You are what you eat Block 3 Week 1 Flashcards
The gastrointestinal tract can be split into the upper and lower respiratory tract. What is in each tract ?
The GI tract involves the oral cavity, pharynx, esophagus, stomach, small intestine (duodenum, jejunum and ileum), large intestine (ascending, tranverse and sigmoid colon), rectum and anal canal.
- The GI tarct is about 5.5 metres long
The boundaries of the mouth
Hard palate at the front
Soft palate at the back
What is the Mylohiod muscle (aka diaphragma oris) ?
The mylohyoid muscle or diaphragma oris is a paired muscle of the neck. It runs from the mandible to the hyoid bone, forming the floor of the oral cavity of the mouth.
What are the folds in the mouth called ?
- palatopharyngeal fold
- palatoglossal fold
- gingiva ( aka gums)
- Superior labial frenum
- Inferior labial frenum
- Lingual frenum
- Superior lip (top lip)
- Inferior lip (bottom lip)
Teeth:
- Incisors (4)
- Canines (2)
- Premolars (2)
- Molars (3)
The oral cavity ( mouth) is split into the oral vestibule and the oral cavity proper.
Oral vestibule: is the area anterior to the teeth.
Oral cavity proper: everything posterior to the incisors - the space between the upper and lower dental arches. This includes the tonge, salivary glands, oral mucosa, hard and soft palate.
What are the accessory organs of the GI tract?
The GI tract involves:
the oral cavity, pharynx, esophagus, stomach, small intestine (duodenum, jejunum and ileum), large intestine (ascending, tranverse and sigmoid colon), rectum and anal canal
The accessory organs are:
- teeth
-tongue
- salivary glands
- pancreas
- liver
- gall bladder
What are the salivary glands?
Function of saliva:
- it lubricates the food to facilitate swallowing
- aids in speech
- contains enzyme a- amylase (ptyalin) which begins the process of starch digestion.
There are 3 main pairs of salivary glands:
- the parotid
- the submandibular
- sublingual glands
Each gland is surrounded by a fibrous capsule and consists of a number of lobules made up of small acini (alveoli) lined with secretory (acinar) cells.
The acini are drained by ductules which join to form larger ducts leading to the mouth
What are the salivary glands?
Function of saliva:
- it lubricates the food to facilitate swallowing
- aids in speech
- contains enzyme a- amylase (ptyalin) which begins the process of starch digestion.
There are 3 main pairs of salivary glands:
- the parotid
- the submandibular
- sublingual glands
Each gland is surrounded by a fibrous capsule and consists of a number of lobules made up of small acini (alveoli) lined with secretory (acinar) cells.
The acini are drained by ductules which join to form larger ducts leading to the mouth
Describe the sympathetic and parasympathetic innervation of the salivary gland ?
- All the major salivary glands receive both sympathetic and parasympathetic
innervation. - noradrenergic sympathetic fibers from the superior cervical ganglion are distributed to both blood vessels and acinar cells.
- The secretion of saliva is primarily controlled by the parasympathetic fibers.
- paraganglionic parasympathetic fibers arrive by way of the facial and glossopharyngeal nerves and synapse with the post ganglionic neurons close to the salivary glands themselves. Both the secretory cells and duct cells receive parasympathetic fibers.
- Secretion of saliva can be serous, mucous or mixed.
Describe the parotid, submandibular and sublingual gland ( ?
Parotid gland ( largest):
- produce only serous secretion.
- it contains a -amylase and antibody (immunoglobin A)
- accounts for 25% of saliva
Submandibular gland:
- more viscid saliva
- Accounts for 70% of saliva
- these glands contain acinar cells which secrete mucoproteins and serous fluid
Sublingual glands:
- 5 % of total saliva
- rich in mucoprotein
Parotid salivary gland
Where:
- situated at the angle of the jaw, lying posterior (behind) the mandible and inferior to the ear.
Bounded by what:
Superiorly : zygomatic arch
Posteriorly : sternocleidomastoid
Anteriorly: masseter muscle
There is a duct from the p gland, its 5 cm long and goes to the secrete saliva into vestibule. The duct goes over the masseter and through the buccinator (cheek muscle)
Describe the submandibular gland (aka submaxillary gland)?
- has a duct which empties into the sublingual caruncle which is a papilla located medially to the submandibular gland.
