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GIR Test 1 > B5.005 Swallowing and Esophagus > Flashcards

B5.005 Swallowing and Esophagus Flashcards

1
Q

what are the 3 main salivary glans and how much saliva do they contribute to the total saliva production?

A

parotid 20%
submandibular 70%
sublingual 5%

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2
Q

parotid gland

A

largest serous gland

releases saliva on the inside of the cheek across from the second upper molars

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3
Q

submandibular gland

A

mucous and serous fluid

releases saliva through the floor of the mouth behind the bottom front teeth

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4
Q

sublingual gland

A

mucous and serous fluid

release fluid from under the tongue

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5
Q

how much saliva is produced per day

A

1-1.5 L

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6
Q

how are salivary glands controlled?

A

high relative blood flow (vessels dilate when stimulated and secrete their own weight every minute)
major control is parasympathetic

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7
Q

stimuli for salivation

A

cephalic activity
chewing
nausea
inhibited during sleep, fear, and fatigue

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8
Q

what causes vasodilation in salivary glands?

A

vasoactive intestinal peptide and ACh

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9
Q

what stimulates acinar (serous) cells

A

ACh, NE, substance P, VIP

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10
Q

what stimulates duct cells

A

ACh, NE

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11
Q

components of saliva

A 
hypotonic
mucins
amylas
proline rich proteins
bicarbonate
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12
Q

why is saliva hypotonic?

A

help with tasting of foods, diluting of substances

keep glucose concentration down

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13
Q

function of mucins

A

lubricate and modulate adhesions of microorganisms

help facilitate smooth transit down to the stomach

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14
Q

function of amylase

A

breaks down starch to oligosaccharides

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15
Q

function of protein rich proteins

A

antimicrobial

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16
Q

function of bicarbonate

A

protects erosion of teeth

neutralizes gastric secretions that reflux into esophagus

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17
Q

additional functions of saliva

A 
antifungal
temperature regulation
growth factors
remineralization
solvent
vitamin B12R binding protein (protects B12 from stomach acid)
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18
Q

what is necessary to complete a swallow

A

sophisticated integration of CNS control and anatomic structures
50 pairs of muscles
6 cranial nerves for sensory and motor functions
initiation of swallowing is under voluntary control while the ensuing sequence of events occur as a pattern-elicited response (not a true reflex)

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19
Q

phases of the swallow

A

oral
pharyngeal
esophageal

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20
Q

mastication

A

grinding of food into smaller particle sizes by the teeth and the start of digestion
breaks cell wall of plant material to expose contents (starches in food exposed to salivary amylase)

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21
Q

what helps facilitate mastication

A

tongue and cheeks position food between teeth

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22
Q

bolus

A

food is mixed with saliva and formed into a bolus of the correct size and consistency for swallowing
tongue facilitates the formation, containment, and propulsion of bolus

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23
Q

describe the process of loading a bolus

A

tip of tongue pressed against the palate lateral regions form seals with alveolar ridges and pharyngeal walls

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24
Q

how is the bolus pushed toward the pharynx

A

tongue moves in a wave motion along central groove
anterior 2/3 of tongue and negative pressure in pharyngoesophageal segment are responsible for driving force
temporary suppression of respiration

