Week 9 Flashcards
1
Q
fill in the gaps
A
Anterior border - lips
Superior border - hard palate
Lateral borders - cheeks
Posterior border - Faucial pillars (arches at the back of the mouth) folds of tissue located on either side of the back of the throat)
Inferior border (floor of mouth) - tongue, submental muscle
2
Q
What are Faucial Pillars?
A
Arches that are at the back of the mouth that creates a transition zone from the oral cavity into the pharynx behind it
3
Q
What is the thing that connects the upper and lower lip to the gingiva?
A
The frenulum
- Libial frenulum on the upper lip
- Lingual frenulum on the lower lip
- a little bit connective tissue but mostly mucus membrane
- if we didn’t have the lingual frenulum, our tongue would have a tendency to go back into our airway and we’d have a lot more difficulty breathing
4
Q
Where do the anterior faucial pillar (palatoglossal arch) and posterior faucial pillar (palatopharyngeal arch) attach?
A
Connected to the uvula
5
Q
Where do the palatine tonsils sit?
A
They sit between the anterior faucial pillar (palatoglossal arch) and the posterior faucial pillar (palatopharyngeal arch)
6
Q
What bones is the hard palatte made of?
A
Made of four bones. The right and left maxilla bones, part of our skull that come together and fused at the midline. Two other bones are the palatine bones. makes up about 2/3 of our palate
7
Q
What is the cleft palate?
A
When babies don’t have that fusion between these bones and there is a big separation between them.
8
Q
What is the soft palatte?
A
It has no bony component. muscle and mucous membrane that is moveable and flexible that can close off the nasal cavity or oral cavity.
9
Q
Sensory nerve of hard palatte?
A
Trigeminal nerve (cranial nerve V)
Lateral borders of the cheeks, so we know if we have taken a bite of carrot vs cracker
- innervates all of the mucosa of the palatte and the upper teeth, mandible and lower teeth
10
Q
Soft palatte sensory innervation?
A
Glossopharyngeal nerve (CNIX)
Pharyngeal branch of vagus nerve (CN X)
- the posterior aspect of the mouth is different from anterior because it is a reflexive area that has different innervation than the rest of the oral cavity which is under voluntary or cortical control
11
Q
What is the difference between the anterior and posterior tongue?
A
- oral tongue is the anterior 2/3 of the tongue (voluntary, eating) and posteriorly is the pharyngeal part of the tongue (involuntary swallowing)
12
Q
What is the marker that separates the front part of the tongue from the back part of the tongue?
A
Terminal sulcus
13
Q
What is the details of the pharyngeal tongue?
A
Smooth but lumpy, made up of tonsil tissue
- tonsil also in the pharynx called adenoids
14
Q
What are the details of the anterior tongue
A
rough and covered in little bumps
- some of the papillae have taste buds and some do not
Fungiform papillae(projection): smooth rounded mushroom shaped
- 3-5 taste buds on top
- sporadically placed around the tongue and more predominant around the tongue tip
Filiform papillae: makes up rest of the tongue, sharp little projections that are somewhat duller in humans than in other mammals like cats
- these projections allow us to grip food
Foliate papillae: on the sides of the tongue that make up most of the surface of the oral tongue, vertical ridges, folds of the mucosa, also contain taste buds but very few
15
Q
What are the papillae called that are the transition from the anterior tongue to the posterior tongue?
A
Circumvallate papillae:
- border terminal sulcus
- house >100 taste buds
16
Q
Oral tongue innervation for sensory and taste?
A
Somatosensation = Mandibular division of Trigeminal (CN V) (sensory to oral tongue). Taste = Facial (CN VII)
17
Q
Pharyngeal Tongue Somatosenation and Taste Sensation
A
Cranial nerve IX (glossopharyngeal) sensory and taste to pharyngeal tongue
18
Q
Why is the tongue called a muscular hydrostat?
