Oral Cavity and Esophagous S2M2

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lancesadams
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91513
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Oral Cavity and Esophagous S2M2
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2011-08-13 13:20:30
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Ross S2M2
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Physiology
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  1. What are the four layers of the GI tract from the lumen out
    • Mucosa
    • Submucosa
    • Muscularis externa
    • Serosa/Adventitia
  2. What is the function and makeup of the Mucosa layer of the GI track
    • Protection, secretion, absorption
    • Epithelium
    • Lamina Propria (GALT) (Loose connective tissue)
    • Thin layer of muscularis mucosae
  3. Where is an exception of the Mucosa layer not having muscularis mucosae
    Gallbladder
  4. What is the purpose of the muscularis mucosae in the Mucosa layer of the GI
    It provides localized movement of mucosa (not peristalsis)
  5. What is the Submucosa made up of
    • Dense Connective tissue (GALT)
    • Meissners plexus (submucosal plexus)
    • Glands in the esophagus and Duodenum
  6. What is the Muscularis Externa layer of the GI made up of, and what is its role
    • 2-3 layers of smooth muscle (inner circular/outer longitudinal)
    • Myenteric plexus
    • Performs peristalsis
  7. Auerbachs plexus (Myenteric Plexus)
    This is the plexus between two layers in the Muscularis Externa that contains parasympathetic ganglia
  8. What is the makeup of the Serosa/Adventitia layer of the GI tube
    • Serosa is covered by mesothelium
    • Adventitia has no mesothelium
  9. Hypodontia/Hyperdentia
    Less teeth then normal/More teeth then normal
  10. Enamel is produced by
    Ameloblasts
  11. What is the hardest part of the teeth
    Enamel
  12. Cementum
    Lower portion of the teeth embeded between the Dentin and the alveolar bone
  13. Dentin is found where and produced by what
    Found just below the enamel and is the thickest portion of the tooth, it is produced by Ondotoblasts
  14. What portion of the tooth is derived from Ectoderm
    Enamel (the rest from mesenchyme)
  15. What portions of the tooth are derived from Neural crest cells
    • Ondotoblasts which develop into Dentin
    • Pulp
  16. What portion of the teeth is derived from Mesoderm
    • Cementocytes
    • Periodontal ligaments
  17. When does tooth development begin
    6th week
  18. What is the difference between Gingivitis and Periodontitis
    • Gingivitis is reversible damage to the gums
    • Periodontitis is irreversible damage to the gums with portions of the roots being uncovered
  19. Malocclusion
    Imperfect position of teeth when the jaw is closed
  20. What nerve provides voluntary movement of the jaw
    Trigeminal (CNV)
  21. What are the two types of oral mucosa
    • Parakaratinized (Masticatory mucosa)
    • Non-karatinized epithelium (Lining mucosa)
    • Both are stratified squamous epithelia
  22. Where is the Parakaratinized epithelium found
    • Hard palate
    • Part of Gingiva (gums)
    • Some of the Dorsal surface of the tongue
  23. Parakeratinized vs keratinized epithelium
    • Parakeratinized epithelium has an outer layer (stratum corneum) that is keratinized and have nuclei but lack a stratum granulosum layer
    • Karatinized epithelium outer cells do not have nuclei but do have a stratum granulosum layer
  24. Where is Non-karatinized epithelium found in the oral cavity
    Internal surface of the lips, cheeks, floor of the mouth, and the underside of the tongue and soft palate
  25. What are the layers of the Non-karatinized epithelium in the mouth
    • Relatively thick mucosa
    • Lamina propria
    • Submucosa
    • No muscularis mucosa
    • No muscularis externa
  26. Why is the underside of the tongue a good place for absorption of oral medication
    Because the underside of the tongue is thin and more permeable therefore absorption will happen rapidly
  27. The oral cavity contains no
    Muscularis mucosa or muscularis externa, therefore, the lamina propria is attached directly to the underlying bone or muscle
  28. What are the three sections of the lip and their contents
    • External aspect - Thin keratinized skin, hair, & glands
    • Vermilion zone - Thin skin, no glands or hairs
    • Internal aspect - Labial mucosa, minor salivary glands
  29. What is the difference in the epithelium of dorsal and ventral tongue
    • Dorsal - Keratinized stratified squamous epithelium
    • Ventral - Non-keratinized lining mucosa
  30. Filiform papillae characteristics
    • Most abundant type of papillae on the tongue
    • Connective tissue core with heavily keratinized epithelium
