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Dysphagia Exam 1
Dysphagia CH 1 & 2
| Question | Answer |
|---|---|
| What is dysphagia? | a disorder or difficulty with swallowing |
| What are the 5 subcategories of dysphagia? | 1. constricta 2. lusoria 3. oropharyngeal 4. paralytica 5. spastica |
| What is constricta? | narrowing of the pharynx or esophagus |
| What is lusoria? | esophageal compression by the right subclavian artery |
| What is oropharyngeal? | difficulty with propulsion from the mouth to the esophagus |
| What is spastica? | dysphagia from spasm of the pharynx or esophagus |
| which is used in clinical practice? | oropharyngeal |
| when used properly, the term should refer to a swallowing disorder of what 3 stages of swallowing? | 1. oral 2. pharyngeal 3. esophageal |
| it is not a medical diagnosis, but a __ | symptom |
| Name complaints associated with dysphagia | coughing, choking during or after a meal, food sticking, regurgitation, odynophagia, drooling, unexplained weight loss, nutritional deficiencies |
| what are the 5 categories of conditions that may contribute to dysphagia | 1. neurologic disorders (stroke, tbi) 2. connective tissue disorders (overlap syndromes) 3. Structural diagnoses (tumor involving alimentary tract( 4. Iatrogenic diagnoses (radiation therapy) 5. Other related ( severe respiratory compromise) |
| what percentage of caseload is dysphagia for acute care? | 60 to 80% |
| dysphagia takes its name from the Greek root word ____ | phagein |
| what does phagein mean? | to ingest or engulf |
| combined with the prefix dys- what does it mean? | a disorder or difficulty with swallowing |
| What are the 5 subcategories of dysphagia? | 1. constricta 2. lusoria 3. oropharyngeal 4. paralytica 5. spastica |
| what is constrictica? | narrowing of the pharynx or esophagus |
| what is lusoria? | esophageal compression by the right subclavian artery |
| what is oropharyngeal? | difficulty with propulsion from the mouth to the esophagus |
| what is paralytica? | paralysis of the muscles of the mouth, pharynx, or esophagus |
| what is spastica? | dysphagia from spasm of the pharynx or esophagus |
| which subcategory of dysphagia are SLPS most concerned with? | oral pharygngeal |
| What are the 3 stages of swallowing? | oral, pharyngeal, esophageal |
| what is the oral prepatory stage? | mastication |
| dysphagia is a ___ disorder | swallowing |
| dysphagia includes what 5 components? | 1. behavioral 2. sensory 3. cognition 4. visual recognition 5. emotion |
| is dysphagia a primary diagnosis? if not, what it is it? | NO! it is a symptom of underlying disease |
| What are common complaints associated with dysphagia? | coughing, choking during or after meal, food sticking, regurgitation (oral or nasal), odynophagia, globus, drooling, unexplained weight loss, nutritional deficits |
| what is odynophagia? | pain when swallowing |
| what is globus? | full feeling in throat |
| definitions of dysphagia imply that it is the result of a ___ change in the ___ needed for swallowing | physiologic change; muscles; swallowing |
| physiologic change often leads to the 2 hallmarks of dysphagia which are.... ??? | 1. delay in propulsion of the bolus as it moves to the stomach 2. misdirection of the bolus |
| can you have both hallmarks? | yes or you can just have one |
| you need to make sure that the patient can swallow enough to stay __ and __ | hydrated and nourished |
| is dysphagia a feeding or eating disorder? | NO |
| what is a feeding disorder? | impairment in the process of food transport outside the alimentary system (motor to mouth) |
| what is an eating disorder/ | psychological disorder that impairs normal eating behavior, overeating, aorexia,and bulimia |
| what is the incidence of a disorder? | the reported frequency of new occurences of that disorder over a long time (at least 1 year) in relation to the population in which it occurs |
| what is the prevalence of a disorder? | the # of cases during a shorter, prescribed period, usually in a specific setting |
| estimates of prevalence vary by __ | setting |
| why do estimates of prevalence vary by setting? | because certain age groups and diagnoses are more likely to demonstrate dysphagia |
| for people over 50, ___ percent have dysphagia | 20 |
| __ percent of the population in chronic geriatric care | 50% |
| __% in general hospitals | 13% |
| ___ people in rehab unit | 1/3 |
| __% with TBI | 50% |
| most severe dysphagia follows __ | TBI |
| stroke depends on the stage: acute = __% | 50% |
| 2 weeks after stroke: __ to __% | 10 to 30% |
| 5 months after stroke: __% | 3% |
