Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CD 663 > Normal Swallowing in Adults > Flashcards

Normal Swallowing in Adults Flashcards

1
Q

Big Picture: 4 Stages of Normal Swallow

A
  1. Oral preparation
    ¥ Food is masticated in preparation for transfer
  2. Oral (transport)
    ¥ Transfer food from the mouth to the oropharynx
  3. Pharyngeal
    ¥ Food is transported away from the oropharynx into upper esophagus
  4. Esophageal
    ¥ Food is transported from the esophagus to the stomach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Oral preparatory

A

the act of taking food, chewing it, mixing it with saliva, and forming it into a bolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Oral transport

A

controlling the bolus and transporting it to the back of the mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pharyngeal stage

A

¥ initiating the swallow reflex in a timely manner which is normally 1 second (or less)

¥ food is transported away from the oropharynx into upper esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Esophageal stage

A

the food enters the esophagus, the passageway to the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Stage 1: Oral Preparation Phase, Function

A 
Function:
• Mastication
• Bolus
formation
• Bolus
maintenance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Stage 1: Oral Prep & Voluntary Mastication

A 
Voluntary control
• Close lips, good buccal tension
• Velum lowered for nasal breathing
• Lingual-­‐velar seal
• Mastication
• Lateral/rotary jaw/tongue movement (chewing
action)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Stage 2: Oral Transport Phase

A 
• Starts when tongue
begins to propel
the bolus posteriorly
• Tongue Tip and sides to the alveolar ridge
• Velum elevates, tongue base
drops
• Propels bolus upward and
backward
• Oral phase ends when bolus reaches ramus of
mandible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When is the Pharyngeal Phase Triggered?

A

Sometime between the ant. faucial arches to the line of the ramus of the mandible

TRIGGERING the pharyngeal phase:
“Voluntary” initiation of a swallow
Rapid, no delaY (1-1.5 SEC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Abnormal if oral transport

A

+ delay > 2 seconds

PERSONS OVER 60 YRS MAY 0.3 seconds longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Trigger points may differ across ages

A

-Young adults: ant. faucial pillars
-Older adults: middle of the tongue base
Infants: valleculae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is the Pharyngeal Phase Triggered?

A

Sensory input from the oral cavity, tonsils, soft palate, and post pharyngeal (CN IX & X)
Posterior tongue movement
HYPOTHESIZED: a sensory recognition center in the lower brainstem (medulla; CPG) decodes sensory info to the nucleus ambiguous, which initiates the motor response for the pharyngeal swallow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Stage 3: Pharyngeal Phase

• Involuntary

A 
• (however,
it requires “voluntary” initiation
of a swallow to trigger the pharyngeal phase)
• (once it is triggered)
Lasts 1 second or less
Velum elevates (VP
port closure)
• Base of tongue retraction
and contact with the posterior
pharyngeal wall
  • Hyoid bone and larynx elevate and move anteriorly
  • Upward + forward
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Stage 3: Pharyngeal Phase (Involuntary)

A

Airway closure at 3 levels (respiration apnea/stops)
Epiglottis
¥ Epiglottic inversion also diverts bolus toward esophagus (liquid vs. solid)
Aryeipiglottic folds
¥ False (Ventricular folds) & True vocal folds

Pharyngeal contractions
¥ Sequential contractions of the superior, middle and inferior pharyngeal constrictors
¥ The bolus moves inferiorly via a combination of
¥ gravity
¥ base of tongue retraction
¥ pharyngeal wall contraction
¥ Upper esophageal sphincter (UES) opens/relaxes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Stage 4: Esophageal Phase

Involuntary

A

¥ Involuntary:
¥ 8~20 seconds in adults
¥ 3~10 seconds in infants
¥ Point where bolus enters esophagus at UES to point where bolus passes into stomach at LES
¥ Larynx descends to rest position and respiration resumes (exhalation)
¥ Velum lowers (VP port open)
¥ UES contracts/closes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Stage 4: About the Opening of the UES

A

¥ The UES is likely composed of multiple muscles
¥ Cricopharyngeal muscle = pharyngeal-­‐esophageal m.
¥ Opening of the UES allows the bolus to enter the esophagus
¥ Opening occurs before the bolus arrives and contributes to the pressure differential within the pharynx
¥ The UES relaxes during the swallow
¥ Elevation of the larynx pulls UES open
¥ Duration of opening increases as bolus volume increases

17
Q

Stage 4: More about Esophageal Phase

A

¥ Another entrance of bolus into the esophagus, the food is carried to the stomach via gravity and esophageal peristalsis.
¥ Passage of food through the hypopharynx is NOT considered to be due to “peristalsis.” ( pharyngeal muscle contraction)

Circular smooth muscle contract behind, relaxes in front of the bolus

18
Q

Stage 4: More about Esophageal Phase

A

¥ LES closes another food enters the stomach
¥ If dysfunction -­‐> Reflux
¥ Esophagus joins the stomach through an opening in the diaphragm called the “diaphragmatic” or “esophageal” hiatus.
¥ “Hiatus hernia”

19
Q

Four Mechanism of Airway Protection

A
  1. Hyoid/laryngeal elevation away from path of bolus
  2. Epiglottis retroflexion
    ¥ Elevation of the larynx to approximate the hyoid bone results in flipping the epiglottis over to a more vertical position.
  3. Closure of the laryngeal vestibule
    ¥ (bounded by the epiglottis, aryepiglottic folds, and arytenoid cartilages)
  4. Adduction of the false/true vocal folds
20
Q

Protective Reflexes

A

Protective Reflexes
¥ Cough reflex

¥ Gag reflex:

¥ Test the integrity of CN X

21
Q

Cough reflex

A

¥ In response to material entering deep into the laryngeal vestibule.
¥ Innervated by CN X (both motor and sensory)

22
Q

Gag reflex:

A

¥ Gag reflex: sensory CN IX, motor CN X
¥ Many individuals with normal swallowing have an absent gag reflex
¥ What does it have to do with swallowing?
¥ Triggered by noxious stimuli
¥ Designed to squeeze material out of the pharynx

23
Q

Oral Preparatory & Transport Phase

A

¥ Tongue positions material on the teeth
¥ Back of tongue and so palate seal ¥ Rotary lateral movement of the mandible and tongue during mastication ¥ Aer cycle is repeated numerous times, a bolus is formed
¥ During active chewing, the velopharyngeal port remains open for breathing.

¥ Little amount of premature spillage at valleculae is common (normal)

24
Q

Pharyngeal Phase

A

¥ Elevation and retraction of the velum and complete closure of the velopharyngeal to prevent passage into the nasopharynx
¥ Pharyngeal contraction and BOT retreats to PPW
¥ Elevation and anterior movement of the hyoid and larynx
¥ Closure of the larynx at the true vocal folds, the laryngeal entrance and the epiglottis to prevent material from entering the airway
¥ USE opens

25
Q

Summary: Events in Normal Swallow

A
  1. Bolus resting on tongue dorsum, tongue tip elevates
  2. Lingual-­‐velum seals
  3. Tongue (elevates) propels bolus moving backward (initiating a swallow)
  4. Initiate a swallow (to trigger swallowing reflex -­‐> More automatic processes of swallowing begin
  5. Velum elevates to seal nasopharynx
  6. Tongue base (pharyngeal tongue) moves forcefully to meet pharyngeal wall and squeeze bolus downward
  7. Pharynx constricts
  8. Epiglottis inverts
  9. Larynx closes (airway closes at 3 levels)
  10. Hyoid bone and larynx move superiorly and anteriorly (away from the airway)
  11. UES region opens to allow bolus to enter esophagus

CD 663 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions