Upper GI

UPPER GI SYSTEM BASICS

upper GI consist of what parts?

mouth, pharynx, larynx, and stomach

lower GI tract consist of

large intestines and small intestines

accessory GI organs consist of

liver, gallbladder, pancreas

Contraction and motility are regulated through the GI tract’s

pacemaker cells called the interstitial cells of Cajal

what two types of neurons regulate contraction of smooth muscle motility and secretory functions

Nonpeptides and peptidases

functions of saliva? (7)

• Moistening and lubricating food to facilitate swallowing

• Initiating digestion of carbohydrate

• Antibacterial protection with lysozyme, lactoferrin, and glycoprotein as well as rinsing away food

• Enhancing taste by providing interacting with taste buds

• Serving as a buffer, and protects the teeth from dental caries

• Oral hygiene by dissolving food, dead cells etc

• Allowing free movement of the lips and tongue.

oral cavity functions in feeding

Contains the food during drinking and chewing and provides for initial mastication before swallowing

pharynx functions in feeding

Funnels food into the esophagus and allows food and air to share space, the pharynx is a space common to both functions

larynx functions in feeding

Valve to the trachea that closes during swallowing

trachea functions in feeding

Allows air to flow into bronchi and lungs

esophagus functions in feeding

Carries food from the pharynx, through the diaphragm, and into the stomach

it is collapsed at rest and distends as food passes through it

the esophagus has was 2 sphincters?

• pharyngoesophageal sphincter

• Lower esophageal sphincter (LES)

esophagus movement

peristalsis

4 layers of the digestive tract

• mucosa

• submucosa

• muscularis externa

• serosa

what are the 4 stages of swallowing

• preparatory phase

• oral transit phase

• pharyngeal phase

• esophageal phase

what is the preparatory phase of swallowing

After food is chewed and mixed with saliva into a sticky ball called a bolus

what is the oral-transit phase of swallowing

The bolus is moved from the front of the oral cavity to the back where swallowing is then initiated

what is the pharyngeal phase of swallowing

The pressure of the bolus on the pharynx stimulates nerve impulses to the swallowing center—> swallowing center stimulates coordination of swallowing muscles

when is swallowing voluntary? involuntary?

initiation of swallowing is voluntary but thereafter swallowing is under autonomic control

what is the esophageal phase of swallowing

the bolus moves through the lower esophageal sphincter into the stomach (involuntary)

the LES is closed when?

always, except when swallowing

what is the function of the LES

serves as a barrier to protect the esophageal mucosa from the stomach contents

how does the LES work (2)

based on pressure and neuropeptides

how does pressure modulate LES

• Atmospheric pressure is greater in the esophagus than in the stomach under normal conditions

• This positive pressure assists in preventing stomach contents from refluxing back into the esophagus (push it closed)

what are the 2 major neuropeptides responsible for allowing LES to relax?

Nitric oxide and VIP

what is the major neuropeptide involved in keeping LES closed?

acetylcholine

what are the functions of the gastric motility (4)

Filling the stomach, storage, mixing, and emptying into the small intestine

gastric secretions are done via

gastric juice

what cells within gastric glands product secretions?

Mucous cells, chief cells, parietal cells, and enterochromaffin (ECL) cells

what are the 3 phases of gastric secretion release?

cephalic, gastric, intestinal

cephalic phase of gastric secretion?

before food enters stomach (triggered via sight, smell, taste of food); starts gastric secretions

gastric phase of gastric secretion?

once food enters stomach; most gastric secretions occur

intestinal phase of gastric secretion?

when chyme enters the duodenum; inhibits gastric secretions

which hormones promote gastric motility and secretion of gastric juices?

acetylcholine, gastrin, histamine, ghrelin

which hormones inhibit gastric motility and secretion of gastric juices?

somatostatin, secretin, CCK, incretins, VIP

what gastric cells release

• HCL

• intrinsic factor

• mucous

• gastrin

• pepsinogen

• histamine

• somatostatin

• parietal cells

• parietal cells

• mucous cells

• G cells

• chief cells

• enterochromaffin-like cells

• somatostatin

gastric digestion occurs via (2)