    • Catches food
    • Gives sandpaper like feel
    • No taste buds
  31. Fungiform Papillae characteristics
    • Mushroom shape projections on the tongue
    • Non-keratinized or lightly keratinized stratified squamous epithelium
    • Have taste buds
  32. Circumvallate Papillae characteristics
    • Largest papillae on the tongue
    • Mushroom shaped
    • Non-keratinized epithelium
    • 250 taste buds per papillae found between each fold
  33. Foliate Papillae
    • Leaf like
    • Found along the side of the tongue
    • Rudimentary in humans
  34. Von Ebners glands
    Pure serous glands found between the circumvallate papillae
  35. What are the four types of cells, and their defining characteristics in taste buds
    • I - Dark
    • II - Light
    • III - Neurosensory
    • IV - Stem cell (basal cell) don't synapse
    • All but IV have microvilli on there outer ends
  36. What are the five components of saliva
    • Hypotonic fluid containing:
    • Lubricating proteoglycans (mucin)
    • Amylase
    • Lysozyme
    • IgA
    • Salivary proteins
    • "SALLI"
  37. Minor salivary glands are found where in the oral cavity
    Lamina propria
  38. Mucocele
    Rupture of the duct and spilling of saliva
  39. What are the major salivary glands
    • Parotid (serous)
    • Submandibular (mixed)
    • Sublingual (mixed)
  40. What is the duct of the parotid gland
    Stensens duct
  41. What is the duct of the sub-mandibular gland
    Whartons
  42. How much saliva is secreted in a day
    Over one liter
  43. Ranula
    Mucoceles in the floor of the mouth
  44. What are the components of salivary ducts and their cell types starting with the beggining of the ducts
    • Intercalated ducts - Low cuboidal cells
    • Striated ducts - Simple cuboidal
    • Interlobular/excretory ducts - varied cell types
  45. What is the role of striated ducts in the duct system of salivary glands
    Actively transport Na+ ions from saliva into extracellular space
  46. How do the salivary glands obtain IgA
    Acinar cells or duct cells (beginning of ducts), endocytose IgA dimers from plasma cells, placing them in the lumen of the duct
  47. Xerostomia
    • Dry mouth
    • Common in the aged
    • Can be drug induced
  48. Sjogren syndrome
    • Autoimmune
    • Obstructed ducts
  49. Sialolithiasis
    • Ca2+ Stone formation in saliva ducts causing obstruction
    • Dehydration, infections occur as a result
  50. What are the primary functions of Saliva
    • Maintenance of oral hygiene
    • Mineralization of teeth
    • Lubrication
    • Digestive function (amylase & lipase)
    • Solvation (taste of soft foods)
    • Lysis
    • "LDS Love M&M's"
  51. What are the two stages of salivary secretion
    • Primary (Acini)
    • Secondary ductal modification (salivary ducts)
  52. What is the composition and flow of ions in the secondary ductal formation of saliva
    • Hypotonic solution
    • Low H2O permeability of ducts
    • Na+ and Cl- leave the duct
    • K+ and HCO3 enter the duct
  53. What is the fluid like in the primary stage of salivary secretion
    Isotonic ECF and plasma like composition (proteins, mucins, & enzymes present)
  54. What is the primary difference between plasma and Primary secretion of the salivary glands form the acini cells
    Acini secrete a higher K+ concentration then what is found the the plasma
  55. What are the normal plasma levels of K+, Na+, HCO3, and Cl-
    • K+ - 3.5-5 mM
    • Na+ - 130
    • HCO3 - 25
    • Cl- - 100
  56. What is the concentration of Na+ in its stimulated and unstimulated state in the Parotid gland
    • Stimulated - 90 mM
    • Unstimulated - 15 mM
    • 6 times higher in stimulated state
  57. What is the concentration of K+ in its stimulated and unstimulated state in the Parotid gland
    • Stimulated - 15 mM
    • Unstimulated - 30 mM
    • Half the amount in stimulated state
  58. What is the concentration of Cl- in its stimulated and unstimulated state in the Parotid gland
    • Stimulated - 50 mM
    • Unstimulated - 15 mM
    • Over 3 times higher in stimulated state
  59. What is the concentration of HCO3- in its stimulated and unstimulated state in the Parotid gland
    • Stimulated - 60 mM
    • Unstimulated - 15 mM
    • 4 times higher in the stimulated state
  60. How does Aldosterone and ADH effect the Salivary glands
    • Aldosterone - Increases NaCl absorption and K+ secretion
    • ADH - Increases NaCl absorption
  61. What is the difference in Parasympathetic and Sympathetic stimulation of salivary secretion
    • Parasympathetic - Copious flow of watery saliva
    • Sympathetic - Reduced volume of saliva, rich in enzymes
  62. What is the route of parasympathetic innervation of salivary secretion
    • Reflex (smell, taste, ect.)