| name 4 special populations that may have dysphagia | 1. stroke 2. head/neck cancer 3. TBI 4. progressive neurologic disease |
| what is prevalence for head/neck cander | 60% (radiation and chemo) |
| prevalence in head injury? ___% admitted to rehab and __% 5 months after | 30%, 5% |
| prevalence for progressive neurologic disease? | 50-80% (higher with dementia)(als starts with 30%)(ms about 30%) |
| name etiologies related to dysphagia | stroke, head/neck cancer, tbi, dementia, cleft palate, cerebral palsy, anoxic injury, surgery, premature birth, trach/vent, spinal cord injury, progressive neurologic disesases |
| name ex of progressive neurologic disease | parkinson's, als, ms, mg, ra |
| __ from waist up can cause dysphagia | surgery |
| __% dysphagia seen with premature births | 90% |
| what is the prevalence of dysphagia in the medical setting? | 70 to 80% of caseload |
| what is the prevalence in clinical settings? | 50% of caseload (outpatient) |
| what is the prevalence in school settings? | less than 50% but more than 20% in some school settings |
| what are the 6 levels of care for dysphagia? | 1. acute 2. subacute 3. rehab 4. outpatient 5. long term care 6. home health |
| what are 4 medical complications? | 1. aspiration pneumonia 2. infection (sepsis, death) 3. undernutrition 4. dehydration |
| what are 2 emotional/physchosocial complications of dysphagia? | 1. embarrassing/aggrevating 2. can get expensive |
| Dysphagia is a __ of a medical condition | symptom |
| Describe clinical management | 1. dr will diagnose problem & ask for eval or screening to detect dysphagia 2. results depend on problem & severity & may range from suggestions to change how a person swallows to NPO |
| describe clinical examination process | 1. history, medical & pyschosocial 2. screen mental & language staqtus 3. phsycial eval; OM exam 4. trial swallows of liquid & food as appropriate |
| what are you looking for with mental and language screening? | see if they can follow instructions |
| what are you looking for with physical eval & Oral motor exam? | see how their articulators are working |
| __ and __ = always safer but not always easier | thinner & clearer |
| Name 2 types of instruments to exam swallowing | FEES & Modified barium swallow |
| What are examples of barium x ray studies | modified barium swallow (esophagram, videofluroscopy) |
| what is an example of direct visualization? | FEES (endoscopy) |
| Exam: measurement of pressures (___) within the __ __ during swallowing attempts | manometry; aerodigestive tract |
| what are 3 types of treatment optios? | medical, surgical, behavioral |
| describe medical treatment option | medications affecting swallow or mental status or NG feeding tube |
| describe surgical treatment options | phonosurgery for vf paralysis, placing gastrostomy tube |
| describe behavioral treatment optios | 1. compensatory sugggestions 2. restore: exercises, mechanism |
| what is the P D F SM ? | posture/patient, dietary, feeding activity, swallow, mechanism |
| who manages dysphagia? | slp, gastroenterologist, radiologist, neurologist, nurse, dietician, OT, pulmonologist/respiratory therapist, neurodevelopmental specialist |
| how does gastroenterologist help? | PEG tubes |
| how does radiologist help? | barium swallow study |
| how does neurologist help? | make referrals |
| how does nurse help? | helps carry out tx & reports on patient |
| how does pulmonologists/respiratory therapists help? | trach/vents |
| how does neurodevelopmental specialist help? | premature babies |
| what are the 4 stages of the normal swallow? | 1. oral prep 2. oral 3. pharyngeal 4. esophageal |
| how long does oral stage last? | 1 second |
| how long does pharyngeal stage last? | 1 second |
| how long does esophageal stage last? | 8 to 20 seconds |
| What is involved in the oral prep/oral phase? | lips, tongue, mandible, buccal muscles, teeth |
| what are the cranial nerves involved in teh oral prep/oral phase? | CN V, VII, XII |
| What structures are involved in pharyngeal phase? | epiglottis, valleculae, pyriform sinuses, thyroid & cricoid cartilages, larynx, cervical spine, posterior pharyngeal wall |
| what cranial nerves re used in the pharyngeal pahse? | CN V, VII, IX, X, XI, XII |
| what is the esophagus? | a closed muscular tube that intersects with the lower portion of the pharynx and the stomach |
| what is the section that intersects with the lower portion of the pharynx called? | upper esophageal sphincter |
| what is the part that intersects with the stomach called? | lower esophageal sphincter |
