Brainscape's Knowledge GenomeTM

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


See full index

HDSO Digestion System > Physiology -- Deglutition and Dysphagia > Flashcards

Physiology -- Deglutition and Dysphagia Flashcards

1
Q

3 functional activities of the GIT

A
  1. Propulsion
  2. Secretion & digestion
  3. Absorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What do the pressure gradients of the GIT result from?

A

Coordinated contraction of muscular elements in the GI wall

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

Magnitude of the pressure gradient in the GIT

A

5 - 30 mm Hg

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

Stimulus to generate contractions in the GIT

A

Physiological distension

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

What does physiological distension cause?

A
  • Stimulation of stress muscle fibres
  • Neurotransmitter release (ENS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the ENS modulated by?

A

ANS and hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

2 types of contraction

A

Segmentation and Peristalsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define segmentation

A

Standing rings of contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define peristalsis

A

Propagated contraction

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

5 sphincters in the GIT from top to bottom

A
  1. Upper esophageal
  2. Lower esophageal
  3. Pyloric
  4. Ileocecal
  5. Internal and external anal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

3 requirements for flow

A
  • Generate pressure
  • Prevent dissipation of pressure
  • Decrease resistance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

3 phases of swallowing

A
  1. Oral
  2. Pharyngeal
  3. Esophageal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Alteration in the phases of swallowing can result in what?

A

Dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Define dysphagia

A

Difficulty or delay in passage of solid or liquid food bolus that is sensed by the patient within seconds of initiaiton of a swallow attempt

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

Prevalence of dysphagia in people over 65

A

15%

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

2 types of dysphagia

A
  • Oropharyngeal
  • Esophageal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Define esophageal dysphagia

A

Food stuck in the center of the chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Define oropharyngeal dysphagia

A

Coughing or choking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

2 mechanisms that can result in dysphagia

A
  • Mechanical obstruction and/or structural abnormality
  • Neuromotor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Type of control exhibited in the oral phase

A

Voluntary control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

2 neural components of the oral phase

A
  1. Ability to initiate (voluntary –> cortex)
  2. Coordinated movements (reflex; involuntary –> medulla)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

4 abnormalities in the oral phase

A
  1. Neuromuscular defect
  2. Congenital abnormalities
  3. Bucco-pharyngeal obstruction
  4. Trauma and inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do neuromuscular defects cause abnormalities in the oral phase

A

Prevent generation of pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do congenital abnormalities cause abnormalities in the oral phase?

A

Promote dissipation of pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How can bucco-pharygneal obstruction cause abnormalities in the oral phase?

A

Increase resistance to flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

DIfferential diagnosis of dysphagia in the event of trauma and inflammation causing abnormalitites in the oral phase

A

Odynophagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

3 prerequisites for propulsion

A
  • Generation of pressure
  • Prevention of the dissipation of pressure
  • Decrease resistance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Pharyngeal receptors bring afferent neurons to which part of the brain?

A

Deglutition center

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Deglutition reflexes sent out from the deglutition center resulting from the information received from the pharyngeal receptors

A
  • Protective reactions
  • Deglutition apnea
  • Relax UES
  • Contract pharyngeal constrictors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Trigger areas for deglutition reflexes

A
  • Soft palate
  • Uvula
  • Palatine tonsil
  • Root of tongue
  • Epiglottis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What does the deglutition center have a direct inhibitor influence on? What does this lead to?

A

Respiratory center –> deglutition apnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

6 steps in the pharyngeal phase

A
  1. Raise soft palate
  2. Raise base of tongue
  3. Vocal cords come together
  4. Forward and upward movement of larynx
  5. Propagated contraction of pharyngeal constrictors
  6. Relaxation of UES
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Where do the impulses for the closure of the cricopharyngeus originate?

A

Centraly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What mediates the closure of the cricopharyngeus

A

Vagus releasing ACh at neuromuscular junction –> muscle contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How does the cricopharyngeus relax?

