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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
Q

pharyngeal stages of swallowing

A
  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
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26
Q

what makes up to oropharynx

A 
base of tongue
soft palate
tonsils
uvula 
pharyngeal wall
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27
Q

how are receptors in the oropharynx activated

A

activated by the passing bolus of food

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28
Q

neural control of swallowing

A

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

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29
Q

what muscle makes up the UES

A

cricopharyngeus muscle

horizontal, striated sphincter muscle located at the top of the esophagus

30
Q

what is the function of the UES

A

controls flow of material between pharynx and esophagus

tonically contracted at rest and relaxes during swallowing, vomiting and belching

31
Q

what causes cricopharyngeus relaxation

A

NOT direct inhibitory signals, but rather inhibition of firing that causes tonic contraction

32
Q

describe the process of swallowing through the UES

A

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
Q

what is a premature spill

A

bolus on back of tongue too soon, falls into trachea due to lack of preparation for swallow

34
Q

mechanisms involved in preventing aspiration

A

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
Q

definition of dysphagia

A

difficulty in swallowing, may be pain or discomfort

36
Q

consequences of dysphagia

A 
asphyxiation
aspiration pneumonia
dehydration
starvation
weight loss
malnutrition
37
Q

functional changes in the oral phase of swallowing

A

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
Q

functional changes in the pharyngeal phase of swallowing

A

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
Q

normal P for swallow contractions

A

80-90 mmHg

40
Q

what happens when there is low force generation in the pharyngeal muscles

A

trouble moving bolus despite an open UES

41
Q

what is aspiration

A

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
Q

failure of UES relaxation

A

may be due to a number of neurological disorders

43
Q

impaired opening of UES

A

cricopharyngeal fibrosis (Zenkers diverticulum)
cricopharyngeal bar
suboptimal pharyngeal propulsion
neural problem

44
Q

what is intrabolus pressure

A

obstruction (resistance) to flow across the pharyngo-esophageal junction during swallowing

45
Q

what is an indirect measure of UES compliance?

A

hypopharyngeal intrabolus pressure

46
Q

what does an increased intrabolus pressure indicate?

A

restriction in UES

P increased to try to force bolus out, but no place for bolus to go

47
Q

what is the Nadir UES

A

lowest pressure during relaxation

48
Q

what does an increased Nadir UES indicate

A

diminished UES relaxation or diminished opening of UES

49
Q

what is Zenkers diverticulum

A

herniation between inferior pharyngeal constrictor and cricopharyngeus

50
Q

what can happen as a result of the formation of Zenkers diverticulum

A

retention of food in pouch
often present with dysphagia, aspiration, regurgitation, halitosis, noisy deglutition, changes in voice
restriction of UES

51
Q

histo of Zenkers diverticulum

A

muscle fiber dropout due to necrosis
variability in fiber size
increase in fibroadipose tissue
restricted compliance of UES

52
Q

what is a cricopharyngeal bar

A

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
Q

what type of muscle makes up the esophagus

A

striated (upper portion)- under central control

smooth (lower portion)- under intrinsic control

54
Q

how long does it take for food to move from esophagus to stomach

A

8-10 sec

55
Q

primary peristalsis

A

continued peristaltic wave that started in pharynx

56
Q

secondary peristalsis

A

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
Q

describe peristalsis in the esophagus

A

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
Q

what causes contraction in the esophagus

A

ACh

59
Q

what causes relaxation in the esophagus

A

NO

60
Q

what is deglutitive inhibition

A

if there are multiple successive swallows, the peristaltic wave is inhibited down the esophagus to avoid backups
last swallow generates the wave

61
Q

localized esophageal motor disorders

A 
achalasia like syndromes
diffuse esophageal spasm
nutcracker esophagus
hypertensive LES
hypocontractile disorders
62
Q

diffuse esophageal motor disorders

A 
GERD
scleroderma
myopathies
diabetes
Parkinson's
idiopathic pseudo obstruction
63
Q

what is hypotensive peristalsis

A

incompetent peristalsis
contraction have a decreased strength leading impaired esophageal transit
impaired clearance of refluxed contractions

64
Q

result of weak pressure waves in esophagus

A

residual food lest in esophagus and can move into trachea

65
Q

telangiectasia

A

dilated blood vessels near the surface of the skin

66
Q

perioral radial furrowing

A

vertical, radial furrows from the mouth

67
Q

what is scleroderma

A

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
Q

effects of scleroderma on the esophagus

A

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
Q

what is hypertensive peristalsis (nutcracker esophagus)

A

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
Q

symptoms of hypertensive peristalsis

A

chest pain

dysphagia

71
Q

definition of diffuse esophageal spasm

A

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
Q

symptoms of diffuse esophageal spasm

A

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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