Pharynges & Esophagus Flashcards
How many pharynges are there?
3
- nasopharynx (NP)
- oropharynx (OP)
- Laryngopharynx (LP)
the laryngopharynx is a.k.a. _____________
hypopharynx
How long is the pharynx?
12 cm tube
what is vertebral level is associated with the pharynx
base of skull to C6
How many layers of tissue in the pharynx? Name them.
- mucosa
- aponeurosis
- muscles
How many muscles are associated with the muscle layer of the pharnyx? name them
6 muscles
- superior constrictor
- middle constrictor
- inferior constrictor
- stylopharngeus
- salpingopharyngeus
- palatopharyngeus
True or False.
The opening to the eustachian tube is in the oropharynx?
False.
Nasopharynx
How can nasotracheal instrumentation produce otis media (ear infection)?
middle ear can’t drain due to edema at eustachian tube opening (in nasopharynx).
i.e. edema caused by manipulation when inserting NG tube or NAW
What is a potential complication regarding the mucosal lining of the pharynx when inserting an NG tube or nasal ETT?
perforation that may cause accumulation of blood or puss in the retropharyngeal space === airway obstruction
know the oropharynx anatomy
What techniques can be used to view the nasopharynx and the laryngopharnx?
- direct – by FFOB (flexible fiber optic broncoscope)
- indirecdt – mirror tool
what’s the purpose of swallowing
move solids and liquids to the stomach
what are the phases of swallowing?
- oral
- pharyngeal
- esopageal
what occurs durring the oral phase of swallowing
- Saliva moistens food and helps form food bolus.
- Chewing produces mechanical alteration of food.
- Movement of bolus assists mechanical alteration.
- Tongue forms a posterior trough and moves against roof of mouth.
- Palatoglossal arches relax.
- Food bolus moves into oropharynx.
what happens during pharyngeal phase of swallowing?
- Nasopharynx occludes.
- Larynx closes to prevent aspiration.
- Other aerodigestive activities are inhibited. ( i.e. Breathing, Coughing, Sneezing, Vomiting)
- Hypopharynx elevates to receive the food bolus.
- Oropharynx closes behind the food bolus.
- Pharyngeal peristalsis moves the food bolus toward the
- esophagus by serial contraction of …Superior pharyngeal constrictor, Middle pharyngeal constrictor, &Inferior pharyngeal constrictor
- Lower segment remains closed except for bolus passage.
- Food bolus moves into the esophagus.
how does the larynx close to prevent aspiration?
- vocal cords aDduct
- aryepiglottic folds aDduct, epiglottis folds over glottis
what is the main cranial nerve associated with inhibiting the involuntary actions associated with swallowing? (i.e. couging sneezing breathgin)
Main mediator is CN X
what is the term for successive waves of involuntary undulating contraction passing along the walls of a hollow muscular structure
peristalsis
what happens during esophageal phase of swallowing?
- Esophageal peristalsis moves food bolus to stomach.
- Pharynx and larynx return to rest positions.
what is the medical term for swallowing
deglutition
The larynx ______ and ______ during swallowing.
(hint: movement)
a) elevates
b) descends
True or False.
Swallowing is gravity dependent.
False.
It is NOT gravity dependent
True or False.
Deglutition can occur during inspiration
False.
During exhalation
The exophagus is how long?
24 cm
What level of vertebrae are associated with esophagus?
C6 - T11
How many laryers make up the esophagus? Name them.
- mucosa
- submucosa
- muscular
- fibrous
what esophageal pathophysiology is this?
spasm
It has been discovered that your patient has the fallowing symptoms…
- LES (lower esphageal sphincter) has increased tone and fails to relax completely.
- Aperistalsis of the esophagus
what is the pathophysiology
Achalasia ( an innervation dissorder)
literal meaning = “failure to relax”
what are complications associated with achalasia?
- progressive dysphagia
- nocturnal regurgitation
- aspiration (even with Sellick maneuver)
- difficult airway managment
what esophageal pathophysiology is this?
diverticulum
True or False.
Diverticulum only occurs in the upper 1/3 of the esophagus
False
Can occur in upper, middle or lower esophagus
Diverticulum can impede the placement of what ?
NG tube
(enters pouch created by diverticulum, can perforacte pouch)
what type of diverticulum is this?
Zenker’s Diverticulum
Zenker’s Diverticulum is outpouching of the mucosa between the ____ muscle and the ________ muscle.
a) cricopharyngeus
b) inferior pharngeal constrictor
what pathophysiology is a mucosal herniation produced by occlusive mechanisms related to uncoordinated swallowing and impaired relaxation and/or spasm of the cricopharyngeus muscle produce increased pressure in the distal pharynx
Zenker’s Diverticulum
Zenker’s occurs in what population of patients
M:F::1.5:1
Older patients
occurs on Left side 90% of the time
list the clinical findings of Zenker’s
- asymptomatic
- dysphagia
- neck mass
- regurgitation
- cough
- aspiration
- recurrent pneumonia
- halitosis
What are some anesthesia considerations in repairing Zenker’s Diverticulum via a pharyngoesophageal myotomy
table may be turned with the left side away from you (so IV on right side, ETT taped to right side of mouth)
what type of abnormality is this?
hiatal hernia
Left pic = axial (sliding) hernia
Right pic = nonaxial (paraesophageal) hernia
what risk is associated with hiatal hernia
Aspiration
what are the risk factors associated with Aspiration
- “Full stomach”
- Gastroesophageal reflux disease
- Hiatal hernia
- Upper GI diverticula
what are risk management steps for dealing with aspiration
- Identify patient’s risk-related problems
- Discuss those risk-related problems with patient
- Use preventative measures
- Non-particulate antacid preinduction (i.e. 50 mL P.O. Bicitra)
- Sellick maneuver
- RSI (rapid sequence intubation)
what is the name of technique applied during endotracheal intubation, used to either prevent regurgitation, or to assist with visualisation of the glottis by a practitioner attempting intubation
Sellick Maneuver
