Quiz 1 - Overview/ Stages of swallowing Flashcards
1
Q
This is NOT dysphagia
A
Difficulty feeding yourself or anorexia
2
Q
What is dysphagia, in short?
A
A difficulty in swallowing
3
Q
What is swallowing?
A
The act of taking in a substance through the mouth and pharynx, and into the esophagus. It is a combination of voluntary action and reflexive action that once started, cannot be stopped
4
Q
Dysphagia is often related to…
A
a primary diagnosis. Dysphagia is often a symptom.
5
Q
What is odynophagia?
A
Pain with swallowing
6
Q
Describe dysphagia
A
When it takes more time or effort to move food or liquid from your mouth to your stomach or the inability to swallow at all.
7
Q
What is aspiration?
A
When food or liquid goes down the trachea and into your lungs so you are unable to get it out.
8
Q
When it comes to swallowing disorders, what are some duties of the SLP? (Name at least 4)
A
- Performing feeding and swallowing evaluation
- Performing instrumental evaluation
- Identifying normal and abnormal swallowing function
- Identifying potential disorders and referring
- Making decisions about management
- Developing a treatment plan
- Providing treatment
- Providing teaching and counseling to patient and families.
- Education of other professionals
- Being a team member
- Advocacy
- Ongoing education
9
Q
How does dysphagia impact a person’s general medical condition?
A
- Decline in health
- Could get pneumonia
- Major cause of comorbidities
- Malnutrition and dehydration
- Weight loss
10
Q
How does dysphagia impact a person’s psychological well-being?
A
Could cause social isolation, depression, anxiety..
Eating is a social event
11
Q
How does dysphagia impact a person’s financial health?
A
Healthcare is very expensive
12
Q
What is oral dysphagia? What is its code?
A
Difficulty with losing food or liquid from the front of the mouth, difficulty with chewing, difficulty with controlling the food or liquid in the mouth.
R13.11
13
Q
What is pharyngeal dysphagia? What is its code?
A
Coughing, choking, gagging on food or liquids, difficulty with swallowing including pain and feeling of food or liquid sticking.
R13.13
14
Q
What is pharyngoesophageal dysphagia? What is the code?
A
Difficulty with food or liquid traveling through the esophagus
R13.14
15
Q
How many stages of swallowing are there?
A
3 (some say 4)
16
Q
How many pairs of muscles are involved in swallowing?
A
25
17
Q
What are the stages of swallowing? (4)
A
- Oral Preparatory phase
- Oral phase
- Pharyngeal phase
- Esophageal phase
18
Q
What is the term used for food or liquid that is in the mouth and being swallowed?
A
Bolus
19
Q
What is the technical definition of dysphagia?
A
Any disturbance in the functional elements or coordination in the stages of swallowing is likely to result in less efficient transfer of a bolus from the oral cavity to the stomach
20
Q
Normal swallowing involves….
A
The bolus moving through the oral cavity, oropharynx, and esophagus, dependent on expanding and contracting chambers, opening of muscular sphincters, and positive/negative pressures.
21
Q
What is the “first chamber”?
A
The oral cavity
22
Q
What does oral prep include?
A
Mastication of the bolus, mixing the bolus with saliva, and dividing the bolus for transport through the pharynx.
23
Q
Is the oral prep phase voluntary or involuntary?
A
It is completely voluntary and can be stopped at any time.
24
Q
Oral pattern is determined by ______ and ______
A
Viscosity ; Amount of the bolus
25
What are the structures of the oral prep phase? (11) (Not specific muscles)
1. Lips
2. Teeth
3. Hard Palate
4. Soft Palate
5. Uvula
6. Mandible/ lower jaw
7. Floor of the mouth
8. Tongue
9. Anterior and posterior faucial arches
10. Palatine tonsils
11. Cheeks
26
What is the circular muscle of the lips and what is its purpose for swallowing?
Orbicularis Oris
| Bolus containment
27
Can teeth impact nutrition? How?