| what cranial nerve is involved in the esophageal phase | CN X |
| which CN holds the mouth shut? | VII |
| which CN provides sensory input to where bolus is in the mouth? | V |
| which CN activates the mastication? | V |
| Which CN senses the arrival of the bolus at the level of the posterior faucil arches? | IX |
| which CN pushes the bolus up & back against the velum? | XII |
| Which CN pulls the hyoid bone up & forward bringing the larynx beeath the back of the tongue? | V |
| which CN assists the hyoid bone in pulling up the arytenoids and lifting the larynx forward? | IX |
| Describe CN X in sequence | 1. elevates the palate to occlude the nasopharynx 2. flips the epiglottis forward over the top of the elevated & tilted larynx 3. dilates the hypopharynx allowing the bolus to fall back into the esophagus - initiates peristalsis in the esophagus |
| LOOK at figure 2-8 in book | *** |
| what structures are involved with moving the bolus? | lips, velum, true vfs, false vocal folds, pharyngoesophageal sphincter (UES) & lower esophageal sphincter (LES) |
| How do we protect the airway? | airway closure, laryngeal elevation, tongue base retraction, epiglotti inverts, valleculae |
| oral cavity extends from the __ anteriorly to the ___ posteriorly | lips; nasopharynx |
| __ and posterior ___ wall seal and open communication between the nasal & oral cavities during swallowing & respiratory behaviors | velum & posterior velopharyngeal wall |
| ___ lies above the velum & ___ lies posterior to the mouth | nasopharynx & oropharynx |
| __ extends __ the esophagus, separated from the esophagus by ___ muscle | pharynx; below; cricopharyngeal muscle (upper esophageal sphinctor_ |
| cricoid cartilage lies above the __ with the thyroid cartilage above it, both suspended by muscles attached to the __ bone | tracha; hyoid |
| The respiratory system is protected during pharyngeal swallow by __ __ __ of the __ __ and downward placement of the ___ | occlusive muscular constriction of laryngeal vestibule ; downward placement of epiglottis |
| __ ___ are inferior margin of layrngeal ventricle & anteriorly attached at thyroid cartilage & posteriorly at the arytenoid cartilages | TRUE vfs |
| __ vocal folds separate the ventricle & vestibule | vestibular vfs (false vfs) |
| __ : lateral recessses at the base of the tongue on each side of the epiglottis | valleculae |
| ___ ___ : lateral recesses between the larynx & anterior hypopharyngeal wall | piriform sinuses |
| ____ serve as important anatomical landmarks in videoradiographic assessment of pharyngeal swallow | the recesses |
| how do we breath during chewing? | through our nose |
| is the epiglottis the primary preventor of aspiration? | no |
| mandibular branch of CN V innervates principle muscles for __ behaviors | chewing |
| what are the primary muscles for chewing? | masseter, temporalis, pterygoid |
| what does the masseter do | close jaw |
| what does temporalis do? | moves jaw up, forward, or backward |
| what are the types of pterygoid muscles? | medial & lateral |
| what do what do the medial pterygoid muscles do? | work bilaterally to elevate mandible while shift jaw to opposite side unilaterally (important for grinding) |
| what do the lateral pterygoid muscles do? | work together, pulling down or forward while moving the jaw or chin to opposite sides unilaterally |
| both pterygoid muscle sets cooperate to ___ | grind |
| ___ innervates lower facial muscles attached to the maxillae & mandible (including ___) | cranial nerve 7; buccinator |
| What does the buccinator muscle do? | compresses lips & flatten the cheeks in movement of food across the teeth |
| __ innervates the tongue | CN 12 (XII) hypoglossal |
| CN XII (innervates tongue) has 4 separate intrinsic muscles that have different effects on __, __, and __ of the tongue | shape, contour, function |
| what will happen if the buccinators are weak? | food will be pocketed |
| pharyngeal cavity is formed by __ pairs of __ muscles, innervated by __ cranial and __ cervical nerves | 26; striated muscles; 6 cranial & 4 cervice |
| __ __ provides a mechanical advantage for the pharyngeal musculature associated with swallowing behaviors of the posterior __, __ and __ | hyoid bone; tongue larynx, phayrnx |
| nasopharynx: __ muscles adjust position of ___ in response to food bolus | 5 muscles; velum |
| nasopharynx: palatoglossal and levator veli palatine muscles: __ the soft palate & __ the nasopharynx | elevate soft palate & seal nasopharynx |
| what happens if nasopharynx is not sealed | nasopharynx |
| tensor veli palatine: ___ the palate & ___ the orifice of the eustachian tube | tightens; dialates |