• mechanical

• chemical

absorption in the stomach

limited except for alcohol

infants and digestion: stomach capacity within 1 year

increases from 20ml-200ml

infants and digestion: acidity of stomach

lower at birth

infants and digestion: protein digestion

Pepsin activity lower for first 3 months; decreased trypsin activation

infants and digestion: lipid digestion

• breast milk contains lipases

• lingual and gastric lipase active

infants and digestion: carb digestion

• disaccharidases reach adult levels at 20-32 weeks

• pancreatic amylase low until 6 months of age

infants and digestion: lactase

adult levels at birth

older adults experiences what oral cavity physiological changes (2)

• dental status

• decreased saliva production

older adults experiences what esophageal physiological changes (2)

• decreased UES

• weaker peristalsis

older adults experiences what gastric physiological changes (2)

• gastric atrophy

• decreased secretions of pepsinogen, HCL, mucus

physical examination of oral cavity can access what issues (8)

• Micronutrient deficiencies

• Dehydration

• Oral-motor defects

• Cranial Nerve Evaluation

• Cheilosis

• xerostomia

• pale tissues

• bleeding gums

• missing teeth

ORAL DISEASES

oral diseases involve problems that interfere with what related to nutrition?

 adequate oral intake and can lead to nutritional deficits

what are the most common oral diseases (3)

caries, gingivitis, periodontal disease

what oral diseases/conditions do we cover?(9)

• dental caries

• gingivitis

• stomatitis

• glossitis

• cheilosis

• xerostomia

• dysgeusia

• ageusia

• jaw fractures

dental caries have highest prevalence amongst

those living in poverty

what conditions are associated with dental caries (6)

• Inadequate saliva production

• Tobacco use

• Alcohol use disorder

• Diabetes Mellitus

• Bulimia eating disorders

• “Baby bottle” tooth decay

DENTAL CARIES

dental caries is what

tooth decay

what are the main causes of dental caries (4)

• MAIN: Streptococcus mutans bacteria

• Structure of the tooth

• Immunologic response to bacteria

• Composition of saliva in the mouth

plaque and calculus of the teeth is associated with (5)

• frequency of eating

• stickiness of foods

• composition of saliva

• presence of buffers

• overall oral hygiene

how can one prevent tooth decay (4)

• fluoridation of water supply

• topical fluoride and sealants

• proper dental hygiene

• nutrition choices (avoidance of sugar sweetened beverages)

oral hygiene =

preventative care

what diseases/conditions are linked to oral health problems

diabetes, osteoporosis, HIV/AIDS, Alzheimer’s disease, etc.

what are the components of good oral hygiene (4)

• Brushing: twice a day for 2 minutes

  • Use fluoridated toothpaste and soft brush; 45 degree angle

• Interdental cleaning (such as flossing): once daily.

• Brush your tongue

• Visit a dentist regularly.

how does dental caries occur? (process)

enamel crystal —> acid production due to fermentation of CHO in mouth by cariogenic bacteria —> pH decreases —> demineralization of tooth enamel —> partially dissolved enamel crystal —> carious tooth

is demineralization reversible?

yes

how can demineralization be reversed? (4)

if progress is halted via fluoride treatment, saliva (phosphorus and calcium content), plaque control, and dietary modification

when is tooth decay not reversible

once bacteria invade the tooth

why do nutrition deficits affect oral cavity?

oral tissue turnover occurs every 3-7 days

quick turnover means what in terms of nutrition signs

Earliest clinical manifestations of nutrition or other health disorders are often first visible in the oral cavity

Deficiencies of water-soluble vitamins, protein, and iron are more readily visible in the oral cavity

what is associated with hypomineralization and enamel hypoplasia (nutritionally)?

vitamin A, D and malnutrition

what is associated with salivary gland atrophy (nutrionally)

vita A deficiency and malnutrition

what dietary factors are associated with increased risk of tooth caries? (5)

• Sugar-sweetened liquids

• Sticky foods, such as candies

• Slowly dissolving candies

• Sugary, starchy snacks, such as cookies, cakes, etc.