A
- we have a portion that is constant volume
- mollusks and elephant
19
Q
Intrinsic Muscles
A
- aren’t’ connected to bone
- are just within the epithelial structure
- can change shape
- longitudinal muscles: run from the back of the tongue to the tip
- muscles that run straight up and down vertically and horizontally
- if the vertical fibers contract, they pull the top of the tongue down toward the bottom (flat and wide
- hypoglossal (CNVII) only motor nerve for tongue
20
Q
Extrinsic Muscles overall characteristics
A
- move the tongue outside of the mouth
- need to be attached to the skull, jaw (manible) or hyoid bone
- change position of tongue
21
Q
What three muscles attach to the temporal bone?
A
- Styloglossus comes from the styloid process and inserts into the sides of the tongue and can pull the tongue up and back
- Hyoglossus has the opposite effect and inserts into the lateral sides and pulls the tongue down and back, below the tongue
- these two muscles can cancel out and act as antagonists to each other
- Palatoglossus muscle
22
Q
What are the extrinsic muscles innervated by?
A
Hypoglossal nerve (CXII) except for palatoglossus which is innervated by the cranial nerve (CNX), vagus nerve
23
Q
What are the three acessory glands?
A
- the parotid gland is the largest one and more superficial and most inferior to the ear
- empties to the second molar
- motor innervation forom glossopharyngeal (CNIX)
- most active during chewing and eating
- Submandibular are close to the manible, each side of lingual frenulum, motor innervation = Facial nerve (CN VII)
- Sublingual salivary glands sit under the tongue. Facial nerve (CN VII)
- sublingual and submandular glands are activate at rest. help keep mucosa moist and to protect your teeth from bacteria
24
Q
What is the purpose of saliva?
A
- sublingual and submanibular glands keep the mucosa moist
- along with the parotid gland, they bind to food together to form something called the bolus (make all the food the same)
- Saliva is also injecting enzymes into the oral cavity that break down starches and fats into our food. Ions - bicarbonate buffer neutralized acids from oral bacteria (acids cause tooth decay)
- enzymes - amylase and lipase
25
What is the pharynx?
- a horizontal chamber, the oral cavity was a vertical chamber
- pharynx becomes the esophagus at the inferior aspect
26
What separates the nasopharynx and the oropharynx?
Soft palatte
- soft palatte controls if the food and fluid go in the wrong direction into the nasal pharynx or continue into the oropharynx
27
Nasopharynx features
- Pharyngeal tonsils (adenoids)
- Eustachian tube: the tube that connects the middle ear space into the pharynx, to drain into the pharynx so fluid doesn't build up
- babies are more at risk because they have more horizontlal Eustachian tubes
- Somatosensation: Vagus (CNX) plus glossopharyngeal (CNIX) in oropharynx
28
What tonsils do we have in the oropharynx?
Palatine tonsils between the faucial pillars
- Lingual tonsils at the back of the tongue
Somatosensation: Vagus (CNX) plus glossopharyngeal (CNIX) in oropharynx
29
What happens in the first phase of swallowing: 1. Oral Prepatatory and Oral Transport Phase
- when you take a bite of food, you chew it as much as you think you need to
- mixing with saliva and becoming
mouth --> oropharynx
- trigeminal nerve innervation to glossopharyngeal nerve and vagus nerve innervation, information is sent to the brainstem and it triggers a swallow response
- swallow isn't necessarily a reflex but a pattern motor behaviour (happens the same way no matter what you are eating or drinking)
- Oral transport: tongue elevates against hard palate to propel bolus
30
What is the Liguapalatal valve for during the oral preparatory phase?
We close off the oral cavity and keep material in the oral cavity until we are ready to swallow
- hidden muscles in the faucial pillars
- Palatoglossus muscles and Palatopharyngeus muscle bring the tongue down to seal
- motor innervation by the vagus (CN X) nerve
31
What happens in the second stage of swallowing: 2. Pharyngeal stage?
- food bolus fets from the oral pharynx all the way to the esophagus
- have to seal off the nasal cavity and larynx closed off
- soft palatte has to raise to seal off the nasal cavity, otherwise the food and fluid would go up. We need to close the airway
- upper esophageal spincter opens (close behind as it goes)
32
What happens in the third stage of swallowing: 3. Esophageal stage?
