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Salivation and swallowing Flashcards

1
Q

What are the functions of saliva?

A

• Hydrate food
• Aids movement of tongue during speech
o Mucins (glycoproteins) help with the lubrication
• Keeps teeth healthy due to saliva having antibacterial properties
• Saliva acts as first line of defence against pathogenic food that has been injested
• Saliva is a solvent that can dissolve flavour molecules
• It begins the process of digestion (amylase and lingual lipase)
• Transmits infection

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2
Q

What is the medical word for reduced flow of saliva in the oral cavity and what are its consequences?

A

xerostomia

  • get a VERY dry mouth
  • Can cause difficulty swallowing, mouth ulcers, dental cavities and oral candidiasis, bad breath
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3
Q

Why can xerostomia cause oral candidiasis?

A

because there is no saliva there to protect the mouth against the fungi

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4
Q

What causes xerostomia?

A

drug side affects (SSRI)
blocked noses and breathing through mouth
radiotherapy to head
salivary gland surgery

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5
Q

What is the composition of saliva?

A
  • mostly water
  • has potassium and bicarbonate
  • IgA
  • lysozyme
  • lactoferrin
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6
Q

What is the function of K+ and HCO3- in the saliva?

A

makes it slightly acidic (pH 8)

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7
Q

What do IgA do in the saliva?

A

secrete immunoglobulin

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8
Q

What does lactoferrin do in the saliva?

A

-sequesters iron meaning it holds on to it so bacteria don’t get to it

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9
Q

How is saliva made hypotonic?

A
  • ductal modification where more ions are reabsorbed from saliva than secreted
  • the ductal cells are relatively impermeable to water
  • the overall effect is more ions are removed from saliva than water
  • tonicity varies the flow rate
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10
Q

What salivary glands are the largest?

A

parotid glands

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11
Q

Where are the parotid glands?

A

they pass over the masseyter muscle and pierce the buccinator
-can be found lateral t the second top molar

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12
Q

Where are the submandibular glands?

A

They open on the medial side of the most floor

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13
Q

Where are the sublingual glans?

A

they open on the later side of the mouth

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14
Q

What is the neural control of the salivary glands?

A

-via the autonomic nervous system with the parasympathetics being the main driver of salivary secretion (increasing secretion)

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15
Q

What nerve are the sublingual and submandibular glands innervated by?

A

facial nerve

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16
Q

What nerve is the parotid gland innervated by?

A

glossopharyngeal

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17
Q

What do the sympathetics do?

A

stimulates small amounts of saliva secretion but also causes vasoconstriction if there is too much stimulation

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18
Q

What drugs have a side effect of dry mouth?

A

anti-muscarinic drugs e.g. SSRI’s

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19
Q

What are MUMPS?

A

also known as paratoiditis

-very painful

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20
Q

Why are mumps so painful?

A

the parotid gland has a tight capsule surrounding it (innervated by the trigeminal nerve) so when swollen, it causes severe pain

21
Q

How would you palpate the sublingual glands?

A

one finger in the mouth and one under the chin

22
Q

How would you image the parotid glands?

A

using parotid sialography
-catheter is inserted into duct of parotid and contrast is injected to see structures of the gland
-where contrast doesn’t reach could indicate pathology blocking the route
(can be used for other glands too not just parotid)

23
Q

What are the stages of swallowing?

A
  • oral preparatory phase
  • pharyngeal phase
  • oesophageal phase
24
Q

What occurs in the oral preparatory phase?

A

the bolus of food is pushed towards the pharynx

-once bolus touches the pharyngeal wall, the pharyngeal phase begins

25
What occurs in the pharyngeal phase?
the soft palate seals off nasopharynx - the pharyngeal constrictor muscles push the bolus down - the larynx elevates closing the epiglottis - the vocal cords adduct and breathing temporarily ceases - the upper oesophageal sphincter opens
26
Why does the nasopharynx need to be sealed off?
you dolt want food or liquid going into the nasal cavity
27
How does the larynx elevate?
due to supra hyoid muscles
28
Why does the epiglottis close?
passively through elevation of the larynx
29
What occurs the oesophageal phase?
- closure of the upper oesophageal sphincter | - peristaltic wave carries bolus downwards into the oesophagus
30
Which phases are voluntary/involuntary?
oral preparatory phase is voluntary | pharyngeal and oesophageal are involuntary
31
How can babies breath and suck milk out of the breast at the same time?
babies have a short neck so the epiglottis sits higher so diverts milk laterally when feeding - the epiglottis elevates into the nasopharynx - also neurologically immature so are at risk of aspiration due to immature swallowing reflex
32
Describe the gag reflex?
- when bolus touches mechanoreceptors in the pharyngeal wall - glossopharyngeal nerve (afferent sensory) - medulla (information received that food is ready to swallow) - vagus nerve (motor nerve to pharynx) - pharyngeal constrictors
33
Where is the gag reflex?
-more anterior in children and moves posterior in adults
34
What is dysphagia?
difficulty swallowing
35
Why can babies only have fluids in their early life?
tongue thrust reflex - more prominent gag reflex to reject solids or anything else until they are 6 months old as they are not developed enough to consume anything but milk
36
When may a patient present with dysphagia?
- post stroke | - oesophageal tumour
37
Why would someone get dysphagia post stroke?
- the part of the brain controlling swallowing may be infarcted as it is close to the brain supplying the day and so may be left with difficult swallowing - damage to facial expression muscles and pharyngeal muscles
38
How would a patient with post-stroke dysphagia present?
patient will cough and splutter immediately when trying to swallow something
39
Why would someone get dysphagia with an oesophageal tumour?
impinge into the lumen of the oesophagus which narrows it so food can get caught giving the feeling of food sticking (fluids go down easy) -red flag is associated with weight loss
40
What can a patient post stroke at risk of?
if they can't coordinate swallowing, they are at risk of aspiration pneumonia which kills a lot of stroke patients
41
How can you combat this risk of aspiration pneumonia in post stroke patients?
-put patient on IV fluid until confirmed that swallowing is safe!
42
How many narrowing are there in the oesophagus?
4 - junction with the pharynx - where the arch of the aorta crosses over the oesophagus - where the bronchi branch of the left lobe crosses over - just before to pierces the diaphragm (oesophageal hiatus)
43
Where does the oesophagus run?
down the posterior mediastinum and pierces the diaphragm at T10 -the top is made from skeletal muscle (voluntary) but at the end it is smooth muscle (involuntary)
44
NOTE
Due to the cartilage the trachea is lined with, if a large food bolus is swallowed, when it reaches the part of the oesophagus where the left bronchi branch crosses over, it can be VERY painful
45
What is GORD?
gastro-oesophageal reflux disease | -dangerous if left untreated
46
What happens in GORD?
- the bolus from the stomach refluxes into the oesophagus | - it CAN cause metaplasia
47
What is barrats oesopahgus?
due to repeated insult from the stomach, metaplasia can occur from stratified squamous to simple columnar epithelium
48
How is GORD prevented?
- lower oesophageal sphincter (diaphragm compresses it) - angle at which the oesophagus enters the stomach is oblique forming a flap valve preventing the reflux - mucosal rosette at the cardia which increases the surface area of the mucosa

GI (10 decks)

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