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Gastrointestinal > Session 4 - Salivation and Swallowing, and Hernias! > Flashcards

Session 4 - Salivation and Swallowing, and Hernias! Flashcards

1
Q

What is the composition of saliva?

A
  • Mostly water
  • Hypotonic (dependent on flow rate)
  • Rich in potassium and bicarbonate.
  • Mucins - lubrication
  • Amylase - salivary glands
  • Lingual lipase - lingual glands
  • Immune proteins - IgA, lysozyme, lactoferrin
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2
Q

What is the pH of saliva?

A

slightly acidic to ~8

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3
Q

What are briefly the functions of saliva?

A
  • Lubricate food
  • Lubrication of mouth structures for speech
  • Oral hygiene - healthy teeth (immune proteins, ions)
  • Protection - lysozyme, IgA etc.
  • Solvent - carries taste molecules to taste buds.
  • Digestion - amylase
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4
Q

What is xerostomia? What causes it?

A

Dry mouth.

Most common due to dehydration

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5
Q

What subsequent problems can xerostomia cause?

A
  • Dental problems/ cavities
  • Mouth ulcers
  • Speech problems
  • Oral candidiasis (or other infection)
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6
Q

Why may dry mouth cause oral candidiasis?

A

Due to reduced IgA, lysozymes and other immune defenses, it is easier for an infection to take place.

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7
Q

How many salivary glands are in the head?

A

Three pairs

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8
Q

What are the different salivary glands of the head?

A
  • Parotid Glands
  • Submandibular glands
  • Sublingual glands
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9
Q

Describe the location and ducts of the parotid glands.

A

Sit most laterally over the ramus and angle of
mandible.
Parotid duct goes medially over masseter muscles,
and penetrates buccinator muscle, opening into
mouth.

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10
Q

Which muscle forms the main bulk of the floor of the mouth?

A

Mylohyoid

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11
Q

Describe the anatomy and ducts of the sublingual glands?

A

Most of the gland sits above the mylohyoid muscle.

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12
Q

Where are the submandibular glands located?

A

Most of gland is below the mylohyoid muscle.

split into superficial and deep lobes (around mylohyoid)

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13
Q

How is the submandibular gland examined?

A

Can be felt under the mandible, the floor of the mouth.

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14
Q

How can the sublingual glands be examined?

A

Using two digits.

One in the mouth, pushing of the floor, and one underneath.

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15
Q

Where does the submandibular duct enter?

A

Opens onto the floor of the mouth, most medially.
(under the tongue)
subMandibular M = medial

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16
Q

Where are the ducts of the sublingual glands?

A

Multiple ducts Laterally!

subLingual - L = lateral

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17
Q

How is secretion of the salivary glands neurally?

A

Primarily by the parasympathetic NS.

  • Submandibular + lingual = supplies by FACIAL nerve. (C VII)
  • Parotid - Glossopharyngeal (C IX)

Parasympathetic increases production of saliva (rest and digest)

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18
Q

Which drugs may affect saliva production?

A

Drugs with an antimuscarinic effect (inhibit muscarinic acetyl choline receptors)

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19
Q

What effect do sympathetic nerves have on saliva production?

A

Stimulates secretion of small amounts of saliva. BUT

Vasoconstriction (so less produced, reduced perfusion of salivary gland)

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20
Q

What is a facial sign of mumps?

A

Swollen parotid glands, seen at cheeks.

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21
Q

Why is parotid swelling with mumps particularly painful?

A

Parotid glands enclosed in a tense fibrous capsule which doesn’t stretch - so parotid cannot swell so causes intense pain.

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22
Q

What is parotid sialography?

A

Sialography: Radiographic examination of salivary glands.

Insert a little catheter into duct, via mouth, and contrast injected.

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23
Q

What are the three phases of swallowing?

A

1) Oral preparatory phase - voluntary
Pushes bolus towards pharynx

2) Pharyngeal phase - involuntary
- Starts once bolus touches pharyngeal wall.
- Soft palate seals off nasopharynx
- Larynx elevates, closing epiglottis
- Vocal cords adduct closing, and breathing temporarily stops. (protect airway)
- Upper oesophageal sphincter opens.

3) Oesophageal phase - involuntary
- Closure of Upper oesophageal sphincter
- Peristalsis of bolus down oesophagus.

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24
Q

How is breathing possible for infants in breast feeding, when they don’t pause from drinking?

A

In babies, the epiglottis projects UP into the nasopharynx, so can breathe, and drink milk.
(not fully understood)

25
Q

How is swallowing neurally controlled?

A
  • Mechanoreceptors in pharynx detect bolus.
  • When activated, talk to glossopharyngeal, which synapses with vagus nerve neurones in the medulla.
  • Efferent motor response travels through vagus nerve, activating the pharyngeal constrictors.
26
Q

What controls the gag reflex?

A

The same pathway as the swallowing reflex.

Gag reflex is probably psychologically balanced.

27
Q

What is the difference between ana dult and baby gag reflex?

A

Baby gag reflex is more anterior.

If gag when given food, not ready yet?

28
Q

Why would a stroke cause a problem with swallowing?

