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GI Week 1 > Oral & Esophageal Phys > Flashcards

Oral & Esophageal Phys Flashcards

1
Q

Increase in LES tone

A

Achalasia

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2
Q

Decrease in LES tone

A

GERD

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3
Q

Main muscles of mastication (raise mandible)?

A

Masseter

Temporalis

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4
Q

Muscle to move lips?

A

Orbicularis ori

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5
Q

Muscle to move cheek?

A

Buccinator

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6
Q

Initial opening of jaw (lower mandible)?

A

Pterygoid muscles

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7
Q

Nerve that controls the muscles of mastication?

A

Trigeminal (V3)

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8
Q

What do saliva serve as a buffer against?

A

Bacteria in our mouths create a lot of acid from fermentation…so having bicarbonate in saliva helps to neutralize that!

Additionally the possibility for acid reflux to get back into the mouth…bicarbonate will neutralize stomach acid

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9
Q

What structure serves as amylase-containing primary secretor of saliva?

A

Acinus

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10
Q

Where is ionic content of saliva modified?

A

Duct cells

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11
Q

Is saliva primarily exocrine or endocrine?

A

Exocrine (but some salivary substances are secreted into the blood suggesting endocrine role as well)

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12
Q

Serous cells secrete?

A

Amylase and water

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13
Q

Mucous cells secrete?

A

mucin

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14
Q

Largest volume of saliva comes from which gland?

A

Submandibular

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15
Q

Composition of saliva is different from each of the glands…
Which is entirely serous, watery?
Which is mainly mucous?
Which is mixed?

A

Serous - Parotid

Sublingual - mucous

Submandibular - mixed

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16
Q

pH of oral cavity?

A

6.3

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17
Q

What parasympathetic nerves act through VIP and acetylcholine on muscarinic receptors to INCREASE secretion of WATERY saliva?

A

Glossopharyngeal and facial nerves

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18
Q

What acts through NE on Beta-1 and alpha-1 adrenergic receptors to INCREASE secretion of VISCOUS saliva?

A

Cervical sympathetic chain

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19
Q

If you are making less saliva when you sleep, why do people drool?

A

Normally most of your saliva is being swallowed, but when you’re sleeping it isn’t swallowed!

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20
Q

What does vomiting do to saliva production?

A

Increase

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21
Q

Ganglion before parotid gland?

A

Otic

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22
Q

Ganglion before submandibular gland?

What is the action of amylase?

A

Submandibular

Hydrolyze alpha-1,4 glycosidic linkages in starch

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23
Q

What ion in saliva activates amylase?

A

Chloride

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24
Q

What 2 situations may cause you to see an increase in salivary enzyme production?

A

Pancreatic insufficiency

Neonates

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25
Q

Nerve that innervates tongue muscle for movement?

A

Hypoglossal

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26
Q

What are the 5 primary qualities detected by taste buds?

A 
Salty
Sour
Sweet
Bitter
Umami
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27
Q

What does dysguesia mean?

A

Abnormal taste

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28
Q

What 3 types of receptors are on the tongue?

A

Taste
Pain
Temperature

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29
Q

Where do taste signals go to lead to an increase in gastric acid secretion?

A

Nucleus tractus solitarius

30
Q

What type of receptors do taste ligands bind?

A

G-protein coupled receptors

31
Q

Is there much nutrient absorption in oral cavity?

A

No…very little!

32
Q

What drug was used in class as an example of one you’d want to administer sublingual or buccal to avoid hepatic first-pass metabolism?

A

Nitroglycerin

33
Q

What is Xerostomia?

A

Subjective sensation of dryness of oral mucosa!

34
Q

What large class of drugs causes dry mouth?

A

Muscarinic antagonists

35
Q

What is sialolithiasis?

A

Stone in salivary gland!

36
Q

When someone has gone through menopause, what happens to saliva?

What about during pregnancy?

A

Decreases postmenopause

Increases in pregnancy

37
Q

In a normal individual, when you stimulate salivation with citric acid, how much should you get per minute?

A

> 1 mL/minute

38
Q

What is halitosis?

