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Block 3 Week 1 > Physiology of oral cavity and esophagus T. Smith > Flashcards

Physiology of oral cavity and esophagus T. Smith Flashcards

1
Q

The act of swallowing pushes food down the esophagus, disposes of (blank), opens (blank), and stops (blank).

A

mucus (bacteria and dust)
Eustachian auditory tube
breathing

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2
Q

What is deglutination?

A

swallowing

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3
Q

The cripharyngeal muscle is always (blank). When a bolus of food comes, this muscle must be (blank)>

A

constricted, relaxed

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4
Q

What muscles must constrict to aid food through the esophagus? These and the cripharyngeal muscle make up what?

A

superior pharyngeal constrictor muscle
middle pharyngeal constrictor muscle
inferior pharyngeal constrictor muscle
they make up the upper esophageal sphincter

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5
Q

Integrated neural pathways mediate (blank).

A

swallowing reflex

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6
Q

Where are the swallowing centers located? What do they do?

A

in the medulla

controls muscle relaxation and contraction

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7
Q

What are the major peripheral sensory inputs to the swallowing center carried by?

A

1)the maxillary branch of the trigeminal nerve (V2)
[face, sinus and teeth]
2)the glossopharyngeal nerve (IX) [Posterior 1/3 of tongue, tonsil, pharynx and middle ear]
3) the superior laryngeal branch of the vagus (X) [larynx, pharynx].

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8
Q

The motor output of the swallowing center is via the motor branches of the????

A

trigeminal (V) [muscles of mastication]
facial (VII) [muscles of face]
glossopharyngeal (IX) [stylopharyngeous, upper pharyngeal muscles]
vagus (X) [palate, pharynx, larynx, esophagus]
and
hypoglossal (XII) [tongue muscles].

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9
Q

(blank) is the symptom of the failure of normal propulsion of the bolus from mouth to esophagus. Because the oropharyngeal phase of swallowing is coordinated with respiratory activity, respiratory symptoms often accompany

A

oropharyngeal dysphagia

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10
Q

Oropharyngeal dysphagia and associated respiratory symptoms are caused by:

A

1) a failure of the driving force
2) obstruction to flow
3) a combination of 1 and 2

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11
Q

(blank) is an autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatigability. It is an autoimmune disorder, in which weakness is caused by circulating antibodies that block acetylcholine receptors at the postsynaptic neuromuscular junction, inhibiting the excitatory effects of the neurotransmitter acetylcholine (Ach) on nicotinic receptors throughout neuromuscular junctions.

A

myasthenia gravis

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12
Q

(blank) is a motor neuron disorder that can lead to swallowing difficulties.

A

poliomyelitis

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13
Q

(blank) is a muscle disease characterized by inflammation and a skin rash. It is a type of inflammatory myopathy. It is one of a group of acquired muscle diseases called inflammatory myopathies. Problems with swallowing (dysphagia) may occur.

A

dermatomyositis

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14
Q 
What can these cause:
Cerebral vascular accident
Poliomyelitis
Myasthenia gravis
Dermatomyositis

Tumor or abscess
Cricopharyngeal achalasia

A

Oropharyngeal dysphagia

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15
Q

primary peristalsis is triggered by (Blank)

A

swallowing

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16
Q

THe pressure wave that moves down the esophagus during swallowing is coordinated with opening of the (blank) which relaxes before the propagating contraction. (i.e it relaxes first then contracts after)

A

Lower esophageal sphincter

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17
Q

Where is there a delay during swallowing?

A

in the smooth muscle parts of the esophagus

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18
Q

What part of the esophagus has the highest pressure?

A

the Upper esophageal sphincter

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19
Q

Swallowing or a bolus of food in the pharynx stimulates tension receptors in the wall of the pharynx. Pharyngeal contraction coincides with relaxation of the (Blank) and relaxation of the (Blank). This remains relaxed until the (blank) arrives which consists of sequential phasic contraction along the esophageal body, which propels the swallowed bolus toward the stomach.

A

Upper esophageal sphincter
lower esophageal sphincter
peristaltic wave

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20
Q

When food goes down the esophagus what does the muscle do?

A

the longitudinal muscle shortens and the circular muscle constricts

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21
Q

What are the thre major layers of the esophagus?

A

mucosa and submucosa
circular muscle
longitudinal muscle

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22
Q

What is the nerve plexus between the longitudinal muscle and the circular muscle called?

A

the myenteric plexus

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23
Q

What muscle type does polymyositis and myasthenia gravis attack in the esophagus?

A

striated

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24
Q

What muscle type does scleroderma and achalasia attack in the esophagus?

A

smooth

25
Q

The proximal portion of the esophageal body is composed of striated muscle and is innervated by somatic lower motor neurons whose cell bodies are located in the (blank)

A

nucleus ambiguous (NA).

26
Q

The more distal portion of the esophageal body is composed of smooth muscle and is innervated by (blank) fibers whose cell bodies are located in the (blank) and synapse with intramural neurons whose cell bodies are located in the (Blank) of the esophagus.

A

vagal preganglionic
dorsal motor nucleus (DMN)
myenteric plexus

27
Q

What nerve creates persistaltic contractions in the esophagus?

A

vagus!

28
Q

Vagus nerves arising from the Nucleus Ambiguous release (blank) directly onto the skeletal muscle where they activate (blank) on Skeletal Muscle Fibers to produce contraction.