Yes, problems with teeth can affect the types of food you can eat.
28
Why are teeth important for swallowing?
Mastication of the bolus
29
What type of movement is required for mastication?
Rotary lateral movement
30
What are the 4 muscles of mastication?
1. Masseter
2. Temporalis
3. Lateral Pterygoid
4. Medial Pterygoid
31
What is the purpose of the buccinator?
Not considered a muscle of mastication but it assists in mastication by keeping the bolus between the teeth
32
What are the 4 roles of saliva?
1. Digestion
2. Lubrication
3. Taste
4. Maintain oral hygiene
33
When does the oral preparatory phase end?
After chewing and a cohesive bolus is formed
34
Is the Oral Phase voluntary or involuntary?
Voluntary
35
Summarize the Oral Phase
Masticated bolus begins its journey to the oropharynx.
Tongue presses the bolus, segmentally and sequentially backward against the hard palate.
36
This muscle serves to prevent pressure escape forward or laterally out of the mouth.
Orbicularis Oris
37
Phase when the bolus is propelled from the oral cavity to the pharynx
Oral phase
38
What is the tongue doing/ where is it during the oral phase?
The anterior portion of the tongue is pressed against the maxillary alveolar ridge (right behind the upper front teeth) and the anterior part of the hard palate
39
Explain the lingual movement happening during the oral phase
The movement of the tongue continues as a rapid sequence moving the bolus posteriorly onto the dorsum of the tongue
40
The lingual movement of the tongue is characterized as what kind of movement?
"Stripping" action
41
More muscle activity is required during the oral phase as _______
Viscosity thickens
42
What stage does velar elevation begin?
Oral phase
43
Opening of the pharynx begins in ____ and continues into the _____
Oral phase ; Pharyngeal phase
44
______ is elevated in preparation for the pharyngeal phase
Hyoid bone
45
_____ is suspended from hyoid bone by __________ & _______.
So if _______ elevates and moves forward, then the _______ moves upward
Larynx; thyrohyoid ligament & thyrohyoid muscles
Hyoid ; Larynx
46
What are the muscles of the oral phase? 4 mastication muscles and 1 other
Mastication muscles
1. Masseter
2. Temporalis
3. Lateral Pterygoid
4. Medial Pterygoid
Other: Buccinator
47
_____ is the foundation for the tongue and is embedded in the _____ _ ___ ______.
Hyoid; base of the tongue
48
Early elevation of the hyoid is controlled by what nerve? Via what?
CN V (trigeminal) Via the mylohyoid
49
In the oral phase, the elevation of the ____ allows the bolus to pass through the tonsillar pillars
Soft palate
50
In the oral phase, the elevation of the soft palate allows the bolus to pass through the _______
Tonsillar Pillars
51
In the oral phase, this action prevents penetration of the bolus or escape of air pressure through the nasopharynx
The fully elevated soft palate contracting the adjacent pharyngeal walls in a valving action
52
The ______ in the walls of the nasopharynx oppose one another to close nasopharynx
Superior pharyngeal constrictor
53
____ is a protective vegetative function
Swallowing
54
_____ & ____ are overlaid functions
Speech production & Voicing
55
When does the pharyngeal swallow/phase initiate?
When the bolus passes the pharyngeal line (aka mandibular line)
56
This phase includes the passage of food from the oral cavity through the pharynx to the esophagus
Pharyngeal phase
57
Swallowing and respiration are _____ and therefor they must be ______
mutually exclusive ; must be coordinated
58
What is apneal?
cease in breathing
59
During the pharyngeal swallow, how long, approximately, is the apneal?
1 - 3.5 seconds
60
If the body needs to choose between swallowing or respiration, it will choose....
Respiration
61
Is the pharyngeal response voluntary or involuntary?