A

Cessation of impulses from vagus releasing ACh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

4 characteristics of the pharyngeal phase

A
  • Involuntary
  • Rapid
  • “Stereotyped”
  • Temporospatial coordination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

3 defects in the pharyngeal phase

A
  • Failure of propulsion
  • Obstruction to flow
  • Psychological factors
38
Q

2 effects caused by failure of propulsion in pharyngeal phase

A
  • Generates less pressure
  • Increases dissipation of pressure
39
Q

4 parts that can be involved in the failure of propulsion in the pharyngeal phase

A
  • Brain
  • Cranial nerves
  • Myoneural junction
  • Muscle
40
Q

Effect of obstruction to flow causing pharyngeal phase defects

A

Increased resistance

41
Q

2 causes of obstruction to flow in pharyngeal phase

A
  • Mass effect
  • Incomplete sphincter relaxation
42
Q

Psychological factor that can cause defective pharyngeal phase

A

Globus hystericus

43
Q

3 esophageal forces

A
  1. Pharyngeal momentum
  2. Gravity
  3. Peristalsis
44
Q

What force is generated each time that we swallow

A

A single primary peristaltic wave (part of the deglutition reflexes)

45
Q

Time of propagation of one wave of primary peristalsis along the length of the esophagus

A

8 - 10 seconds

46
Q

Describe the vagal innervation from the deglutition center to generate primary peristalsis (diagram)

A
47
Q

Consequence of cutting the vagal fibres high up in the neck on primary peristalsis

A
48
Q

Consequence of cutting vagal fibres transthoracically on primary peristalsis

A

Primary peristalsis continues because the distal esophagus has the enteric circuitry necessary for the propagation of the peristaltic wave (orange fibres in diagram)

49
Q

Define “vago-vagal reflex”

A

Reflex produced due to the vagal afferent nerves sending information to the brain centers, which send out efferent vagal nerves

50
Q

What is essential for initiating peristalsis in the proximal esophagus

A

Vagus

51
Q

What is required for the continuation and propagation of peristalsis in the distal esophagus

A

Intactness of ENS

52
Q

Stimulus for secondary peristalsis

A

Local distension (i.e. food lodged in esophagus)

53
Q

Similarities between primary and secondary peristalsis

A
  • Upper esophagus requires vagus
  • Lower esophagus requires ENS
  • Pressure generated is 30 - 60 mmHg
54
Q

Differences between primary and secondary peristalsis

A
  • Different stimuli
    • Primary = pharyngeal receptors
    • Secondary = local distension
  • Different frequency
    • Primary = only 1 contraction per swallow
    • Secondary = many contractions until bolus is displaced
55
Q

Define deglutitive inhibition

A

Central inhibition of primary peristaltic wave resulting from rapid, repeated stimulation of pharyngeal receptors (i.e. sipping fluid through a straw)

56
Q

How are liquids brought through the esophagus?

A

Deglutitive inhibition –> cessation of stimulation of pharyngeal receptors –> single peristaltic wave sweeps over esophagus –> empty contents

57
Q

3 facotrs influencing esophageal transport

A
  • Viscosity of bolus
  • Temperature of bolus
  • Posture of subject
58
Q

What type of control is exhibited in the closure of the LES

A

Myogenic

59
Q

What type of control is exhibited in the relaxation of the LES?

A

Neurogenic –> local release of NANC

60
Q

Compare the characteristics of the upper esophageal sphincter vs. the lower esophageal sphincter

A
61
Q

When closed, what is the magnitude of the resistance to flow provided by the lower esophageal sphincter?

A

10 - 30 mm Hg

62
Q

6 characteristics of the LES musculature (in vitro)

A
  1. More collagen fibres
  2. Lower RMP; partially contracted at RMP
  3. More resistant to stretch
  4. Sensitive to hypoxia
  5. Ca++ dependent
  6. More sensitive to transmitters and hormones
63
Q

Does gastrin provide modulation of the LES?

A

ONLY in large (pharmacologic) doses!!

