Dysphagia 2 - Anatomy & Physiology Flashcards by Jesus Bernal

Identify the four stages of swallowing.

Oral preparatory
Oral-Transit
Pharyngeal
Esophageal

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T/F - All four swallowing stages are interdependent.

T/F - Disorders or dysfunctions in the oral cavity DO NOT spill over into other areas of swallowing.

True - each stage influences one another.

False

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The Anticipatory Stage involves everything that happens before you put food in your mouth.

Name some examples of this stage.

True

Examples include setting the table; cutting up the food, make food appetizing (i.e. taste, smell, sight); prayer; order of meal.

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Trachea is (Posterior/Anterior/Inferior/Superior) to the esophagus.

T/F - Both structures have a shared wall.

True

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Identify the four anatomic parts of the swallowing mechanism.

Oral Cavity
Pharynx
Larynx
Esophagus

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Describe the four features of the Esophagus.

25 cm long
Flat/collapsed tube
It travels straight thru to stomach to Lg & Sm intestines

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Identify the Seven structures of the Oral Cavity.

Jaw
Cheeks
Lips
Teeth
Tongue
Hard Palate
Soft Palate (Uvula)

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The Base of the Tongue is AKA (_____) tongue.

What is the difference b/w the back of the tongue & the base of the tongue?

Pharyngeal tongue

Back of tongue is in the oral cavity whereas the base of the tongue is inside the pharynx.

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The oral cavity extends from the lips anteriorly/posteriorly to the nasopharynx anteriorly/posteriorly.

What two structures separate the oral cavity from the nasal cavity?

Anteriorly / Posteriorly

The bony palate & velum (soft palate)

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Where is the “triggering point” of the swallow located in oral cavity?

What two structures inside the oropharyngeal stage make up the valleculae?

The edge of the jaw

BOT & epiglottis

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Which two areas inside of the oral cavity do people w/ Dysphagia usually pocket food?

Anterior & Lateral Sulcus

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Identify the three major divisions of the pharynx.

Nasopharynx
Oropharnyx
Hypopharnyx

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The (?) is shared b/w the nasal & pharyngeal cavity.

The (?) is shared b/w the oral & pharyngeal cavity.

The (?) is located at the bottom 1/3 of the pharynx.

Nasopharynx

Oropharynx

Hypopharnyx

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What structure is anterior to the Hypopharnyx?

The Hypopharnyx extends from the (?) to the (?) muscle.

Larynx

Epiglottis to the cricopharyngeus muscle

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The oropharynx extends from the lower (?) to the (?).

Lower SP to epiglottis.

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Identify the five structures that need to move in order to provide proper closure for airway protection.

Epiglottis
Aryepiglottic folds
True & False VFs
Arytenoid cartilages

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Name the three main constrictors in the pharynx.

Superior, Middle & Inferior pharyngeal constrictor muscles.

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Describe the two main purposes of the pharyngeal constrictors.

The PCM contract in order to move bolus thru the pharynx.

These muscles are attached to other structures that facilitate the swallow.

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Identify the four structures that attach to the Superior Pharyngeal constrictor muscle.

Tensor
Levator Palatine
Pterygoid
BOT

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Identify the two structures attached to the Middle Pharyngeal Constrictor Muscle.

The jaw & hyoid bone.

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Identify the two structures attached to the Inferior Pharyngeal Constrictor Muscle.

Thyroid & cricoid cartilages

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In the oropharynx, the space b/w the BOT & epiglottis is known as (?).

What two structures are located w/in the hypopharynx?

Valleculae

Hyoid bone & Piriform sinuses

T/F - The UES contracts during hyolaryngeal elevation.

The cricopharyngeus muscle is a ring-like muscle located at the top of the (?).

Name the area located b/w the inferior & lower constrictor muscle.

False - It relaxes

Esophagus

Kilanis Dehiscence

The attachment of which two areas form the pyriform sinus?

T/F - The pyriform sinuses is considered a structure NOT a space.

Where does the pyriform sinus end?

ICM & Thyroid cartilage

False - It’s a space

It ends at the bottom of the pharynx at the cricopharyngeal muscle.

The cricopharyngeus muscles is also known as (???).

UES

The epiglottis is a (?)-like structure that lies above the (?), posterior to the (???). Identify the two main spaces in the pharynx.

Leaf-like, Larynx & Base of the Tongue Piriform sinuses & valleculae

What ligament divides the BOT & epiglottis?

Hyoepiglottic ligament

T/F - The hyoepiglottic ligament divides the valleculae. How many spaces does the Hyoepiglottic ligament separate the valleculae into?

True Two: Left & right

What structure sits on the posterior rim of the cricoid cartilage?