Involuntary
62
The pharyngeal response is an involuntary airway ____ and bolus _____ event
airway protective ; bolus propulsive
63
What are the 3 stages of swallowing
oral, pharyngeal and esophageal
64
Dysphagia is not a _____ _____ _____ but rather a ______ of underlying disease and therefore is described most often by its _______ _______ (____).
primary medical diagnosis ; symptom ; clinical characteristics (signs)
65
Normal swallowing includes....
an integrated, interdependent group of complex feeding behaviors emerging from interacting cranial nerves of the brainstem and governed by neural regulatory mechanisms in the medulla, as well as in sensorimotor and limbic cortical systems.
66
stage in which food is masticated in preparation for transfer
Oral preparatory stage
67
stage which entails the transfer of material from the mouth to the oropharynx
Oral stage
68
stage in which material is transported away from the oropharynx around an occluded laryngeal vestibule, and through a relaxed cricopharyngeus muscle into the upper esophagus
Pharyngeal stage
69
stage in which material is transported through the esophagus into the gastric cardia
esophageal stage
70
The oral cavity extends from ____ and contains the ____, ____ & ____
the lips anteriorly to the nasopharynx posteriorly
| tongue, gums, and teeth
71
The oral cavity is separated from the nasal cavity by _____ & _____
The bony palate and velum (soft palate)
72
The respiratory system is protected during pharyngeal swallow by
Occlusive muscular constriction of the laryngeal vestibule and downward displacement of the epiglottis
73
Epiglottis extends from... into..
the base of the tongue into the pharyngeal cavity
74
Lateral recesses at the base of the tongue on each side of the epiglottis
Valleculae
75
Action of the Temporalis
Elevates or closes mandible; retracts mandible
76
Action of Masseter
Elevates or closes mandible
77
Action of Medial pterygoid
Elevates or closes mandible
78
Action of Lateral pterygoid
Depressor or opener of mandible; protrudes mandible; permits side-to-side movement of mandible
79
Muscles which which compress the lips and flatten the cheeks in the movement of food across the teeth
Buccinator muscles
80
Action of Orbicularis oris
Closes, opens, protrudes, inverts and twists the lips
81
Action of Levator veli palatini
Raises soft palate
82
Action of Tensor veli palatini
Stretches soft palate
83
This muscle Raises back of tongue during the first stage of swallowing
Palatoglossus
84
This muscle Shuts off nasopharynx during second stage of swallowing
Palatopharyngeus
85
Muscle that Shortens and raises uvula
Uvulae
86
These 3 nerves innervate the suprahyoid group of muscles.
Hypoglossal, trigeminal and facial
87
This suprahyoid muscle Elevates tongue and floor of mouth; depresses jaw when hyoid bone is in fixed position
Mylohyoid
88
This suprahyoid muscle Raises hyoid bone if jaw is in fixed position; depresses jaw if hyoid bone is in fixed position
Digastric
89
important single muscle that lies at the transition level between the pharynx and the esophagus
cricopharyngeal
90
The ______ muscle acts as a sphincter, and ______ during passage of the bolus from the pharynx into the esophagus.
Cricopharyngeal ; relaxes
91
This connects the pharynx and the stomach
Esophagus
92
The esophagus is separated from the pharynx by the ______ ______ _____ and from the stomach by the _____ _____ ______.
pharyngeal esophageal segment (PES) ; lower esophageal sphincter (LES)
93
Efficient movement of a bolus is accomplished when
coordinated neuromuscular contractions and relaxations create zones of high pressure on the bolus and zones of negative pressure below the level of the bolus
94
______ provides the initial positive driving force
the tongue
95
Efficient (i.e., timely and strong) laryngeal elevation helps create a
Negative zone of pressure in the pharynx
96
Many mechanisms are active in preventing the bolus from entering the upper airway. These include:
(1) cessation of active respiration, (2) approximation of the true and false vocal folds, (3) closure of the laryngeal aditus, (4) deflection of bolus material by the tongue base over a rising larynx, and (5) division of the bolus through the valleculae that direct the bolus around the superior aspect of the airway entrance.
97
The pharyngeal response is ________ once started.
an irreversible motor event
98
What is Boyle's Law?
When the pressure in an adjacent area is lower, a vacuum is created and the contents of the higher region are “sucked” into the lower region of negative pressure
99
_____ pressure is always to the bolus tail and _____ pressure is always at the bolus head
Positive ; negative
100
What are the 3 sections of the pharynx?
Nasopharynx, Oropharynx, and laryngopharynx
101
Where is the nasopharynx?
Area directly behind the nasal cavity
102
Where is the oropharynx?
Immediately behind the anterior faucial arches and extends to the hyoid bone
103
Where is the laryngopharynx?
Region posterior to the larynx that extends from hyoid to esophagus
104
When is the pharyngeal response triggered?
When the bolus passes the pharyngeal line
105
What happens after the bolus passes the pharyngeal line?
Velopharyngeal closure
106
This movement is rapid and high in the pharynx to form a complete seal with the posterior pharyngeal wall
Velopharyngeal closure
107
What are the 3 muscles of velopharyngeal closure?
1) Levator veli palatini
2) Tensor veli palatini
3) Musculus uvulae
108
What happens after velopharyngeal closure?
Hyolaryngeal elevation
109
Explain what happens during hyolaryngeal elevation
The Hyoid and the Larynx rise and are pulled forward under the tongue
110
Larynx is a ____ in the throat and pharynx is a _____ in the throat
Organ ; set of regions
111
Larynx is made of _____. Pharynx is made of _____
Cartilage ; muscles
112
What happens after hyolaryngeal elevation?
As the bolus is propelled posteriorly, the pharynx elevates and contracts to create a wave of contraction
113
What are the 3 muscles that contract the walls of the pharyngeal chamber?
1) Superior pharyngeal constrictor
2) Middle pharyngeal constrictor
3) Inferior pharyngeal constrictor
114
The ________, ______, and ________ ____________ form the ______ and _______ pharyngeal walls and serve to _________ and _______ the pharynx
superior, middle, and inferior constrictor;
Posterior and Lateral
Constrict and retract
115
Defined as a pear-shaped passage that flanks the larynx
| Located on either side of the laryngeal vestibule (opening into the larynx), just above the UES
Pyriform sinus
116
What does the pyriform sinus do?
Help direct the bolus and protect from penetration or aspiration
117
After the wave of contraction what happens?
Epiglottic inversion
118
What happens after epiglottic inversion?
Vocal fold adduction
119
What happens after vocal fold adduction?
Airway closure
120
When does the pharyngeal phase end?
when the soft palate returns to the original position and the larynx reopens
121
The simple transport of the bolus to the stomach through a peristaltic wave from the cricopharyngeal juncture to the gastroesophageal juncture
Esophageal phase
122
The esophageal phase is defined as the ______ _____ of the bolus to the ____ through a ________ ______ from the _______ _______ to the _______ ______.
simple transport; stomach ; peristaltic wave ; cricopharyngeal juncture ; gastroesophageal juncture
123
a wave of contraction the propagates down the esophagus
Peristaltic
124
Esophageal motoneurons are ______ during ___ /_______ phases
inhibited ; oral/pharyngeal
125
Once the bolus enters the esophagus, bolus movement involves the coordinated contraction
of smooth and striated muscles
126
What are the 3 distinct areas of the esophagus
1. cervical esophagus
2. thoracic esophagus
3. Abdominal esophagus
127
Site of high pressure, resulting from tonic contraction of the smooth muscle making up the sphincter
Lower Esophageal Sphincter (LES)
128
The primary peristaltic waves are initiated by the:
pharyngeal swallow
129
```
Occurs in response to stimulation of esophageal sensory receptors by the distension of the esophageal lumen
Wave movement similar to primary waves
Not initiated by pharyngeal swallow
```
Secondary esophageal peristalsis wave