Describe the sublingual gland ?
- The sublingual gland opens up to multiple ducks on either side of the sublingual papilla ( caruncle) along the ridge.
note: you can have blockages of these ducks as stones can forma nd block them
Describe the teeth and their function to the digestive system ?
- A full set of adult teeth will amount to 32 teeth in total. This includes the wisdom teeth
- most people have 28 because their wisdom teeth don’t come through
- Teeth have their own nerve supply, they need to detect pressure on food so you know how hard to bite.
- both the maxillary and mandible teeth is supplied by branches of the trigeminal nerve (CN V)
Upper teeth = maxillary teeth
lower teeth = mandibular teeth
Branches of the trigeminal neve ?
Branches of the trigeminal nerve (3):
- Opthalmic nerve
- mandibular nerve
- maxillary nerve
The different branches are namely the ophthalmic (V1), maxillary (V2), and mandibular (V3) nerves
Describe the innervation of the upper an lower teeth ?
Upper (maxillary):
- trigeminal nerve - maxillary nerve - superior alveolar nerve - maxillary teeth
Lower (mandibular)
- trigeminal nerve - mandibular nerve - inferior alveolar nerve - mandible teeth
Describe blood supply to the teeth ?
Blood supply to teeth:
- begins at external carotid (left and right) which branches into the maxillary artery
- Both the mandible and maxillary teeth are supplied by the maxillary artery but by different branches of it.
Mandibular teeth:
- maxillary artery -> inferior alveolar artery -> blood supply to mandibular teeth
Maxillary teeth:
- maxillary artery -> posterior superior alveolar artery -> blood supply to maxillary teeth
Describe the muscles of mastication ?
- The muscles of mastication allow us to chew our food.
The whole system hinges at the Temporomandibular joint.
These muscles are innervated by mandibular branches of the trigeminal nerve.
Their blood supply is the maxillary artery and superficial temporal artery
Describe the muscles of mastication ?
There are four muscles:
Masseter
Temporalis
Medial pterygoid
Lateral pterygoid
Masseter muscle:
- most powerful muscle of mastication.
-the muscle lies superficially to pterygoid and temporalis
- innervation: mandibular nerve (v3)
Temporalis:
- muscle is covered in tough fascia
- innervation:
mandibular nerve (v3)
Describe the muscles of mastication ?
Lateral pterygoid muscle:
- triangular shape with two heads: superior and inferior
- Acting bilaterally, the lateral pterygoids protract the mandible, pushing the jaw forwards
- horizontally orientated muscle fibres, and thus is the major protractor of the mandible.
Medial pterygoid muscle:
-quadrangular shape with two heads: deep and superficial. It is located inferiorly to the lateral pterygoid.
Innervation: Mandibular nerve (V3)
Actions: Elevates the mandible, closing the mouth.
What is the buccinator?
Buccinator is the cheek.
It is sometimes called an accessory muscle of mastication.
- It is innervated by the facial nerve
- It is a muscle of facial expression
- Buccinator also has a role in keeping food in the oral cavity when chewing instead of falling in the vestibular region.
Describe the role of the tongue in mastication?
The tongue is made up of intrinsic and extrinsic muscles.
The intrinsic muscles only attach to other structures in the tongue
There are four paired intrinsic muscles of the tongue and they are named by the direction in which they travel:
-the superior longitudinal
- inferior longitudinal
- transverse muscle
- vertical muscle
Describe the role of the tongue in mastication?
The extrinsic muscles of the tongue:
Genioglossus, Hyoglossus
Styloglossus
Palatoglossus
- Genioglossus:
Motor innervation via the hypoglossal nerve (CNXII
protrude the tongue, middle fibres depress the tongue, and superior fibres draw the tip back and down
- Hyoglossus:
Arises from the hyoid bone and inserts into the side of the tongue
Function: Depresses and retracts the tongue
Innervation: Motor innervation via the hypoglossal nerve (CNXII).
- Styloglossus:
Originates at the styloid process of the temporal bone
Retracts and elevates the tongue
Motor innervation via the hypoglossal nerve (CNXII).
- Palatoglossus:
Arises from the palatine aponeurosis
Elevates the posterior aspect of the tongue
Motor innervation via the vagus nerve (CNX).
