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Symposia > Salivary Glands > Flashcards

Salivary Glands Flashcards

1
Q

What are the 3 major salivary gland?

A
  1. Parotid
  2. Sublingual
  3. Submandibular
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2
Q

What type of innervation do salivary glands receive?

A

Autonomic innervation from parasympathetic and sympathetic

Parasympathetic- cranial and sacral level
Sympathetic- Thoracic and lumbar region

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3
Q

What cranial nerves have parasympathetic fibres?

A

Cn3 - Occulamotor
Cn7 - Facial
Cn9 - Glossopharyngeal
Cn10 - Vagus

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4
Q

How does parasympathetic innervation work?

A
  1. Preganglionic neurone leaves the brain stem or sacral spinal chord
  2. Synapses at an ganglion using ACh neurotransmitter and nicotinic receptors
  3. Postganglionic neurone goes to organ and synapses again using nicotinic receptors and ACh
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5
Q

How is the Parotid gland supplied parasympatheticly?

A
  1. Glossopharyngeal nerve leaves the brain stem from the inferior salivatory nucleus
  2. Preganglionic fibres travel to **otic ganglion ** and synapse there using nicotinic receptors and ACh
  3. Postganglionic fibres travel to parotid gland and synapse there again using nicotinic receptors and ACh
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6
Q

How are the sublingual and submandibular gland parasympatheticly innervated?

A
  1. Facial nerve leaves superior salivatory nucleus using the chorda tympani branch
  2. Travel via preganglionic fibres to the submandibular ganglion and synapses using nicotinic receptors and ACh
  3. Leaves submandibular ganglion via shorter postganglionic neurone, to either sublingual or submandibular glands
    - synapses at the gland using ACh and nicotinic receptors
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7
Q

How does sympathetic innervation work?

A
  • Sympathetic chain runs down the spine but leaves via the vertebraes, when they leave via preganglionic neurones they travel to a ganglion in the vertebrae hence these are the short neurones
  • Synapse at ganglion using Nicotinic receptors and ACh
  • postganglionic neurone runs to effector region (gland) and synapses using Nicotinic receptors but a different neurotransmitter Noradrenaline (longer neurone)
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8
Q

How are salivary glands innervated sympathetically?

A

Fibres leave from T1-T4 region

1.Preganglionic neurones travel up sympathetic chain to superior cervical ganglion where it synapses using ACh and nicotinic receptors
2. Postganglionic neurone travels to glands and synapse via nicotinic receptors and Noradrenaline

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9
Q

What are the functions of saliva?

A
  1. Lubrication
  2. Clearance of food
  3. Neutralises acids
  4. Contains digestive enzyme
  5. Pellicle formation
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10
Q

What are the different types of saliva?

A
  1. Serous saliva - liquids, produced by parotid gland
  2. Mucus saliva - thick, produced at submandibular gland (1:2) and sublingual gland (1:3)
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11
Q

How does organisation of salivary gland differ?

A

Parotid - contains serous cells with striated ducts
Sublingual and submandibular- contain mucus cells

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12
Q

What are the Stages of secretion?

A
  1. Acinus
  2. Ducts
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13
Q

How are molecules transported in the acinar cells? (4 types)

A
  1. Active transport - transports Na+ out (causes other passive transportsj and K+ in (creating membrane potential)
  2. Ion channels - selective proteins pore, Na+ driven in due to concentration gradient
  3. Passive ion transporter - Na+ is uptaken causes Cl- and K+ to also be taken in (cotransporter)
    - Na+ is taken in and this causes H+ to be passed out (exchanger)
  4. Aquaporins - pores selective to water no driven by osmosis
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14
Q

What is the difference between a passive exchanger and cotransporter?

A

Exchanger swaps one molecule for another e.g. Na+ in H+ out

Cotransporter brings other molecules with the molecule moving in e.g. Na+ brings Cl- and K+

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15
Q

How do the transporters work in acinar cells?

A
  1. Active ion channels pumps Na+ out of the cell while bringing in K+ to create a membrane charge but also keep the Na+ concentration low so it makes a gradient
  2. Na+ moves in passively, and bring Cl- and K+ with it in a co-transporter
  3. Increase Cl- levels so some diffuses into lumen when apical cl- channels open due to membrane being charged (due to K+)
  4. Water enters cell and leaves into lumen
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16
Q

How is the saliva modified in the ducts?

A
  1. Na+ leaves the saliva into the cell passively via proteins channels
  2. Na + e created out of the cell via the active Na+ pump and K+ enters the cell
  3. Cl- is exchanged with HCO3- via exchanger proteins taking it out of the cell and adding HCO3- into the saliva
  4. Cl- also leaves passively via proteins channels into the cell out of the saliva, and also out of the cell into the blood
  5. To make the HCO3- CO2 is anhydrased causing H+ to be created
  6. H+ leaves cell via H+/Na+ exchangers
  7. Little bit of water is reabsorbed
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17
Q

What is it imports that salivary duct cells absorb the salt?

A
  1. Saliva would taste salty and we would struggle to taste food
  2. Body would have Huge salt lose
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18
Q

How do extracellular signal (hormones) induce salivary production?

A
  1. Hormones - act as a neurotransmitter and bind to cell surface receptors generating an intracellular message
  2. Intracellular messengers activate protein kinases
  3. Protein kinases activate other proteins
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19
Q

How do the cell communicate intracellular?