- most involuntary component
- zero control of what is happening
- once the food blus gets to the esophagus, we have involuntary contractions that push the bolus the rest of the stomach
33
What does matication mean?
Chewing in three dimensions
- rotary lateral motion so we grind the food between our molars
34
Velopharyngeal valve
- to close off the nasal cavity, there are other muscles acting on the top of the soft palatte, raise it
- levator veli palatini muscles and tensor veli palatini muscles come from the base of the skull that raise the soft palatte
- musculus uvula
- vagus nerve (CNX) except tensor veli palatini (Trigeminal CNV)
35
Laryngeal valves
- closes from the bottom up because it means each closure can push any out of the airway
36
Upper Esophageal Spincter (UES)
- Cricopharyngeaus muscle (part of the inferior pharyngeal constrictor muscle)
- pulling open by elevating larynx
37
Pharyngeal Constriction
- 3 constriction muscle
- superior pharyngeal constrictor muscle where the oropharynx is
- middle pharyngeal constrictor and inferior pharyngeal constrictor muscle that squeeze
- Cricopharyngeus muscle
38
Pharyngeal Elevation
- we pull the pharynx up closer to the base of the skull so it doesn't have a long path to go
- Palatopharyngeus (posterior faucial arches), Salpingopharyngeus, Stylopharyngeus
Motor innervation: Vagus (CN X) except Stylopharyngeus = Glossopharyngeal (CN IX)
39
Esophageal Phase
- Peristalsis
- Motor innervation: vagus nerve (CN X)
40
What are the 6 steps of the digestive process?
40
Organization of the GI tract
- all of the organs of the GI tract are composed of the same four layers but the composition will differ slightly depending on the organ
- closest to the lumen is more superficial
1. Mucosa
2. Submucosa
3. Muscularis Externa
4. Serosa
41
What is the layer of the mucosa for?
- layer in contact with the food
- contains molecular transporters
-
42
Submucosa
- connective tissue to hold neurovasculature and lympathatics which have the nutrients that are being transported from the mucosa into the submucosa
43
Muscularis Externa
- two different layers of smooth muscle
- allows for the peristalsis and segmentation
-
44
What is segmentation?
- only occurs in the small intestine
- alternating segments of smooth muscle contracting to mix up the bolus
45
Serosa
- deepest layer
- contains blood vessels and lymphatics as well
46
Which organs are in the foregut from the Celiac Trunk?
- esophagus, liver, spleen, stomach, pancreas, gallbladder, part of duodenum
47
What organs are in the foregut from the Superior Mesenteric artery?
- small intenstine, part of the duodenum, part of the large intestine (colon)
47
What are the hindgut organs from the Inferior Mesenteric Artery?
part of the large intestines (colon) and rectum
48
What is the stomach for?
Lack sack for the purpose of mixing food, helping with mechanical digestion
- holding area for storing food before it's ready to go into the small intestine
- smooth muscle is really important for mechanical digestion
- churning the food and help breaking into smaller pieces
- hydrochloric acid (HCl) that can help kill harmful bacteria that we may have ingested
- pepsin is going to break down proteins into amino acids
49
What are the specific areas of the stomach for?
- body: majority of the stomach
- fundus: can expand if you have eaten a lot of food
- cardia: close proximity of where the esophagus is entering the stomach
-Pylorus: going to meet the duodenum
50
What is the pyloric sphincter for?
- pylroric sphincter is the thickening of smooth muscle to contract the lumen
- it can slow the rate of digestion and slow the movement of chyme into the small intestine
51
What is the Rugae for?
- allows the stomach to have a lot of flexibility to expand when it becomes full
- when stomach becomes full, the rugae flattens out
52
What are the 4 parts of the duodenum?
superior (1st part), descending (2nd part), horizontal (3rd part), ascending (4th part)
52
Papilla vs Ampulla:
- the opening where the bile duct and the pancreatic duct release their contents are major duodenal papilla
- hepatopancreatic ampulla is the wider space where the ducts combine
53
What are the details of the Acessory Organs?