    • Salivary nucleus of medulla
    • CN's VII and IX
    • ACh
    • IP3
    • Ca+ release
    • Saliva secretion
  63. How do the sympathetics trigger salivation
    • T1-T3 nerves
    • Superior cervical ganglion
    • Norepinephrine
    • cAMP
    • Ca+ release
    • Saliva secretion
  64. What is found in the Mucosa in the esophagus
    • Stratified squamous epithelium non-keratinized
    • Thin band of lamina propria
    • Cardiac glands (mucus)
    • Muscularis mucosae (single longitudinal layer)
  65. What is found in the Submucosa layer of the esophogus
    Esophageal glands (Mucus)
  66. What is found in the Muscularis externa layer of the esophagus
    • Inner circular muscle
    • Outer longitudinal layer
  67. The Lower Esophageal Sphincter (LES) opening and closing is controlled by
    • Increase tone - ACh & Gastrin
    • Decreased tone - VIP & NO
  68. The Upper Esophageal Sphincter is controlled by what nerve
    CN X
  69. How are the Serosa and Adventitia layers arranged in the Esophagus
    Only the portion that is in the peritoneal cavity is covered with Serosa, the rest is covered with Adventitia
  70. Barretts esophagus
    Normal non-keratinized epithelium in the esophagus under goes metaplasia into simple columnar epithelium causing chronic heart burn
  71. What are the four main stimuli to Motility and digestion
    • 1. Distention of gut wall
    • 2. Osmolarity of luminal contents
    • 3. Luminal pH
    • 4. Concentrations of fat, peptides, glucose, ect
    • "COLD"
  72. What is the difference between Myenteric plexus and Meissners (submucosal) plexus
    • Myenteric - Mainly gut motility
    • Meissners - Mainly absorption, secretion, and blood flow
  73. Deglutition
    Swallowing
  74. What are the steps to swallowing and how long does it take
    • Tongue thrust up and back
    • Nasopharynx closed
    • Larynx elevated
    • Airway closed
    • Upper esophageal sphincter opens
    • Pharynx contracts
    • Bolus enters esophagus
    • Around 1 second
  75. After initiating swallowing through the vagus and glossopharyngeal nerves, what actions does the Dorsal Motor nucleus control
    • It uses the vagus nerve to increase tone in the esophagus and relax the Lower esophageal sphincter
    • Food enters the stomach through peristalsis
  76. After initiating swallowing through the vagus and glossopharyngeal nerves, what actions do the Nucleus Ambiguus control
    • Sequential activation of pharyngeal-esophageal constrictors as well as relaxes the cricopharyngeal muscle
    • Food enters esophagus through peristalsis
  77. After initiating swallowing through the vagus and glossopharyngeal nerves, what actions do the respiratory and speech center control
    • Respiratory - Decrease breathing
    • Speech - Elevates larynx
    • (Sealing the trachea)
  78. What are the inhibitory signals used by the vagus nerve to stop peristalsis in the esophagus
    • VIP (Vasoactive Intestinal Polypeptide)
    • NO
    • ATP
    • Substance P
  79. What are the excititory signals used by the vagus nerve to initiate peristalsis in the esophagus
    • Acetylcholine
    • Substance P
  80. What effect would atropine have on the esophagus
    It would shut off the Acetylcholine causing dilation of the esophagus
  81. How would an NO inhibitor effect the esophagus
    NO would be shut off while ACh is active causing the esophagus to constrict
  82. What is the state of the esophagus at baseline and vagal transaction
    It is in the central position, not being constricted or dilated
  83. Caudad distension
    This is when NO and VIP cause the esophagus to dilate ahead of the bolus allowing it to move forward
  84. Orad constriction
    This is when ACh and SP are causing the constriction of the esophagus behind the bolus pushing it forward
  85. Achalasia
    Failure of the esophagus to relax lower esophageal sphincters (LES)
  86. What are the treatments for Achalasia
    • Nitrates
    • Calcium Channel blockers
    • Injection of botulinum toxin
    • Balloon dilation
    • Laproscopic myotomy (removal of circular muscles)

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