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Airways > Pharynges & Esophagus > Flashcards

Pharynges & Esophagus Flashcards

1
Q

How many pharynges are there?

A

3

  1. nasopharynx (NP)
  2. oropharynx (OP)
  3. Laryngopharynx (LP)
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2
Q

the laryngopharynx is a.k.a. _____________

A

hypopharynx

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3
Q

How long is the pharynx?

A

12 cm tube

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4
Q

what is vertebral level is associated with the pharynx

A

base of skull to C6

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5
Q

How many layers of tissue in the pharynx? Name them.

A
  1. mucosa
  2. aponeurosis
  3. muscles
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6
Q

How many muscles are associated with the muscle layer of the pharnyx? name them

A

6 muscles

  1. superior constrictor
  2. middle constrictor
  3. inferior constrictor
  4. stylopharngeus
  5. salpingopharyngeus
  6. palatopharyngeus
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7
Q

True or False.

The opening to the eustachian tube is in the oropharynx?

A

False.

Nasopharynx

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8
Q

How can nasotracheal instrumentation produce otis media (ear infection)?

A

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

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9
Q

What is a potential complication regarding the mucosal lining of the pharynx when inserting an NG tube or nasal ETT?

A

perforation that may cause accumulation of blood or puss in the retropharyngeal space === airway obstruction

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10
Q

know the oropharynx anatomy

A
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11
Q

What techniques can be used to view the nasopharynx and the laryngopharnx?

A
  1. direct – by FFOB (flexible fiber optic broncoscope)
  2. indirecdt – mirror tool
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12
Q

what’s the purpose of swallowing

A

move solids and liquids to the stomach

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13
Q

what are the phases of swallowing?

A
  1. oral
  2. pharyngeal
  3. esopageal
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14
Q

what occurs durring the oral phase of swallowing

A
  1. Saliva moistens food and helps form food bolus.
  2. Chewing produces mechanical alteration of food.
  3. Movement of bolus assists mechanical alteration.
  4. Tongue forms a posterior trough and moves against roof of mouth.
  5. Palatoglossal arches relax.
  6. Food bolus moves into oropharynx.
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15
Q

what happens during pharyngeal phase of swallowing?

A
  1. Nasopharynx occludes.
  2. Larynx closes to prevent aspiration.
  3. Other aerodigestive activities are inhibited. ( i.e. Breathing, Coughing, Sneezing, Vomiting)
  4. Hypopharynx elevates to receive the food bolus.
  5. Oropharynx closes behind the food bolus.
  6. Pharyngeal peristalsis moves the food bolus toward the
  7. esophagus by serial contraction of …Superior pharyngeal constrictor, Middle pharyngeal constrictor, &Inferior pharyngeal constrictor
  8. Lower segment remains closed except for bolus passage.
  9. Food bolus moves into the esophagus.
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16
Q

how does the larynx close to prevent aspiration?

A
  1. vocal cords aDduct
  2. aryepiglottic folds aDduct, epiglottis folds over glottis
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17
Q

what is the main cranial nerve associated with inhibiting the involuntary actions associated with swallowing? (i.e. couging sneezing breathgin)

A

Main mediator is CN X

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18
Q

what is the term for successive waves of involuntary undulating contraction passing along the walls of a hollow muscular structure

A

peristalsis

19
Q

what happens during esophageal phase of swallowing?

A
  1. Esophageal peristalsis moves food bolus to stomach.
  2. Pharynx and larynx return to rest positions.
20
Q

what is the medical term for swallowing

A

deglutition

21
Q

The larynx ______ and ______ during swallowing.

(hint: movement)

A

a) elevates
b) descends

22
Q

True or False.

Swallowing is gravity dependent.

A

False.

It is NOT gravity dependent

23
Q

True or False.

Deglutition can occur during inspiration

A

False.

During exhalation

24
Q

The exophagus is how long?

A

24 cm

25
Q

What level of vertebrae are associated with esophagus?

A

C6 - T11

26
Q

How many laryers make up the esophagus? Name them.

A
  1. mucosa
  2. submucosa
  3. muscular
  4. fibrous
27
Q

what esophageal pathophysiology is this?

A

spasm

28
Q

It has been discovered that your patient has the fallowing symptoms…

  1. LES (lower esphageal sphincter) has increased tone and fails to relax completely.
  2. Aperistalsis of the esophagus

what is the pathophysiology

A

Achalasia ( an innervation dissorder)

literal meaning = “failure to relax”

29
Q

what are complications associated with achalasia?

A
  1. progressive dysphagia
  2. nocturnal regurgitation
  3. aspiration (even with Sellick maneuver)
  4. difficult airway managment
30
Q

what esophageal pathophysiology is this?

A

diverticulum

31
Q

True or False.

Diverticulum only occurs in the upper 1/3 of the esophagus

A

False

Can occur in upper, middle or lower esophagus

32
Q

Diverticulum can impede the placement of what ?

A

NG tube

(enters pouch created by diverticulum, can perforacte pouch)

33
Q

what type of diverticulum is this?

A

Zenker’s Diverticulum

34
Q

Zenker’s Diverticulum is outpouching of the mucosa between the ____ muscle and the ________ muscle.

A

a) cricopharyngeus
b) inferior pharngeal constrictor

35
Q

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

A

Zenker’s Diverticulum

36
Q

Zenker’s occurs in what population of patients

A

M:F::1.5:1
Older patients

occurs on Left side 90% of the time

37
Q

list the clinical findings of Zenker’s

A
  1. asymptomatic
  2. dysphagia
  3. neck mass
  4. regurgitation
  5. cough
  6. aspiration
  7. recurrent pneumonia
  8. halitosis
38
Q

What are some anesthesia considerations in repairing Zenker’s Diverticulum via a pharyngoesophageal myotomy

A

table may be turned with the left side away from you (so IV on right side, ETT taped to right side of mouth)

39
Q

what type of abnormality is this?

A

hiatal hernia

Left pic = axial (sliding) hernia

Right pic = nonaxial (paraesophageal) hernia

40
Q

what risk is associated with hiatal hernia

A

Aspiration

41
Q

what are the risk factors associated with Aspiration

A
  1. “Full stomach”
  2. Gastroesophageal reflux disease
  3. Hiatal hernia
  4. Upper GI diverticula
42
Q

what are risk management steps for dealing with aspiration

A
  1. Identify patient’s risk-related problems
  2. Discuss those risk-related problems with patient
  3. Use preventative measures
    • Non-particulate antacid preinduction (i.e. 50 mL P.O. Bicitra)
    • Sellick maneuver
    • RSI (rapid sequence intubation)
43
Q

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

A

Sellick Maneuver

Airways (53 decks)

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