All of the intrinsic and extrinsic muscles are innervated by the hypoglossal nerve (CN XII), except palatoglossus, which has vagal innervation (CN X).
The top of this muscle is what forms the palatoglossal fold
- glossus : means sometging relating to tongue
What is the blood supply to the tongue ?
The lingual artery is a branch of the external carotid artery ?
External carotid artery -> lingual artery
What are the 3 constrictor muscles of the pharynx ?
- There are three circular pharyngeal constrictor muscles:
-the superior pharyngeal constrictor
-middle pharyngeal constrictor
- inferior pharyngeal constrictor
The pharynx ends at c6
What happens once the food has been chewed ?
- Once mastication is complete and the lubricated bolus has formed, it is swallowed.
- From the mouth the food passes posteriorly into the oropharynx and then into the laryngopharynx, both of which are common passageways for food, fluids and air.
What happens when food is swallowed ?
- The fist (oral) phase of swallowing is voluntary but the subsequent pharyngeal and esophageal stages of the process are under reflex autonomic (involuntary control)
- During the oral phase of swallowing the tip of the tongue is placed against the hard pallet and the tongue is then contracted to force the food bolus into the oropharynx ( the part of the pharynx lying immediately behind the mouth).
- As the food enters the pharynx and stimulates mechanoreceptors there, the involuntary phase of swallowing begins.
There are two areas that need to be shut off when food is swallowed what are they :
The two areas which need to be shut off are the nasopharynx and the trachea.
- The 2 muscles which contract so the nasopharynx is shut off are:
- Levator veli palatini muscle
- musculus uvulae
This makes sure the food is passing downwards
To shut off the trachea we have the EPIGLOTTIS which is shutting and closing that off.
Involuntary phase of swallowing (reflex) ?
- innervated by the pharyngeal plexus ( formed by the pharyngeal branches of glossopharyngeal and vagus)
3 Phases of swallowing:
1. Oral
2. Pharyngeal
3. Esophageal
What happens during the pharyngeal phase:
- The tongue lifts up
- soft palate lifts up
-vocal folds close shutting the epiglottis - we have the larynx lifting up which brings the epiglottis down to shut the laryngeal inlet.
The pharyngeal phase is voluntary and the esophageal phase is involuntary
What happens during the esophageal phase ?
- The upper sphincter is an anatomical, striated muscle sphincter at the junction between the pharynx and oesophagus. It stops food going back up to the oropharynx
- It is produced by the cricopharyngeus muscle. Normally, it is constricted to prevent the entrance of air into the oesophagus.
- bolus now enters the esophagus.
- esophagus is 25 cm long (approx) and goes from c6 to t10. The bolus travels down in what is called peristaltic waves
- esophagus passes through the hiatus at t10 into the stomach
- The lower oesophageal sphincter is located at the gastro-oesophageal junction (between the stomach and oesophagus). The gastro-oesophageal junction is situated to the left of the T11 vertebra, and is marked by the change from oesophageal to gastric mucosa.
- During oesophageal peristalsis, the sphincter is relaxed to allow food to enter the stomach. Otherwise at rest, the function of this sphincter is to prevent the reflux of acidic gastric contents into the oesophagus.
Natural points of constriction in the esophagus?
- Pharyngo-oesophageal junction
-Tracheal bifurcation
-Gastro-oesophageal junction
Tracheal bifurcation (when trachea splits into left and right).
This a point where the trachea pushes back onto the esophagus. It is a natural point of constriction.
How could you look at the heart and get a good image ?
Transesophageal Echocardiogram
Better than other ways to image the heart because you have closer contact and therefore imaging of the heart.
The histology varies going along the GI tract?
Stomach:
- simple columnar epithelium
- also parietal cells - secrete Hydrochloric acid
- gastric juices - trigger activation of enzymes
- mucus is released to line the stomach and protect it from gastric juices
When we look at the esophageal gastric junction we can see the difference in histology ?
There is a difference in color between the esophagus and stomach ?
- Stomach looks darker
Describe the structure of the stomach ?
The stomach has four main anatomical division:
- cardia
- fundus,
-body
- pylorus
Cardia:
- surrounds the superior opening of the stomach at the T11 level.
Fundus:
-the rounded, often gas filled portion superior to and left of the cardia.
Body:
- the large central portion inferior to the fundus.
Pylorus:
- This area connects the stomach to the duodenum.
