LAST FINAL AS A FIRST YEAR!!!!!!!!!!! Flashcards
Esophageal physiology
- major function is transportation
- vagus nerve primary
- peristalsis or “squeezing”
primary peristalsis
initiated by swallow
secondary peristalsis
- clean up crew, clears material from first peristalsis and also clears reflux
- dry swallow can also start it
- second swallow inhibits it
third form of peristalsis
- tertiary waves that don’t help move bolus
- ineffective waves (signal of disorder)
- happens frequently with reflux and stress
common esophageal disorder symptoms
- sticking of food in throat
- coughing during or after meal
- globus sensation
- hiccups (huge sign of reflux)
less common esophageal disorder symptoms
- chest pain
- shortness of breath
- respiratory symptoms
- odynophagia (painful swallowing)
structural esophageal disorders (mostly solid food dysphagia)
- strictures
- rings and webs
- hiatal hernias
- CP Bars
- diverticulums
motor abnormalities (motility)
- achalasia
- reflux
- scleroderma
- nonspecific esophagus
diverticulum
- Zenker’s most common
- pouch or sac that branches off the esophagus
- increase pressure secondary to coordination of muscles
esophageal web
- located in proximal or upper third of esophagus
- regurgitation, food sticking
- balloon dilation, diet
esophageal stricture/obstruction
- stricture-narrowing of esophagus
- caused by scar tissue that builds up
- obstruction, usually food blockage
- balloon dilation/PPI Tx/removal of obstruction
c-p bar (cricopharyngeal bar)
- hypertrophied c-p muscle due to overworked muscle, aging or dysfunctional UES
- myotomy/balloon dilation
intraesophageal reflux
- delay in peristalsis
- backflow of bolus in esophagus
gastroesophageal reflux
-backflow of stomach acid into esophagus
laryngopharyngeal reflux
-stomach acid back flowing all the way into larynx
which lung more susceptible to aspiration?
right. wider, more forward, and shorter
pleura
2 thin layers of tissue that surround lungs. like saran wrap that protects and cushions and helps lungs expand and contract
alveoli
clusters of ducts that contain air
when does swallow occur?
interrupts expiratory phase
swallow apnea
airway closes for fraction of a second. bigger bolus=longer apneic period. swallow and respiratory overlap and incoordination may lead to aspiration
mucociliary clearance
movement of mucous through the respiratory tract by movement of cilia that lines bronchi. moves foreign matter, dirt and membranes and prevents infection
who’s at risk for poor mucociliary clearance?
-head/neck cancer
-NPO
-trach/resp pts because not eating or drinking so dry mucous membranes and not making saliva
SALIVA IS KEY!!!!!!!!
pulmonary toilet
body’s natural way of clearing secretions. cilia/mucociliary clearance, coughing, spitting. HYDRATION IS KEY!!!!
artificial pulmonary toilets
suction, bronchoscopy, inhalers
affects of intubation
redness, edema, decreased sensation, odynophagia. wait 24 hours for swallow eval due to pain, swelling, etc.
tracheostomy tubes
patients who need longer time to gain respiratory status back AND used to reduce aspiration, protecting the lungs because able to suction. goal is to go smaller and smaller then pull it
cuffed tube
inflated piece around tube. prevents air from escaping upper airway and assures patient is well oxygenated. cannot phonate and can swallow but not a natural swallow because they don’t feel the pressure. reduces but does not eliminate risk of aspiration. can still aspirate saliva and liquids around the cuff.
cuffless tube
allows air exchange in upper airway. can phonate, swallow and cough.
how does tube affect swallowing?
reduces subglottic pressure, possible reduction in laryngeal elevation, reduced smell and taste.
order of progression for tube
- cuff inflated
- deflated or cuff less (optimal for SLP eval)
- passy muir speaking valve
- trach capped
- decannulated
swallow eval
optimal=cuff deflated. if they can’t tolerate then you may assess while inflated though its not very accurate. don’t eval inflated unless there’s no chance of weaning and they permanently need cuff inflated.
disorders affecting respiratory
aging, COPD, head/neck cancer, neuro disease, stroke
iatrogenic swallowing disorders
anti-psychotic drugs cause tardive dyskinesia (constant movement of tongue in and out of mouth) and alters transport.