A
  1. Ion-channel couples receptors - ions channel will open when the cell releases the receptors needed to open the channel
  2. Enzyme-coupled-receptor - single molecules in form of a dimer
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20
Q

How does parasympathetic cause salivary secretions?

A
  1. Ach released as a neurotransmitter binds to nicotinic receptor
  2. GTP is realised and this activates G proteins
  3. Causes IP3 to be released and this causes the Ca+ channel to open
21
Q

How does the innervation of parasympathetic and sympathetic nervous system differ?

A
  1. Parasympathetic = Acetylcholine realised - increases Ca2+ levels - salt and water secretions
  2. Sympathetic = Noradrenaline released - increase cAMP - proteins secretions
22
Q

What are different types of digestive enzymes in saliva?

A
  1. Salivary amylase - broken down starch into glucose
  2. Salivary lipase - starts fat digestions
  3. Ribonuclease- breaks down RNA
23
Q

What are the different states of saliva in acinar and in the ducts?

A

Acinar - isotonic

Ducts - hypotonic as the salts we’re removed

24
Q

How does exocytosis work?

A
  1. Granules bind to apical membranes due to interactions with snare proteins, stiumulated by cAMP molecules
  2. Membranes fuse to create a pore
  3. Membranes retrieved by endocytosis
25
Q

What are salivary mucins?

A
  • Complex glycoproteins secreted by the mucous acinar cells
    They have a high viscosity, elasticity and adhesiveness so they lubricate the hard and soft palate, some have antimicrobial properties
26
Q

What is a symptom defined as?

A

A subjective feeling of a disease, usually from the patients side

27
Q

What is a sign defined as?

A

An objective piece of evidence of a disease

28
Q

What are symptoms of dry mouth?

A
  • Dry mouth
  • difficulty speaking, swallowing and eating
  • bad taste in mouth
  • bad breath
  • salivary gland swelling
29
Q

How to take history if patients when they have dry mouth?

A
  1. Medical history e.g. systemic conditions any specialist medication
  2. Dental history e.g. recent increase in dental visits
  3. Social history e.g. occupation alcohol intake
  4. Family history e.g. autoimmune history, type 2 diabetes
30
Q

What are signs of dry mouth?

A
  1. Salivary gland enlargement
  2. In examinations the mucus is thick and sticks to the dental mirror
  3. Shinny mucosa
  4. Plaque accumulation
  5. Little pooling of saliva
31
Q

What is Trush

A

Infection of to oral cavity normally on the tongue or cheek
- acute pseudomembranous candidosis

32
Q

How can saliva production be measured?

A

Unstimulated saliva production is measured using sialometry

33
Q

What is sialometry?

A

A method of measuring unstimulated salivary production, patient dribbles into a container for 15 mins, if 0.3-0.4mm/min is produced that is healthy anything under 0.1 is abnormal

34
Q

What are causes of dry mouth?

A
  1. Development - aplasia, atresia
  2. Salivary gland disease - HIV, HEP C
  3. Systemic disease - Diabetes
  4. Alcohol
35
Q

What is Aplasia?

A

This is the complete absence of salivary glands and is very rare

36
Q

What is atresia?

A

This is when the salivary duct is narrowed or absent

37
Q

What is Sjögren’s syndrome? (SS)

A

This is an autoimmune chronic inflammatory condition that effects the bodies ability to make fluids e.g. saliva, tears

38
Q

What are the types of Sjögren’s disease?

A
  1. Primary Sjögren’s syndrome
  2. Secondary Sjögren’s syndrome (more common)
39
Q

How does the infection rate of Sjögren’s syndrome vary for males and female?

A

Female have a 10 times greater effected rate

40
Q

What are the effects of Sjögren’s syndrome?

A
  1. Salivary flow reduced
  2. Tongue appearance changes
  3. Dry eyes
  4. Soreness of mouth
  5. Swelling of parotid gland
41
Q

How can Sjögren’s disease be diagnosed?

A
  1. Oral investigations
    - sialograph
    -sialometry
  2. Ocular investigations (eyes)
    - Schirmers test (lacrimal flow rate)
42
Q

Explain how to do a sialograph test?

A
  1. A Radiopaque dye is inserted into the gland via a catheter and radiographic assistance to guide
  2. The flow rate and path is examined and also the drainage

They are useful when trying to find blockages or areas of inflammation

43
Q

Explain how to do a Schimer test?

A

This is done to determine if the lacrimal gland produces enough tears to lubricate the eyes
1. A paper strip is placed below the eyes and it absorbed the tears
2. Left for 5 minutes
3. Measure the amount of mature absorbed
Normal = 3ml a min
Sjögren’s syndrome = 1ml a min

44
Q

What are the different ways to treat dry mouth? (4)

A
  1. Stimulation treatment
  2. Replacement treatment
  3. Own saliva
  4. Saliva substitute
45
Q

How can saliva be stimulated?

A

Body. An be stimulated to produce saliva via:
1. Chewing gum
2. Saliveze lozenges
3. Systemic therapy

46
Q

How can salivary treatment be done via the replacement method?

A
  1. Carboymethylcelluslose based luborant
  2. Animal mucin - extracted from big saliva
  3. Gels for overnight
47
Q

How to prevent dry mouth?

A
  1. Good diet
  2. Fluoride e.g. toothpaste and mouthwash
  3. Gel
  4. Varnish
48
Q

How much fluoride should be in tooth paste and mouth wash?

A
  • Toothpaste = around 1500pp
  • Mouthwash = 1350pp

Symposia (8 decks)

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