Liver, spleen, pancreas, gall bladder
- recieve blood from the celiac trunk
- part of the foregut
- spleen is derived from the same space but it has no role in digestion, works more with the vascular system, helps to filterate blood and recycle old blood cells
54
What levels do the branched arteries come from the aorta?
- Celiac Trunk (foregut organs) = T12
- Superior Mesenteric Artery (Midgut organs) = L1
- Inferior Mesenteric Artery (Hindgut organs) = L3
54
Celiac Trunk Details
- celiac trunk is really short, these branch off almost immediately after
- left gastric artery
- splenic artery
- common hepatic artery
55
Where does the blood get it's blood from?
The aorta (T12) --> celiac trunk --> common hepatic artery --> little cystic artery branch
56
Jejunum Properties
- many plica circularis (folds inside the lumen). not like the rugae, they don't allow for expansion. the purpose is this to increase surface area for absorption
- even more folds and these are
- villi and microvilli
- primarily for nutrient absorption
- long vasa recta and small arcades
56
Ileum Properties
- fewer plica circularis (so less absorption)
- peyer's patches (part of the immune system)
- short vasa recta and long arcades
57
Colon (Large Intestine) Overall details
- where midgut meets hindgut
- proximal 2/3rd Midgut
- Distal 1/3 Hindgut
- Cecum (receiving food from the ileum)
- Appendix (does not serve a purpose now, but we think it is a storage for healthy gut bacteria if the rest of the gut were wiped out)
-2/3 between the transverse colon is the difference between midgut and hindgut
58
What is the ileocecal valve?
- Where the illeum enters the cecum
59
What is the orfice of appendix?
Opening where the gut bacteria might go to repopulate
60
What is the Tenia coli and Haustra (pouches)??
Thickening of that longitudinal muscle in the muscular externa
- each haustra is separated by plica semilunaris which is a thickening in the cross sectional muscle fibers
61
What are epiploic appendages?
Little fat packages on the colon
62
Superior Mesenteric Artery
L1 vertabral level
- midgut
- branches travel through mesentery to reach intenstines
63
Superior Mesenteric Artery branches
- Inferior pancreaticoduodenal branches which is going to anastemosis with the superior pancreaticoduodenal branches
- jejunal branches
- ileal branches
iliocolic artery (where the ileum meets the cecum)
- sometimes you see the appendicular branch
- right colic artery for the ascending colon
- middle colic artery for the transverse colon
63
Gastric Ulcers
- the gastric ulcers are most commonly found in the stomach lining of the mucosa
- gastric ulcer are most commonly found in the pyrolus of the stomach
64
What is this?
hyoid bone
64
What is this?
The sulcus terminus
65
What are the papillae around the sulcus treminus?
- circumvalliate papillae along the sulcus terminus that are anterior to the v shaped mark
65
Motor innervation of the tongue
Hypoglossal nerve
- the left hypoglossal nerve will supply and the left side and right hypoglossal nerve will for right side
66
What side is not working?
- the right side
- the other side will push out the tongue and take over and the tongue will deviate to the side with the leison
67
What the pharynx level here?
The oropharynx
68
What part of the pharynx is it?
The laryngopharynx
69
What muscle is this?
The genioglossus muscle
- fibers are in a fan shape, going in all directions
- innervated by the hypoglossal nerve
- when the muscle contracts, the tongue will protrude out
70
What muscle is this?
Hyoglossus
- muscle fibers that are running vertically
70
What is this muscle?
- styloglossus and stylopharyngeus
- will act to pull the tongue back, retract the tongue
71
What nerve is this?
Lingual nerve which is the branch of the manible division of the trigeminal nerve that goes to supply the anterior two thrids of the tongue with general sensation
71
What nerve comes here?
- facial nerve supplies the taste to the anterior 2/3s
- the facial nerve runs along with the lingual nerve which is the branch of the manibular division of the trigeminal nerve
72
What is this nerve?