| palatopharyngeal muscle: __ the soft palate, approximates the palate or pharyngeal folds and __ the pharynx | depresses soft palate; constricts the pharynx |
| it may mean the __ muscle is weak if food is in the pirifom sinuses | palatopharyngeal |
| what does the muscularis uvula do? | shorten the palate |
| CN XII, V, and VII innervate the __ group of muscles | suprahyoid |
| CN XII = supplies the ___ | geniohyoid |
| what does the geniohyoid do? | draws the hyoid bone up and forward, depressing the jaw |
| CN V supplies the ___ | mylohyoid |
| what does the mylohyoid o? | elevates the hyoid bone and tongue & depresses jaw |
| ___ muscles contain anterior and posterior bellies | digastric |
| CN VII innervates ___ muscle | stylohyoid muscle |
| what does the stylohyoid muscle do? | elevates the hyoid bone during swallowing |
| __ and __ are laryngeal elevators and extrinsic tongue muscles, designed to do what? | hyoglossus & genioglossus; depress tongue or elevate the hyoid bone when tongue is fixed |
| CN XI along with CN XII innervate the ___ | styloglossus |
| what does the styloglossus do? | draws the tongue up and back during swallowing |
| CN IX and XI also cause teh ___ to raise the back of the tongue & lower velum * when we enter pharyngeal | palatoglossus |
| __ and ___ raise the back of the tongue & lower the sides of the soft palate | styloglossus & palatoglossus |
| CN __ and __ innervate the muscular pahrynx whose superior, middle, and inferior constrictor muscles constitute its __ __ layer & work together to __ __ of food toward the esophagus during swallowing | CN X and XI; eternal circular layer; transport bolus |
| what makes up the internal longitudinal layer of the pharynx? | palatopharyngeus, stylopharyngeus, salpinogopharyngeus |
| what does teh stylopharyngeus do | elevates the pharynx & to some extent the larynx during swallowing |
| what does teh salpingopharyngeus do? | draws the lateral walls of the pharynx up |
| what does the palatopharyngeus do | draws the velum down |
| cricopharyngeal muscle is a single muscle that lies at the __ __ ??? between the __ and __ | pharynx and esophagus |
| functionally, the cricopharyngeal muscle is __ from the pharynx & esophagus | separate |
| the cricopharyngeal muscle acts as a ___ | sphinctor |
| how does the cricopharyngeal muscle act like a sphinctor? | it is relaxed during passage of bolus from the pharynx into the esophagus (if not, the food sits there) |
| esophagus: distensible tube about __ to __ cm | 21 to 27 cm |
| the esophagus connects the __ and __ | pharynx & stomach |
| the esophagus is separated from the pharynx by the __ __ __ and from stomach by __ _ __ | pharyngeal esophageal segment; lower esophageal sphinctor |
| resting - esophageal lumen is collapsed, creating a space that can easily distend up to __ cm as to accommodate swallowed __, __, and __ | 3cm; air, liquids, solids |
| what is the esophagus lined with? | protective, stratified, squamous epithelium (covers inner layer of circular fibers & outer layer of longitudinal fibers) |
| esophagus: at proximal end muscle is __& at distal 2/3 , it's composed of __ muscle | striated ; smooth |
| middle third of the esophagus (region of aorta) is a combination of __ and __ muscles | smooth & striated |
| swallowing ___ is shown in healthy subjects; especially in __ __ and __ stages | variability; oral prep & oral |
| what can part of variability be attributed to? | subject selection, bolus type, and tools used to measure performance |
| normal swallowing performance is dependent o the __ __ of bolus from oral cavity to the stomach | rapid transfer of the bolus |
| liquid bolus can pass through pharynx within __ seconds and enter stomach in less than __ seconds | 2; less than 5 |
| efficient movement of bolus is accomplished by __ ___ __ exerted on bolus and forces of ___ | strength neuromuscular contractions & forces of gravity |
| efficient bolus movement is accomplished when coordiated neuromuscular contractions and relations create zones of __ __ on bolus and zones of __ __ below the level of the bolus | high pressure on bolus & negative pressure below level of bolus |
| some parts in swallowing chain such as __ stay under __ pressure because of their location | esophagus; negative |
| creating zones of high and low pressure is largely accomplished by __ and __ of what 6 things | coordination & strength of swallowing valves, lips, velum, airway closure, PES opening & closing, upper esophageal sphincter opening & closing |
| __ __ airway is also important | patent nasal airway |