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25
pharyngeal stages of swallowing
1. food loaded onto back of tongue 2. pharynx raises to close nasopharyngeal cavity 3. epiglottis lowers to close trachea from bolus and UES relaxes to allow bolus to pass 4. UES contracts and epiglottis returns to normal position
26
what makes up to oropharynx
``` base of tongue soft palate tonsils uvula pharyngeal wall ```
27
how are receptors in the oropharynx activated
activated by the passing bolus of food
28
neural control of swallowing
signals transmitted along afferent nerves to the swallowing center in the brainstem pattern of incoming signals is identified and produces and appropriate set of signals to other neurons that in turn coordinate the muscles involved with swallowing, opening the UES, cessation of breathing, and peristalsis in esophagus
29
what muscle makes up the UES
cricopharyngeus muscle | horizontal, striated sphincter muscle located at the top of the esophagus
30
what is the function of the UES
controls flow of material between pharynx and esophagus | tonically contracted at rest and relaxes during swallowing, vomiting and belching
31
what causes cricopharyngeus relaxation
NOT direct inhibitory signals, but rather inhibition of firing that causes tonic contraction
32
describe the process of swallowing through the UES
increase in pressure in the pharynx on the oral side of the bolus to help push it back contraction wave moves down, pushing the bolus with it through the relaxes UES once contraction wave hits the UES, it contracts following the bolus passing through it
33
what is a premature spill
bolus on back of tongue too soon, falls into trachea due to lack of preparation for swallow
34
mechanisms involved in preventing aspiration
rapid and coordinated movements of bolus through oral cavity and pharynx laryngeal elevation to move out of the way laryngeal closure epiglottis inversion strong cough triggered if bolus enters the trachea
35
definition of dysphagia
difficulty in swallowing, may be pain or discomfort
36
consequences of dysphagia
``` asphyxiation aspiration pneumonia dehydration starvation weight loss malnutrition ```
37
functional changes in the oral phase of swallowing
abnormal bolus control within the oral cavity before swallowing (spilling) impaired swallow initiation (dysfunction of brainstem neurons to form swallow pattern of muscle contractions/relaxations) abnormal bolus transport (dysfunction of intrinsic and extrinsic muscles of the tongue)
38
functional changes in the pharyngeal phase of swallowing
muscle weakness or incoordination (fail to seal pharynx superiorly allowing for regurg into the nasopharynx, or failure of UES to relax) pharyngeal outflow obstruction (impaired relaxation, decreased opening, reduced compliance of UES, reduced propulsion forces)
39
normal P for swallow contractions
80-90 mmHg
40
what happens when there is low force generation in the pharyngeal muscles
trouble moving bolus despite an open UES
41
what is aspiration
during swallow there is poor opening of the UES and substantial retention of bolus within the hypopharynx during a subsequent dry swallow, some of this material is seen to enter the eairway
42
failure of UES relaxation
may be due to a number of neurological disorders
43
impaired opening of UES
cricopharyngeal fibrosis (Zenkers diverticulum) cricopharyngeal bar suboptimal pharyngeal propulsion neural problem
44
what is intrabolus pressure
obstruction (resistance) to flow across the pharyngo-esophageal junction during swallowing
45
what is an indirect measure of UES compliance?
hypopharyngeal intrabolus pressure
46
what does an increased intrabolus pressure indicate?
restriction in UES | P increased to try to force bolus out, but no place for bolus to go
47
what is the Nadir UES
lowest pressure during relaxation
48
what does an increased Nadir UES indicate
diminished UES relaxation or diminished opening of UES
49
what is Zenkers diverticulum
herniation between inferior pharyngeal constrictor and cricopharyngeus
50
what can happen as a result of the formation of Zenkers diverticulum
retention of food in pouch often present with dysphagia, aspiration, regurgitation, halitosis, noisy deglutition, changes in voice restriction of UES
51
histo of Zenkers diverticulum
muscle fiber dropout due to necrosis variability in fiber size increase in fibroadipose tissue restricted compliance of UES
52
what is a cricopharyngeal bar
associated with failure of cricopharyngeus to relax when suprahyoid muscles contract, the lumen of the open UES is obstructed by contracted cricopharyngeus that appears as a bar may be asymptomatic or contribute to dysphagia
53
what type of muscle makes up the esophagus
striated (upper portion)- under central control | smooth (lower portion)- under intrinsic control
54
how long does it take for food to move from esophagus to stomach
8-10 sec
55
primary peristalsis
continued peristaltic wave that started in pharynx
56
secondary peristalsis
if residual food is in esophagus, initiated by intrinsic nervous system and vaso-vagal response can have same strength and speed as primary peristalsis and is generated in the absence of a swallow
57
describe peristalsis in the esophagus
traveling contraction moves from UES to LES sequential pressure waves bolus always in front of pressure wave and is moved downward LES relaxes to allow bolus passage into stomach and recontracts after the contraction wave reaches it
58
what causes contraction in the esophagus
ACh
59
what causes relaxation in the esophagus
NO
60
what is deglutitive inhibition
if there are multiple successive swallows, the peristaltic wave is inhibited down the esophagus to avoid backups last swallow generates the wave
61
localized esophageal motor disorders
``` achalasia like syndromes diffuse esophageal spasm nutcracker esophagus hypertensive LES hypocontractile disorders ```
62
diffuse esophageal motor disorders
``` GERD scleroderma myopathies diabetes Parkinson's idiopathic pseudo obstruction ```
63
what is hypotensive peristalsis
incompetent peristalsis contraction have a decreased strength leading impaired esophageal transit impaired clearance of refluxed contractions
64
result of weak pressure waves in esophagus
residual food lest in esophagus and can move into trachea
65
telangiectasia
dilated blood vessels near the surface of the skin
66
perioral radial furrowing
vertical, radial furrows from the mouth
67
what is scleroderma
autoimmune diffuse fibrosis of skin and internal organs damage to small blood vessels often among earliest signs pain from joint swelling or hard skin around joints 4x more common in women 3rd to 6th decade of life
68
effects of scleroderma on the esophagus
dysmotility LES and smooth muscle atrophy hypotension of LES and loss of peristalsis in smooth muscle reflux with resulting reflux esophagitis (60% of patients)
69
what is hypertensive peristalsis (nutcracker esophagus)
normal sequence of peristalsis on barium swallow, normal appearance on esophagoscopy, but smooth muscle contractions have excessive amplitude or duration as detected by manometry possible loss of inhibition leading to increased activity of excitatory nerves
70
symptoms of hypertensive peristalsis
chest pain | dysphagia
71
definition of diffuse esophageal spasm
inhibitory nerves are disrupted leading to simultaneous contractions in the smooth muscle of the esophagus contractions can occur following swallowing or spontaneously deglutitive inhibition is also impaired
72
symptoms of diffuse esophageal spasm
chest pain, dysphagia, and possible regurgitation | barium swallow reveals simultaneous contractions that can appear as a corkscrew, multiple ripples, or sacculations

GIR Test 1 (24 decks)

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