Glossopharyngeal nerve which supplies both the sensory and taste to the posterior one third of the tongue
72
What gland is this?
- The submandibular gland on both sides on the oral cavity
-
73
What gland is this? On both sides of the oral cavity. A duct anterior to the mouth, and it is on either side of the lingual frenulum? The small strip of tissue that connects the underside of your tongue to the floor of the mouth that holds the tongue down in the anterior aspect.
Sublingual gland. release saliva all along the lateral aspect of the tongue. Innervated by the branch of the facial nerve.
74
What gland is this?
Parotid gland, anterior to the ear.
- The parotid gland is supplied by the glossopharyngeal nerve (CN IX)
74
What are these nerves that come through the parotid nerve?
- facial nerves go through so if someone has an enlarged parotid gland, it could start compressing some of these nerves which which would affect the facial muscles.
75
What gland is this?
Submanibular gland. Lower part, sits below the manible.
76
What nerve is this?
The hypoglossal nerve
- provides innovation to the tongue
- coming from back here running along the mor einferior part of the manible to get into the oral cavity to supply the tongue
77
What is this artery?
The common carotid artery
78
What is artery is this?
External carotid artery
79
What branches from the external carotid artery?
The lingual artery which provides the tongue with blood.
80
What gives the sensory innervation to this part of the tongue?
this is the anterior two thirds which gets its sensory innervation from the lingual nerve
81
What gives the taste buds to this part of the tongue?
Facial nerve (CNVII) which has the branch chorda tympani which brings the taste sensation back to the central nervous system.
82
What gives this part of the tongue sensation and taste?
The posterior one third of the tongue is supplied by the glossopharyngeal nerve for both general sensation and taste.
- we also have taste buds scattered on teh walls of the oral pharynx as well as on the epiglottis.
83
What are the nerve that innervates the taste buds scattered on the walls of the oral pharynx as well on the epiglottis?
The vagus nerve
84
What is this view?
The pharynx from the posterior view
84
What muscle is this?
superior pharyngeal muscles
85
What bone is this?
The hyoid bone
86
What muscle is this?
The middle constrictor muscles
86
What muscle is this?
Inferior constrictor muscles
87
What is this?
The rough of the tongue. The posterior aspect. this is the uvula, which is the end of the soft palatte.
88
What is this part?
Muscles of the laryngeal pharynx that controls the vocal cords.
88
What is this?
The esophagus
89
What is this showing?
How the epiglottis falls down and covers the enterance to the trachea
90
What muscle is this?
Stylopharyngeal muscle
- innervated by the glossopharyngeal nerve which runs on top of it
- elevates the pharynx that makes it shorter
91
What nerve is this?
The glossopharyngeal nerve (CN IX)
- this innervates the stylopharyngeus muscle
- the rest of the elevation muscles are innervated by the vagus nerve (CN X) which are palatopharyngeus (posterior fauchial arches), salpingopharyngeus, stylopharyngeus
91
What is the blue nerve?
Internal laryngeal nerve which is the branch of the vagus nerve goinginside to supply the sensory to the larynx. this image here to show where it supplies
Stylopharyngeus = glossopharyngeal (CN IX) purple one
92
What nerve is this?
External laryngeal branch which will supply that one external
- These nerves also supply the pharyngeal muscles, the constrictor muscles, superior, middle and inferior constrictor muscles.
92
What does the diaphragm separate?
The thoracic cavity from above from the abdominal cavity below
92
What are the raises on the right and left side of the diaphragm from?
- on th eright side we have the liver
- on the left we have the stomach and the spleen
93
Inferior Vena Cava
Inferior Vena Cava
- it is in the tendenous part and the muscle fibers are all more radiating from the center out here
94
What will go through here the muscular part?
- the esophagus goes through here
95
What goes posterior to the esophagus?
The aorta
95
What nerve is this?
The phrenic nerve
- left phrenic nerve which supplies innervation to the diaphragm
95
At what levels do things pass through the diagraphagm?
T8 = inferior vena cava
T10 = esophagus
T12 = aorta
95
96
What side is the aorta more towards?