| ___ provides initial driving force | tongue |
| tongue's __ __ provides basis for laryngeal elevation. How? | posterior deflection; by applying ttraction to hyoid bone |
| efficient ___ elevation helps create ___ zone of pressure in pharynx particularly in ___ region | laryngeal; negative; PES |
| efficient laryngeal elevation creates negative zone of pressure in pharynx (PES). What does this allow the bolus to do? | move rapidly & safely from zone of high pressure to negative pressure |
| Moving from zone of high pressure into another zone of ___ pressure caused by ___ condition inhibits what and results in what? | high to high pressure; pathologic condition; inhibits bolus flow & results in stasis & residue that may be aspirated into the airway |
| what is statis? | slowing movement |
| ca we aspirate after we swallow? | yes because if there is any residue left over then it can get down there when we inhale after our exhale |
| oral prep: food or liquid in mouth stimulates __,__,__ and ___ receptors | taste, temperature, texture, pressure |
| Where are the primary receptors of taste located? | tongue, hard & soft palate, pharynx & in the supralaryngeal region |
| why is taste important? | if food tastes bad or smells bad then we won't salivate & that will affect the swallow |
| receptors are activated by __ which is produced by activation of __,__, and __ glands | saliva; submandibular, submaxillary, and parotid glands |
| How are the submandibular, submaxillary and parotid glands activated? | by actions o the jaw, tongue, and hyoid bone during bolus preparation & by inherent taste of bolus |
| primary sensory receptors on dorsum of tongue are responsibile for the perception o __,__,__and __ are all activated by saliva | salt, sour, sweet, bitter |
| if the larynx isn't elevating, that means what? | the tongue may be weak |
| __ is important in maintenance of adequate __ __ | saliva; oral hygeine |
| number of times a person swallows saliva in one hour can vary between __ to __ times and is largely dependent on what? | 18 to 400 times; dependent on rate of salivary flow |
| taste sensations carried by _ __ branch of CN __ on the anterior 2/3 of tongue and through the greater __ branch on hard & soft palate | chorda tympani; CN VII; petrosal branch of hard & soft palate |
| taste on the posterior third of the tongue is mediated by CN __ | CN IX |
| Sensations of taste sent to __ __ __ in the __ of the brainstem where they are transmitted to __ cortex by the ___ | nucleus tractus solitarii (NTS); medulla of brainstem; sensorimotor coretex; thalamus |
| taste receptors in region of layrngeal aditus are carried to NTS by __ __ brach of __ __ | superior laryngeal branch of CN X |
| Appreciation of taste depends largely on ___ | smell |
| How are smell sensations carried? | Carried by direct stimulation of nasal cavity & by smell elicited by chewing, in which odors travel posteriorly into the nasopharynx |
| Interpretation o smell is ultimately accomplished through the __ to the __ and __ __ by info carried by CN __ | thalamus; frontal & temporal cortices; CN I |
| info relating to smell is stored in the ___ | hippocampus |
| coordinated action of _ and _ moves bolus __ onto the ___ ___ for deformation & further deformation accomplished by various contacts of the __ to the __ __ | tongue & jaw; laterally; molar table; tongue to the hard palate |
| tongue may play large role in ___ bolus in oral cavity before swallow | containing |
| evidence shows that during solid bolus mastication, material is allowed to callect in the __ __ at __ before swallow initiation | vallecular recesses at tongue |
| what is the ultimate role of the tongue? | manipulate, shape, hold and then transfer bolus into the oropharynx, signaling onset of oral stage of swallow as swallowing sequence transitions into the pharyngeal stage |
| are the exact nature of sensory cues that signal the bolus completely understood? | no |
| studies show that __ __ nerve branch of __ nerve is important in swallow initiation & in sensory protective mechanisms of upper airway | superior laryngeal nerve branch of vagus nerve |
| if a patient can't chew and grind, they may need a __ diet | chopped |
| oral stage: once bolus is prepared, what happens? | tongue tip is elevated to close the anterior oral cavity (lips) at the alveolar ridge & bolus is held against the hard palate |
| edges of tongue __ contain bolus __ | dorsum; laterally |
| __ __ and __ appear to work longer in ___ activity than the posterior tongue after the oral stage is initiated | tongue tip & dorsum; containment |