64
Q

3 gut hormones that have an effect on LES

A
  • Gastrin (increase tone)
  • Secretin (decrease tone)
  • CCK (decrease tone)
65
Q

Special hormone that decreases LES tone and the specific period when it has an effect

A

Progesterone decreases sphincter tone during the last trimester of pregnancy (reason for reflux during this period)

66
Q

6 external influences on the LES and their effects

A
  • Cigarette smoking
  • Alcohol (high doses)
  • Morphine, valium
  • Fat
  • Chocolate
  • Carminatives

All decrease LES tone

67
Q

Factors that affect the LES (Venn diagram)

A
68
Q

Define pyrosis

A

Heartburn: retrosternal burning sensation, radiating upwards from the xiphoid towards the neck

69
Q

Rate of occurrence of reflux in healthy individuals + duration

A

1 - 4 instances per hour (usually <30 sec)

70
Q

Define transient LES relaxation (TLESr)

A

Reflux occurring in healthy individuals

71
Q

3 disordered functions associated with GERD

A
  • Ineffective esophageal clearance of refluxate
  • Less effective secondary peristalsis
  • Defective epithelial resistance to damage by refluxate
72
Q

Why does an increase in intraabdominal pressure cause a greater than expected increasei in LES pressure?

A

Reflex tightening of the LES (vago-vagal reflex)

73
Q

3 ways to examine the esophagus

A
  • Radiology
  • Endoscope
  • Intraluminal pressure recording (manometry)
74
Q

Esophageal resting pressure

A

-5 mm Hg

75
Q

UES resting pressure

A

+80 mm Hg

76
Q

LES resting pressure

A

+20 mm Hg

77
Q

Pharyngeal resting pressure

A

0 mm Hg

78
Q

Stomach resting pressure

A

+5 mm Hg

79
Q

Describe the normal manometric recordings in response to swallowing

A
  • 8 - 10 sec for wave to reach distal esophagus
  • Pressure complex = 30 - 80 mm Hg
  • LES relaxes early
80
Q

Describe the manometric findings of a patient with achalasia

A
  • LES does not relax with wet swallows
  • Wet swallows do not produce peristaltic pressure waves in the esophagus
  • Instead, there are low-amplitude, simultaneous P waves with a nearly identical configuration (not sequential)
81
Q

Define achalasia

A

Failure to relax:

  • Aperistalsis
  • Incomplete relaxation of LES with swallowing
  • Increased resting tone of LES
82
Q

Potential cause for achalasia

A

Dysfunction of inhibitory neurons in distal esophagus:

  • NO
  • VIP
83
Q

3 categories of oropharyngeal dysphagia

A
  • Structural
  • Myogenic
  • Nervous system
84
Q

3 types of structural oropharyngeal dysphagia

A
  • Poor dentition, xerostomia
  • Intraluminal
  • Extraluminal
85
Q

3 intraluminal causes of oropharyngeal dysphagia

A
  • Diverticulae
  • Webs
  • Oropharyngeal tumors
86
Q

3 extraluminal causes for structural oropharyngeal dysphagia

A
  • Osteophytes
  • Thyromegaly
  • Lymphadenopathy
87
Q

5 causes for nervous system-related oropharyngeal dysphagia

A
  • Head injury
  • Brainstem tumors
  • Stroke
  • MS
  • Parkinson’s
88
Q

2 types of esophageal dysphagia

A
  • Structural
  • Motility abnormalities
89
Q

4 intraluminal causes for esophageal dysphagia

A
  • Stricture
  • Schatzki’s ring
  • Cancer
  • Eosinophilic esophagitis
90
Q

Extraluminal cause for esophageal dysphagia

A

Mediastinal tumors (lymphoma, lung cancer)

91
Q

5 motility abnormalities that may cause esophageal dysphagia

A
  • Achalasia
  • Esophageal spasm
  • Secondary achalasia from tumor infiltration
  • Diabetes
  • Collagen vascular disorders

HDSO Digestion System (29 decks)

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