The aorta is a little bit more on the left side of the vertebral bodies
96
What happens to the vagus nerve in the thorax?
It will become the esophageal plexus
- Those nerves will run through along with the esophagus, through the diaphragm to enter the abdominal cavity.
96
What is this?
the spleen
97
What is this?
The celiac trunk
97
What artery is this?
The splenic artery
98
What artery is this?
Common Hepatic Artery
99
What artery is this?
- The gastroduodenal branch from the common hepatic artery
100
What artery is this?
The left gastric artery, which will go to supply the lesser culture of the stomach as well as the lower part of the esophagus
100
What is the esophagus supplied by?
In the thoracic cavity, the esophagus was supplied by the small banches coming off of the aorta as it traveled through that space.
100
What region of the stomach is this?
The cardiac region, where the distal part of the esophagus joins the stomach
100
What is this area of the stomach called?
Fundus
101
What is the main part of the stomach called?
The body
101
What is this region of the stomach called?
Pyloric Region
101
What is the pyloric sphincter?
Thick muscle of the walls of the stomach that controls the exit of the contents from the stomach into the next segment o f the digestive tract
102
What is the cardiac or the lower esophageal sphincter?
controls the entrance of contents from esophagus into the stomach
- not very robust
- prevents the regurgitation of stomach contents back into the esophagus
-
103
What are these surfaces inside the stomach called?
Rugae, allow the stomach to expand
- when the stomach is empty, they are all foleded up and small
104
104
Is the upper part of the esophagus voluntary or involuntary?
Voluntary
- skeletal muscle
104
Is the middle third of the esophagus voluntary or involuntary?
- mixture or skeletal muscle and smooth muscle
105
What type of layers of muscle are in stomach?
- walls are fairly thin, it's got muscle arranged in longitudinal, circular and transverse
105
What nerves innervate the walls of the stomach?
Smooth muscle in the esophagus and the stomach are both controlled by branches of the vagus nerve
-
105
What artery is this?
- the celiac trunk
105
What artery is this?
- The splenic artery
105
What artery is this?
- Splenic Artery
105
106
What artery is this?
- Left gastric artery that supply the lesser culvature and the distal part of the esophagus
106
What is the artery?
- Common hepatic artery
106
What artery is this?
- gastroduodenal artery, which supplies the duodenum
107
What is the Innervation of the anterior 2/3?
Lingual nerve, mandibular division of the trigeminal nerve
107
What is teh innervation of the posterior 1/3 ?
- general and special sensory - glossopharyngeal nerve
107
What is the nerve for epiglottis and parts of oral pharynx?
special sensory - vagus nerve
107
What is the motor innervation of the tongue?
Hypoglossal nerve
107
Label the last gastric artery, common hepatic artery, gastroduedenal artery, splenic artery?
107
A- cardia
B - fundus
C- greater curvature
D - body
E - Pyloric region
F - Lesser curvature
G - esophagus
H - duodenum
108
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108
This image shows a Hiatal Hernia: the stomach has moved up into the chest through diaphragm through the natural T10 opening. The diaphragm usually provides extra support to stay closed but when a hiatal hernia occurs, it loses this support and becomes weaker. This makes it easier for stomach acid to flow back into the esophagus, causing a reflux.
108
Smell: Special sense - Olfactory nerve
Salivary glands - PNS - facial and glossopharyngeal and vagus nerves
Taste: special sense - facial, glossopharyngeal and vagus nerves ( helps with taste by carrying taste signals from the back of the throat (like the area near the epiglottis)
Swallowing: vagus and glossopharyngeal nerves (somatic and PNS)
Stomach: PNS - vagus enrve
- SNS would also supply these structures to cause vasocontriction
108
Salivary gland shown is the submandibular gland:
- single duct
- body of gland can be seen inferior to mandible
Innervation: Salivary glands are innervaed by the PNS
Submandibular gland - facial nerve (Cn VII) via lingual nerve
Sublingual gland - facial nerve via lingual nerve
Parotid gland - Glossopharyngeal nerve (CN IX)
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