• Simple sugars, such as sucrose, honey, and molasses

what dietary factors are associated with decreased risk for dental caries? (5)

• Sugar-free chewing gum (xylitol), mints, and candies

• Fresh fruits and vegetables

• High-quality protein foods

• Whole-grain, low-sugar breads, and cereals

• Non-cariogenic foods at the end of a meal (cheese, nuts, whole grains)

what eating patterns are associated with increased risk for caries (3)

• Frequent and prolonged intake of foods rich in simple sugar

• Eating sticky, retentive foods alone

• Sipping sugar-sweetened beverages for prolonged periods

what eating patterns are associated with decreased risk of dental caries? (3)

• Space frequency of food and beverage intake at least 2 hours apart

• Select fresh, whole, unprocessed food to stimulate salivary output

• Chew sugarless gum for a brief period immediately after a meal or snack

GINGIVITIS/PERIODONTITIS

what is gingivitis?

inflammation of the gums

what health issues are affected by gingivitis and stomatitis? (5)

• Cardiovascular disease

• Stroke

• Endocarditis (inflammation of the heart’s inner lining)

• Pneumonia

• Premature birth and low birth weight

XEROSTOMIA

what is xerostomia?

decreased production of saliva from salivary glands (dry mouth)

what are the possible causes of xerostomia (5)

• Side effects of medication

• Disease

• Radiation therapy

• Chemotherapy

• Nerve damage

what are the nutritional interventions for xerostomia (5- food wise)

• Try tart foods to stimulate saliva.

• Sip on liquids or suck on ice chips throughout the day.

• Avoid caffeine, alcohol, and tobacco products.

• Try drinking through a straw.

• Add extra sauces and gravies to foods.

what are the interventions for xerostomia (2- not food)

• Try using a cool mist humidifier at bedtime

• Rinse mouth frequently with mild saline solution.

STOMATITIS

what is stomatitis

is a broad medical term used to describe inflammation of the mucous membranes inside the mouth.

This painful swelling can affect any part of the oral cavity—including the lips, cheeks, gums, tongue, or floor and roof of the mouth—and often presents as redness, swelling, or open ulcers.

what is key for stomatitis

prevention

how can stomatitis be prevented (3)

• maintain good oral hygiene

• Clean your teeth and mouth every 4 hours and at bedtime

•  Use frequent mouth rinses and avoid alcohol-based products.

what are the nutritional interventions for stomatitis (6)

• adjust textures and temps as tolerated (extremes of very hot or cold are often not tolerated)

• avoid carbonated beverages

• avoid caffeine, alcohol, tobacco products

• avoid other irritants (acidic, spicy, etc)

• try glutamine supplementation (optimal dose of 10g 3x a day)

• consider EN support if unable to maintain nutritional status orally

what are non-nutrition (medical) interventions for stomatitis (2)

• Treat oral lesions pharmacologically as appropriate (antifungal medications if needed).

• Consider using oral topical agents and anesthetics, such as viscous lidocaine and institution-specific mouth rinses

GLOSSITIS AND CHEILOSIS

define glossitis

redness, swelling and pain of the tongue

cheilosis is what?

fissuring and scaling at the corners of the mouth

glossitis and stomatitis may be associated with what deficiencies (6)

 riboflavin, folate, niacin, pyridoxine, B12 or iron

DYSGEUSIA AND AGESUSIA

what is dysgeusia?

Condition of altered or impaired sense of taste

what is ageusia?

Inability to taste or “mouth blindness”

what are the possible etiologies (causes) of dysgeusia and ageusia? (9)

• Closely tied to sense of smell

• chemotherapy/radiation

• Diseases of tongue and palate can interfere with normal function of taste buds

• nervous system diseases

• traumatic brain injury

• Reduced saliva production

• Medications

• pregnancy

• micronutrient deficiencies such as zinc or B12

what are some possible nutrition diagnoses

• Inadequate oral, fluid, and protein-energy intake

• Biting, chewing, and swallowing difficulty

• Unintended weight loss

what are the nutrition interventions for impaired taste? (5)

• Avoidance of foods with not tolerated with appropriate substitutions for adequacy

• Add tart, spicy foods may enhance flavor

• Oral Hygiene

• Adequate water intake

• Avoidance of metal utensils

impaired taste should be monitored and evaluated via (3)

observation, kilocalorie count, or a food diary