The ductal orifices of the parotid gland and the submandibular gland should be visualized. The condition of the papillae should be inspected. Is there a flow of saliva? This is best evaluated by drying the papilla with a cotton applicator and observing the flow of saliva produced by exerting external pressure on the gland itself.
The salivary glands are usually not visible. Careful observation of the face determines any asymmetry that is due to unilateral salivary gland enlargement. Obstruction to flow or infiltration of the gland results in glandular enlargement. Figure 12-39 illustrates a patient with left parotid enlargement as a result of obstruction to flow by a stone.
Palpate the parotid and submandibular glands. Determine the consistency of each gland. Is tenderness present?
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Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.