-It is divided into the pyloric antrum, pyloric canal and pyloric sphincter. The pyloric sphincter demarcates the transpyloric plane at the level of L1.
What is your peritoneum ?
Your peritoneum is the tissue that lines your abdominal wall and covers most of the organs in your abdomen.
Retroperitoneal - organs in the abdomen which are only covered in the front
Peritoneal - organs in the abdomen that are entirely covered by the peritoneum.
The stomach is a peritoneal organ
Describe the blood supply to the stomach ?
The arterial supply to the stomach comes from the celiac trunk and its branches.
Anastomoses form along the lesser curvature by the right and left gastric arteries and along the greater curvature by the right and left gastro-omental arteries
Right gastric:
– branch of the common hepatic artery, which arises from the coeliac trunk.
Left gastric:
– arises directly from the coeliac trunk.
Right gastro-omental:
– terminal branch of the gastroduodenal artery, which arises from the common hepatic artery.
Left gastro-omental:
– branch of the splenic artery, which arises from the coeliac trunk.
Describe the blood supply to the stomach ?
The arterial supply to the stomach comes from the celiac trunk and its branches.
Anastomoses form along the lesser curvature by the right and left gastric arteries and along the greater curvature by the right and left gastro-omental arteries
Right gastric:
– branch of the common hepatic artery, which arises from the coeliac trunk.
Left gastric:
– arises directly from the coeliac trunk.
Right gastro-omental:
– terminal branch of the gastroduodenal artery, which arises from the common hepatic artery.
Left gastro-omental:
– branch of the splenic artery, which arises from the coeliac trunk.
We also have the gastric arteries that come off the spleen
- hence why we say there are 5 arteries of the stomach
The veins of the stomach run parallel to the arteries. The right and left gastric veins drain into the hepatic portal vein. The short gastric vein, left and right gastro-omental veins ultimately drain into the superior mesenteric vein.
Lymph nodes around stomach
- There are lymph nodes associated which roughly follow the blood supplies.
- There are lots of lymph nodes around the coeliac trunk
Describe the nervous supply to the stomach ?
- The stomach receives innervation from the autonomic nervous system:
Parasympathetic nerve supply arises from the anterior and posterior vagal trunks, derived from the vagus nerve.
- Vagus nerve stimulation allows peristaltic waves
Sympathetic nerve supply arises from the T6-T9 spinal cord segments and passes to the coeliac plexus via the greater splanchnic nerve. It also carries some pain transmitting fibres.
- This causes us to feel visceral pain
What is Rugae of stomach ?
- The stomach needs to expand and shrink with food
However internal stomach epithelium cannot stretch
- When the stomach is full the lining made up of rugae is stretched and it smoothens and flattens out
- This also serves to increase the surface area which will also increase digestion
What happens when food enters the stomach ?
- Once the food enters the stomach we refer to it as chyme
- Once the chyme has been churned and broken down in the stomach it exits through the pyloric sphincter
- The pyloric sphincter is at level with a region known as the transpyloric plane (more on this later)
- The chyme then enters the duodenum.
Describe the duodenum ?
- Some parts of the duodenum is peritoneal and other parts are retroperitoneal
-The duodenum can be divided into four parts: superior (L1)
descending (L1-L3)
inferior (L3)
ascending (L3-L2)
- Together these parts form a ‘C’ shape, that is around 25cm long, and which wraps around the head of the pancreas.
- superior duodenum is the most common site of duodenal ulceration
What is duodenal ulcer?
A duodenal ulcer is the erosion of the mucosa in the duodenum. It may also be described as a peptic ulcer (although this term can also be used to refer to ulcerations in the stomach). Duodenal ulcers are most likely to occur in the superior portion of the duodenum.
The most common causes of duodenal ulcers are Helicobacter pylori infection and chronic NSAID therapy.
An ulcer in itself can be painful, but is not particularly troublesome and can be treated medically. However, if the ulcer progresses to create a complete perforation through the bowel wall, this is a surgical emergency, and usually warrants immediate repair. A perforation may be complicated by:
Inflammation of the peritoneum(peritonitis) :
-causing damage to the surrounding viscera, such as the liver, pancreas and gall bladder.
Erosion of the gastroduodenal artery:
-causing haemorrhage and potential hypovolaemia shock.