| what is thte posterior tongue more responsible for? | delievering the bolus into the pharynx |
| before but almost stimultaneously, 1st posterior movement of the tongue, ___ __ | respiration ceases |
| what follows the cease of respiration? | arytenoid cartilage approximation precipitating true vocal fold adduction |
| tongue retraction is primarly accomplished by which muscles? | extrinsic tongue muscles: digastricus, mylohyoid, and geniohyoid |
| tongue base applies __ pressure to tail of the bous by its contact with the __ and __ __ __ allowing bolus to move rapidly thruough pharynx into an open __ | positive pressure; velum & posterior pharyngeal wall; PES |
| as tongue propels bolus posteriorly, __ __ are pulled ___ to form a slit which bolus can pass though | palatopharyngeal folds are pulled medially |
| __ __ __ muscles help elevate the velum to seal the nasopharyngeal opening | levator veli palantinii |
| what 2 things contribute to maintenance of positive pressure on the bolus as it moves toward zones of negative pressure in the hypopharynx | tongue's contact to velum & posterior pharyngeal wall AND sealing of the nasopharynx |
| by tongue's connection to the __ __ and hyoid bone's connection to __ and __ caritlages.... what happens? | hyoid bone; thyroid & cricoid; larynx is pulled up & foward restig under tongue base (tongue base is partically covering opening of airway (offers protection)) |
| as larynx rises, __ __ makes descent over top of ___, completing airway protections that directs bolus toward esophagus rather than trachea | cartilaginou epiglottis; airway |
| what does extent of epiglottic descent depend on? | 1. anterior hyoid displacement 2. tongue base retraction force 3. bolus size |
| rapid and complete laryngeal elevation (about 1 inch) aids in doing what? | creating negative pressure in the region of the hypopharynx |
| what happens as the bolus enters the pharynx? | it is divided by vallecular spaces at level of tongue base helping to deflect it away from the airway as added protection element |
| what may happen in the oral stage that causes aspiration? | because of delay we may have premature leakage that goes into the airway |
| why do we have to protect the airway? | misdirection of the bolus |
| protection of airway through ___ phase of swallowing is crucial to swallowing safety | oropharyngeal |
| how are respiration & swallowing linked? | by anatomy (parts of mouth and pharynx) and their neuroanatomic relations in the medulla |
| what will happen if the medulla is damaged? | incomplete swallow |
| relation of respiration & swallowing linked functionally because....? | respiratio is inhibited by swallowing (we don't breathe when we swallow) and disorders of respiration can affect swallow |
| what is the period of airflow inhibition called? | swallow apnea |
| when does swallow apnea begin? | before onset of oral stage of swallow ( not until bolus collects at the vallecular level ) |
| short __ cycle precedes apnea | exhalation (we exhale right before we stop breathing) |
| as tail of bolus passes through PES, larynx __ and respiration continues on __ cycle slightly before PES closes | descends; exhalation |
| exhalation is accompanied by build up of __ __ that separates vocal folds apart | subglottic pressure |
| release of pressure is heard as an __ __ by using stethescope placed at laryngeal level | audible burst |
| this burst is considered a __ __ . Why? | protective feature; in case any swallowed material is lodged in the upper airway |
| explosion of exhaled air encouraged with __ __ | Heimlich maneuver |
| when does the pharyngeal stage begin? | when the bolus arrives at the level of valleculae |
| when does the pharyngeal stage end? | when PES closes |
| when bolus enters pharynx, hyoid bone continues __ and __ movement toward edge of the mandible, tilting larynx __ ___ tongue base to protect bolus from entering upper airway | superior & anterior movement; under retracting tongue base |
| __ __ offer further protection in conjuction with closure of __ __ by the __ folds | false vfs; laryngeal aditus; aryepiglottic folds |
| as a result of contraction of thryoepiglottic ligament & posterior tongue contraction, __ __ descends from its erect position over laryngeal aditus | epiglottic caritlage |
| *** List 5 mechanisms that prevent bolus from entering upper airway in pharyngeal stage | 1.cessation of active respiration 2.approximation of true and false vfs 3.closure of laryngeal aditus 4.deflection of bolus material by tongue base over rising larynx 5.division of bolus through valleculae that direct that bolus around top of airway |