A

Ach

Nicotinic receptors

29
Q

Vagus nerves arising from the DMN release (blank) where they activate (blank) on (blank) inhibitory and excitatory motor neurons to the smooth muscle to produce relaxation followed by contraction.

A

Ach
Nicotinic receptors
myenteric

30
Q

What is the resting pressure of the esophagus everywhere other than the LES or UES?

A

zero or slightly negative

31
Q

What has a prolonged relaxation the UES or LES?

A

LES

32
Q

When the vagus nerve is causing relaxation what is released?

A

NO/ VIP

33
Q

Latency of esophageal contractions is regulated by (blank)

A

Nitric oxide

34
Q

If you treat the smooth muscle of the esophagus with a inhibitor of NO, what happens?

A

you lose the latency gradient of contraction (i.e. you dont have delayed contractions)

35
Q

If you treat smooth muscle of the esophagus with a muscarinic inhibitor, what happens?

A

have very small contractions :(

36
Q

WHat 2 things make up the intrinsic and extrinsic sphincters. The two structures are superimposed and anchored by the (blank) ligament.

A

LES and crural diaphragm

phrenoesophageal ligament

37
Q

Esophageal peristalsis is initiated in what 2 ways?

A

swallowing (primary peristalsis) and esophageal distention (secondary peristalsis)

38
Q

(blank) is triggered by distention in the smooth muscle portion of the esophagus. Contraction orad (nearer to the mouth) to the bolus is followed by a descending pressure wave that is coordinated with lower esophageal sphincter opening.

A

secondary peristalsis

39
Q

This is the control of peristalsis by the (blank)
Peristalsis can be triggered when a sensory nerve detects distension or luminal acidity. Interneurons convey the signal to excitatory and inhibitory nerves above and below the site of stimulation, respectively. ACh, acetylcholine; NO, nitric oxide; VIP, vasoactive intestinal polypeptide

A

enteric nervous system

40
Q

Ascending interneurons activate (blank) Motor Neurons that release acetylcholine (Ach) that excite muscarinic receptors on the smooth muscle leading to contraction of the smooth muscle above the bolus. Whereas descending interneurons activate (blank) Motor Neurons that release nitric oxide (NO) and vasoactive inhibitory polypeptide (VIP) onto the smooth muscle to cause relaxation of the smooth muscle below the bolus respectively.

A

Excitatory

Inhibitory

41
Q

LES relaxation is (Blank)

A

neurogenic

42
Q

These do something to LES:
(blank) stimulation relaxes it
it is blocked by (blank)
it is blocked by (blank)

A

vagal
tetrodotoxin (TTX)
Hexamethonium

43
Q

(blank) is the inhibitory neurotransmitter that mediates esophageal relaxation.

A

Nitric oxide

44
Q

What do anticholinergic drugs do to LES pressure in man?

A

decreases it

45
Q

If you block nicotine what happens to the LES?

A

it doesnt relax or contract properly

46
Q

What three factors play a role in determining resting LES pressure?

A

Neurogenic - cholinergic blockade decreases sphincter tone.
Myogenic - vagotomy or cholinergic blockade does not lead to total abolition of sphincter tone
3) Hormonal - the differing effects on LES pressure by fat and protein meals is best explained by hormonal action.

47
Q

What is this:
Failure of propulsive force
Obstruction to flow
In-coordination of contraction and relaxation

A

dysphagia

48
Q

What are three symptoms of esophageal dysfunction?

A

gatroesophageal reflux systems
dysphagia
esophageal pain (non cardiac chest pain)

49
Q

(blank) involves inserting a long, flexible tube (endoscope) down your throat and into your esophagus. A tiny camera on the end of the endoscope lets a gastroenterologist examine your esophagus, stomach and the beginning of your small intestine (duodenum).

A

upper endoscopy procedure

50
Q

If you have myasthenia gravis what happens to your UES? How do you treat this?

A

you cant get it to relax

give an anticholineresterase :) (it prevents break down of acetylcholine)

51
Q

What is edrophonium?

A

an anticholineresterase

52
Q

The heart and the esophagus are located in the chest cavity (thorax) in close proximity. SOO They receive very similar (blank) supply. Thus, pain arising from either organ travel through the same nerve sensory fibers to the brain. What does this mean for us!?!?

A

nerve
pain from either organ may have similiar presentations of pain so it can be hard to differentiate where the pain is coming from.

53
Q

(blank) is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms.

A

GERD

54
Q

(blank) is a change in the normal lining of the esophagus (squamous mucosa) to a lining similar to the lining of the stomach (columnar mucosa) that is visible by endoscopy.

A

Barrett’s esophagus

55
Q

(blank) occurs when part of your stomach pushes upward through your diaphragm.

A

hiatal hernia

56
Q

Name the procedure and what it is for?
In this procedure, the surgeon wraps the top of the stomach around the lower esophagus. This reinforces the lower esophageal sphincter, making it less likely that acid will back up in the esophagus.

A

The Nissen Fundoplication for GERD

57
Q

(blank) is a disorder of the movement of the esophagus. It causes difficulty swallowing, or dysphagia, to both solid and liquid foods, and can cause chest pain; it may also be asymptomatic. It is a disorder with very intense contractions of the esophagus!

A

Nutcracker esophagus

58
Q

(blank) is a disease where the LES cannot relax due to a loss of inhibitory neurons, or a loss of both inhibitory and excitory neurons resulting in loss of contraction and relaxation.

A

achalasia

Block 3 Week 1 (18 decks)

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