A

Infarction.
Area of brain supplying face is close to area supplying pharynx.
So if facial features of stroke, also difficulty swallowing possible.

29
Q

How do you hydrate someone after a stroke having difficulties swallowing?

A
  • IV Fluids

- Swallow rehabilitation

30
Q

Which other condition can cause difficulty swallowing?

A

An oesophageal tumour.
When eating solid food. (less so with liquids)
Food gets caught/ blocked on tumour.

31
Q

Where are the narrowings along the length of the oesophagus?

A

1) Junction with pharynx
2) Where crossed by arch of aorta
3) Where is compressed by left main bronchus
4) At oesophageal hiatus (at diaphragm)

32
Q

Which features prevent gastro-oesophageal reflux?

A
  • Functional sphincter, formed from smooth muscle of distal oesophagus.
  • Diaphragm
  • Intra-abdominal oesophagus, gets compressed when intra-abdominal pressure rises (e.g. forcing in defacation)
  • Acute angle of entry (flaps shut with increase pressure/force)
33
Q

What is a hernia?

A

A protrusion of part of the abdominal contents beyond the normal confines of the abdominal wall.

34
Q

What are the parts of a hernia?

A
  1. The sac (a pouch of peritoneum)
  2. Contents of the sac
  3. Coverings of the sac
35
Q

Which structures in the abdominal cavity commonly herniate?

A
  • Loops of bowel

- Omentum

36
Q

What makes up the coverings of the sac?

A

Consists of the layers of the abdominal wall through which the hernia has passed.

37
Q

Where are common sites of hernias, where the wall is weak?

A
  • Inguinal canal
  • Femoral canal
  • Umbilicus
  • Previous incisions (surgery)
38
Q

What is the inguinal canal?

A

Oblique passage through the lower part of the abdominal wall.

  • In males: structures pass through from abdomen-testis.
  • In females: round ligament goes from uterus-labium majus.
39
Q

What is the processus vaginalis?

A

Pouch of peritoneum covering the testes (precursor to tunica vaginalis)

40
Q

What is the gubernaculum?

A

Condensed band of mesenchyme that links inferior portion of testis (gonad) to labioscrotal swelling.

41
Q

What may happen if processus vaginalis doesn’t close properly?

A

Could cause an inguinal or scrotal hernia.

42
Q

What are the two types of inguinal hernias?

A
  • Indirect

- Direct

43
Q

Which sex is affected more by inguinal hernias? Which side?

A

Men
Ratio 7:1
Mainly right sided

44
Q

Where are the entrance and exit to the inguinal canal?

A

Entrance = Deep ring: in the posterior wall (transversalis fascia)

Exit = Superficial ring: in the anterior wall (Aponeurosis of external oblique)

45
Q

What factors define if a hernia is direct or indirect?

A

Where the contents leave the abdomen.
Indirect - lateral to the inferior epigastric vessels.
Leaves through the DEEP ring.
Direct - Medial to inferior epigastric vessels
Goes straight through the wall

46
Q

What are the borders of hesselbachs triangle?

A

An area of relative weakness in abdominal wall.
Medial = rectus abdominus muscle
Superior = Inferior epigastric artery
Inferior = Inguinal ligament

Area where hernias can commonly occur

47
Q

Where do direct hernias through hesselbachs triangle normally end up?

A

Usually in vicinity of the superficial inguinal ring.

48
Q

How do scrotal hernias form?

A

Leaves abdomen lateral to inferior epigastric vessels through deep inguinal ring.
Through inguinal canal.
Moves through superficial inguinal ring.
Can then possibly move into tunica vaginalis (if not fully close during development)

49
Q

What are the borders of the femoral canal?

A 
Medial = Lacunar ligament
Lateral = Femoral vein
Anterior = Inguinal ligament
Posterior = pectineal ligament.
50
Q

What are the contents of the femoral canal?

A

NAVEL

Nerve, artery, vein, empty space, lymphatics.

51
Q

What is the femoral ring?

A

The base of the femoral canal.

52
Q

Why are women more likely to get femoral hernias than men?

A

The femoral ring can be wider in females, more likely something may go into it.
(still less common than inguinal hernias in females, so much rarer)

53
Q

Why can femoral hernias become easily incarcerated?

A

Due to the small size of the space.

54
Q

What are reducible, and irreducible hernias?

A

Reducibe: if it can be pushed back in.
Irreducible: Incarcerated, cannot be pushed back in.

55
Q

What can happen to an incarcerated hernia?

A

Increased venous pressure, causes increased pressure and can cause strangulation.
This means the blood supply is compromised, can become necrotic, and could cause sepsis.

56
Q

What is an adult umbilical hernia (para-umbilical)?

A

Hernia through the linea alba.
Goes through region of umbilicus.
F>M

57
Q

Where is an epigastric hernia found?

A
  • Between xiphoid process, to umbilicus.
    (tend to be midline)
  • Usually starts with small hole through linea alba.
    (straining can cause it to push through)
58
Q

What are some symptoms of hernias?

A

Very varied (based around what happens if loops of bowel get trapped)

  • Pain
  • Vomiting
  • Sepsis

Gastrointestinal (9 decks)

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