A

bad breath!

39
Q

Consequences of dry mouth?

A

Increase in opportunistic infections

Halitosis due to production of hydrogen sulfide by bacteria and accumulation of dead cells

Decrease in pH leading to tooth decay

Decrease in taste

Speech problems

Dysphagia leading to malnutrition

40
Q

Technical term for swallowing?

A

deglutition

41
Q

Size of bolus to stimulate the involuntary swallow reflex?

A

2 cm

42
Q

Upper 1/3 of esophagus has what type of muscle?

Somatic or autonomic regulation?

A

Striated

Somatic

43
Q

Type of muscle in bottom 2/3 of esophagus?

Somatic or autonomic?

A

Smooth muscle

Autonomic

44
Q

Mucosal mechanoreceptors transmit messages through what 2 nerves to the medullary swallowing center?

A

Glossopharyngeal

Vagus

45
Q

What is the function of the larygopharynx?

A

Relax and segregate food and air to prevent food from going into trachea

46
Q

Is peristalsis necessary for liquid transport down esophagus?

A

No

47
Q

Predominant technique to diagnose a diverticulum?

A

Videofluoroscopic swallowing study

48
Q

Takes how long to move food from mouth to stomach?

A

10 seconds

49
Q

Interneurons of the myenteric nerve plexus detect sensory information…
Contraction occurs from release of what?

Relaxation occurs from release of what?

A

Contraction of circular muscles above bolus: ACh

Relaxation below bolus: NO/VIP

50
Q

Describe the speed and force of larger or colder boluses.

A

Greater force

Slower

51
Q

Secondary peristalsis is restricted to what type of muscle?

A

Smooth muscle

52
Q

Normally primary peristalsis occurs…what happens if the bolus gets stuck?

A

Then we have a secondary peristalsis that occurs!

53
Q

Eructation?

A

Burping

54
Q

Nutcracker esophagus

A

Painful contractions

55
Q

How do PPIs work?

A

Raise the pH of the stomach so the acid doesn’t cause as many problems

56
Q

Why are you more likely to have GERD after a meal?

A

Increased acid production

57
Q

Describe Achalasia mechanistically.

What does this look like on swallow study?

A

Loss of inhibitory neurons so no NO and VIP can cause relaxation of LES

“Bird beak” due to dilation of esophagus and very little food entering stomach

58
Q

Where does venous drainage of esophagus go?

A

Directly into systemic circulation

59
Q

Most important function of esophagus?!

A

Peristaltic movement of a bolus

60
Q

What activates salivary amylase?

What does salivary amylase hydrolyze?

A

Cl-

alpha-1,4 glycosidic linkages in starch

61
Q

Single most important action in swallowing?

Damage to which nerve would interfere with this?

A

Plunging action of tongue

Hypoglossal!

62
Q

Relaxation of what muscle leads to opening of the distal pharynx and UES?

What nerve innervates this muscle?

A

Cricopharyngeal muscle

Vagus

63
Q

Predominant diagnostic technique in a patient with dysphagia or odynophagia?

A

Videofluoroscopic swallowing study (VFSS) using Barium

64
Q

Do circular muscles relax or contract upstream and downstream of bolus?

What about longitudinal muscles?

A

Circular muscles contract upstream of bolus and relax downstream.

Longitudinal muscles relax upstream and contract downstream.

65
Q

What muscles are involved in primary peristalsis?

A

Both circular and longitudinal

66
Q

What is secondary persistalsis?

A

Restricted to smooth muscle…enteric neurons produce a strong peristaltic wave starting above the obstruction.

*Elicited by distention of GI tract or acid in esophagus

67
Q

What causes the LES to be closed between swallows?

A

Acetylcholine

68
Q

What causes the LES to be relaxed during swallows?

A

NO anad Vasoactive Intestinal Peptide (VIP)

69
Q

What hormone causes GERD in pregnancy?

A

Progesterone

70
Q

What cells are lost in Achalasia?

A

Myenteric ganglion cells

71
Q

What part of the brain coordinates swallowing with respiration and speech?

A

Medulla

GI Week 1 (10 decks)

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