| as bolus enters pharynx... what muscles are activated sequentially? | superior, middle, and inferior constrictors |
| what do the superior, middle, and inferior costrictors do as the bolus enters the paharynx? | narrow and shorten pharynx; makes perastalisis like movements in posterior pharyngeal wall that aids in bolus propulsion into the esophagus |
| is duration of pharyngeal muscle contraction affected by bolus size? | no |
| why is forward movement of the hyoid bone important? | applies traction forces on PES to achieve max opening |
| before bolus arrives in pharynx, muscles in PES region that had been closed before are relaxed by ___ signals carried by CN __ to brainstem | parasympathetic; CN IX |
| after relxation, PES is pulled open during ___ movement | hyolaryngeal movement (as hyoid and larynx move up_ |
| bolus remains divided as it travels until it is rejoined as it enters the __ | esophagus |
| in addition to PES relaxation & mechanical traction, the PES is distended by __ __ of ___ | driving force of bolus |
| as the tail of the bolus passes PES region, __ __ __ begins as PES closes | esophageal peristalisis |
| why does the PES need to close? | to create the pressure difference needed |
| what activities signal end of pharyngeal phase of swallow? | PES closes, airway reopens, hyoid bone returns to resting position |
| esophageal stage: before bolus enter esophagus, esophageal lumen remains __ within chest cavity under ___ pressure | closed; negative pressure |
| pressures generated in closed UES vary from __ to ___ mm Hg depending on what 2 things? | 30 to 100 mm Hg; depending on patient age & type of manometric catheters used |
| esophageal swallowing tasks require ordered pattern of function that depends on coordinated activity in what 3 zones? | 1. proximal, striated muscle zone 2. the body 3. specialized smooth muscle of distal zone |
| how are bolus movements through these zones characterized? | orderly, ring like progression of contractions until bolus enters LES and stomach |
| liquid boluses (depending on viscosity) often ___ this wave of contraction | precedes |
| ___ portion of esophagus works in conjunction with hypopharynx allowing the PES to do what? | cervical; relax & distend to acommondate bolus size |
| As bolus enters esophagus, a primary contraction wave triggered in __, __portion by CN __ efferent activity, may be inhibited by what? | proximal, striated; CN X; may be inhibited by multiple swallow attempts if pharynx fails to clear its content |
| motor activity in cervical esophagus is __ and gradually slows as it approaches __ and __ esophageal regios | rapid; mid (level of aortic branch) and distal |
| typically, contraction force in __ esophagus is strongest and accompanied in time by a drop in __ in __ to allow bolus to enter stomach | strongest; pressure in LES |
| what does drop of pressure in LES allow bolus to do? | enter stomach |
| bolus propagation pressures generated in esophagues are generally measure by __ techniques | manometric |
| esophageal __ muscle contraction (distal 2/3) has sequential behavior by which proximal activity inhibits the next most distal portion of the esophagus | smooth muscle |
| Primary peristalsis followed by __ __ | secondary peristalsis |
| Secondary peristalsis is propogated by bolus ___ in esophagus | distending |
| Its propogation may begin at __ point in esophageal _. What does it propagation assist with? | any; body; assists in primary transport of solid food boluses bc primary wave may fail to push bolus to level of LES |
| What are primary and secondary perastalsis accompanied by? | longitudinal muscle contraction |
| what does this longitudinal muscle contraction result in? | shortening of esophagus by its proximal attachments to the hypopharynx and distal attachments to stomach |
| results in shortening of esophagus by its __ attachments to the __ and __ attachments to ___ | proximal; hypopharynx and distal; stomach |
| what are tertiary contractions? | random contractions that are not orderly in nature and are inefficient in assisting in bolus transport |
| are tertiary contractions efficient in bolus transport? | no |
| in general tertiary contractions occur ____ of swallowing activity | independently |
| tertiary contractions tend to occur more rrequently in which age group? | older adults |
| what are tertiary contractions the result of? | air trapped in esophagus; OR irration of the esophageal lumen (from gastroesophageal reflux) |
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jjohns53grad2