pH of 6.5-7.0 via hydrolysis. In the stomach, the pH is much more acidic, so the amylase is inactivated.

Lingual lipase- Secreted by glands in the TONGUE. Begins breakdown of triglycerides into a free fatty acid and monoglyceride (fatty acid +glycerol)

81
Q

4 main functions of saliva

A
  1. Digestion by amylase
  2. Lubrication by mucous
  3. Protection. Neutralizes gastric juices after vomiting. Prevents cavities and periodontal disease.
  4. Bactericidal. Lysozyme binds to IgA, which is immunologically active against bacteria. And lactoferrin sequesters iron required for bacterial growth.
82
Q

How does saliva differ from blood plasma?

A

Ionic distributions between the two are similar with 2 exceptions:

  1. Saliva bicarbonate concentration is greater. This causes a more alkaline pH than blood plasma
  2. Less Na+ and Cl- concentrations in saliva. Therefore, saliva is hypotonic to plasma.
83
Q

How is saliva modified as it passes through the ducts within the gland?

A

As saliva passes through the ducts, Na+ and Cl- are reabsorbed into the body, while K+ and HCO3- are secreted into the ducts.

When secretion rates increase due to increased volume, secretion and reabsorption rates are lowered as there is not enough time to fully modify the saliva since it is moving quicker and at higher volumes.

84
Q

Four gastrointestinal tract layers from outer to inner

A

Outer

  1. Adventitia- esophagus and majority of duodenum. Outside the peritoneum and Serosa (visceral peritoneal)- everything else in GI tract within the peritoneum.
  2. Muscular externa
    - outer longitudinal muscle
    - myenteric plexus
    - inner circular muscle
  3. Submucosa
    - submucosal plexus
    - connective tissue, exocrine glands, lymphatics and vasculature
    - Loose, distensible elastic fibers.
  4. Mucosa (tunica mucosa)
    - Muscularis mucosae
    - Manina propria is rich in blood and lymph vessels, tissues, and glands
    - SSNK transitions to simple columnar epithelium at the gastroesophageal junction.

Inner

85
Q

Difference between adventitia and serosa (visceral peritoneal)

A

Adventitia is an organ not inside the peritoneum. This includes the esophagus and majority of the duodenumm.

Serosa= visceral peritoneal. Organs inside of the peritoneum. Includes everything else in the GI tract.

86
Q

SSNK transitions to simple columnar epithelium where within the GI tract?

A

At the gastro-esophageal junction.

87
Q

Portions of the esophagus from upper to lower

A

connects pharynx with the stomach.

Cervical
Upper
mid thoracic
abdominal

88
Q

What are the two esophageal spinctors? Are they voluntary or involuntary?

A
  1. upper esophageal: Striated muscle with circular orientation. VOLUNTARY.
  2. Lower esophageal: INVOLUNTARY. Located at gastroesophageal junction as esophagus inserts into stomach at an acute angle. Pinching effect due to crux of diaphragm. As sphincter releases, bolus is allowed to enter the stomach. At rest, this sphincter prevents reflux of gastric acids into esophagus.
89
Q

Esophageal structure limits dilation (is constricted) in which four areas?

A
  1. The upper esophageal sphincter. Junction of esophagus with pharynx.
  2. Aortic arch crosses and compresses esophagus.
  3. Left primary bronchus can compress on esophagus when it splits.
  4. Esophageal hiatus (lower)
90
Q

3 main areas of vascular supply to the esophagus?

A

Lots of diff supplies because so long.

  1. Cervical
  2. Upper and mid-thoracic (bulk)
  3. Abdominal
91
Q

Vascular supply to the cervical esophagus

A

Inferior thyroid artery and vein

92
Q

Vascular supply to the upper and mid thoracic esophagus

A

Arteries: Bronchial and esophageal arteries.
Veins: Azygous, hemiazygous, and accessory hemiazygous vv.

93
Q

Vascular supply to the abdominal esophagus

A

Artery: Left gastric.

94
Q

Arterial supply to esophagus superior to inferior

A

Inferior thyroid, bronchial and esophageal, left gastric.

95
Q

Veinous supply to esophagus superior to inferior

A

Inferior thyroid, azygous and hemiazygous and accessory. left gastric.

96
Q

Esophageal innervation

Sympathetic and parasympathetic

A

Sympathetic: Thoracic plexus AKA esophageal plexus. Passes through the sympathetic trunk and travels to esophageal plexus.

Parasympathetic: Vagus nerve.

97
Q

Fancy word for “swallowing”

A

Deglutition

98
Q

Swallowing reflex (2 main parts)

A
  1. Voluntary. Pharyngeal phase.
    Pressure sensors in pharynx send signals to medulla. Medulla signals skeletal muscles within pharynx, larynx, and upper esophagus.

Tongue pushes up against hard palate, bolus is moved towards oropharynx while soft palate moves to seal off nasal cavity. Epiglottis seals over glottis to prevent food going down trachea. Striated muscles contract, forcing bolus towards esophagus. This all occurs at about the same time.

  1. Involuntary. Esophageal phase.
    bolus passes through esophagus by peristalsis. Longitudinal muscles contract/shorten. Circular muscles contract after bolus has passed to allow for unidirectional movement. Lower sphincter immediately closes after bolus has passed into the stomach.
99
Q

Total travel time from oral cavity to stomach

A

4-8 seconds for solids. 1-2 seconds for fluids.

100
Q

GERD

A

Gastroesophageal reflux disease

caused by poor lower esophageal sphincter closer.

101
Q

Barrett’s esophagus

A

can occur after chronic acid reflux. At higher risk of esophageal cancer. Fried bacon look. (adenocarcinoma is associated with this. Involves glands.)

Dangerous because esophagus is very close to the spinal column.

AHP II (11 decks)

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