Arytenoids

In terms of movement, the epiglottis moves (?) towards the (?) pharyngeal wall. This movement is known as (?) T/F - As the epiglottis moves towards the pharyngeal wall it makes contact w/ the arytenoids.

Back / Posterior PW Retroversion True

The fold of the epiglottis & arytenoid cartilage is known as (?). T/F - These seams close in order to avoid partial closure of the airway.

Aryepiglottic folds True

The opening of the larynx is called (??). The entrance or (?) is the (upper/lower) most portion. This area extends from the (?) to (superior/inferior) surface of the (??).

Laryngeal vestibule Aditus / uppermost Entrance / Superior / False Folds

The trachea is (Superior/Anterior/Inferior) to the (True/False) VFs. (?) is the space b/w the false & true VFs. (?) is the space b/w the false VFs.

Inferior / True VFs Ventricle Glottis

The (?) is described as a long, collapsed muscular tube. The contraction to push bolus thru the esophagus is called (?).

Esophagus Peristalsis

What is Tonic Contraction? What two structures in the esophagus are in tonic contraction? T/F - Hyolaryngeal movement impacts relaxation of CPM.

It means the muscles are always contracted until a swallow is initiated.

Where does the esophagus begin? The esophagus separates which two areas in the swallowing mechanism?

Bottom of pharynx Pharynx & esophagus

What is the purpose of the oral-preparatory stage? T/F - This is an involuntary stage. How does the soft palate move during chewing?

Preparing food for swallowing False - It's voluntary It lowers & touches the back of the tongue to avoid spillage into the pharynx.

Identify the five major components of the oral preparatory stage.

``` Lip closure Facial tone Rotary jaw motion Rotary lateral tongue motion Soft palate pulled anteriorly ```

Identify the five areas where the primary receptors of taste are located. What substance in the body activates these receptors? (HINT: secretion)

Tongue Hard/soft palate Pharynx, Supralaryngeal region Saliva

After food is chewed & bolus forms in the oral preparatory stage, when does the oral transit stage begin?

When the tongue pulls bolus together & holds it at the hard palate.

What type of movement does the tongue make as it positions a bolus into the oropharnyx? A patient w/ damage to CN (?) may have problems cradling & pushing up bolus.

Anterior to posterior movement CN XII

Where is the trigger point of the swallow located? What is the duration of the oral transit stage? Oral transit time is measured at (?) & examined (?). When does OT stage end?

At the edge of the jaw 1 second Bedside / radiographically OT ends when bolus head passes the anterior faucial arches.

Which stage begins as the swallowing reflex is "triggered"? T/F - It takes a single stimulus to elicit a swallow response.

Pharyngeal stage False - It takes multiple stimuli

The swallow response occurs when the head of bolus passes b/w (???) & (??). In young adults, where the the triggering point begin?

Anterior faucial arches & trigger point Anterior faucial arches

Pharyngeal Transit Time (PTT) examines the movement of a bolus between which to areas in the pharynx?

Trigger point & UES

During a swallow reflex, sensory input from bolus involves the sensory receptors on which seven structures?

``` hard palate posterior tongue anterior faucial arches tonsils valleculae piriform sinuses laryngeal vestibule ```

Describe the five neuromuscular events that occur during the swallowing reflex. These acts take place (independently/simultaneously).

``` Closure of soft palate/VP Ramping of tongue base Elevation & closure of the larynx Relaxation of the cricopharyngeus muscle Pharyngeal contraction ``` Simultaneously

Identify the four sphincters that close in the Larynx during the swallowing reflex. Why do these four areas close during the swallow response?

Epiglottis, aryepiglottic folds & False/True VFs For airway protection

Which neuromuscular event during the swallowing reflex is one of the most important aspects? Describe its movement during this process.

Ramping of BOT It retroverts & contacts the pharyngeal wall.

Name the the four swallowing valves active during the swallow response.

Lips, velum, VFs & UES

Lip & velum closure create (+/-) pressure. As the UES relaxes & opens up, it creates a vacuum suction w/ (+/-) pressure.

Positive Negative

What effect does a leak in any of the swallowing valves have on pressure build up?

A leak in the lips, VFs or velum will have a negative effect on positive pressure build up, which affects movement of bolus thru

T/F - Bolus size DOES NOT impact movement thru the pharynx. T/F - Bolus size influences consistency.

False True

# Define apneic period (i.e. takes place during swallow). When does the Apneic period occur? Larger bolus ( > / < ) Apnea period How long does the apneic period last?

It is the point during swallowing where we are not breathing. Just before or at the same time the bolus moves posterior to the oropharnyx. Larger apnea period Fraction of a second