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Clinical Nutrition 2 > Swallowing Anatomy, Physiology and Dysphagia > Flashcards

Swallowing Anatomy, Physiology and Dysphagia Flashcards

1
Q

Prevalence of dysphagia in olde adults?

A

-Wide range between 22-68%

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2
Q

In which condition is dysphagia the most prevalent?

A

As high in 90% in ALS

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3
Q

Other conditions where dysphagia is common?

A
  • Dementia
  • Parkinsons
  • MS
  • TBI
  • Stroke
  • Oral cancer, tracheotomy and ventilator
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4
Q

Distinguish between the larynx and the pharynx

A

Larynx is the voice box, whereas the pharynx is found within the throat

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5
Q

Distinguish between dysphagia and dysphasia

A

Dysphagia is a swallowing disorder, while dyphasia is a language disoder

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6
Q

Distinguish between aphagia and aphasia

A

Aphagia is the inability or refusal to swallow, where aphasia is the impairment of language

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7
Q

What is aspiration pneumonia?

A
  • A complication of pulmonary aspiration
  • Happens when food, beverage or saliva enters the lung. Can also aspirate if vomiting, and therefore stomach acid could also be aspirated.
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8
Q

Why doesn’t aspiration pneumonia happens in healthy individuals?

A

-When bacteria is carried into the lungs, health individuals are capable to easily fight off small amounts of aspirate, but the less healthy (immune impaired) may develop pneumonia

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9
Q

What is silent aspiration?

A

Aspiration with no outwards signs (such as coughing). Usually happens in a person with decreased awareness, such as after a stroke

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10
Q

How can aspiration pneumonia happen?

A

Can sometimes happen when drooling and/or choking on saliva during sleep when the swallowing refluxes and muscles are more relaxed and the saliva can accumulate. This can also happen to people with a healthy swallow

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11
Q

What is the order of procedures to diagnose dysphagia?

A

1) Bedside swallow assessment
2) MBS videofluorscopy
3) Fiber-optic endoscopic evaluation of swallowing (FEED)

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12
Q

What are the key anatomical landmarks in swallowing?

A
  • Nasal cavity
  • Oral cavity
  • Larynx
  • Pharynx
  • Esophagus
  • Trachea
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13
Q

What does the pharynx consist of?

A
  • Nasopharynx
  • Oropharynx
  • Hypo-pharynx
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14
Q

What is the epiglottic valleculae?

A

A depression just behind the root of the tongue between the folds in the throat
–> The depressions serve as “spit-traps” where saliva is temporarily held to prevent the initiation of the swallow reflec

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15
Q

What else can the epiglottic valleculae hold?

A

Retain food particles or liquids which could later fall into the trachea –> increased risk of aspiration pneumonia

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16
Q

What is the pyriform sinuses?

A

Part of the pharynx which leads to the esophagus in a small channel

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17
Q

What is the relationship between the epiglottic valleculae and the pyriform sinuses?

A

Are known as the pharyngeal recesses, or the side pockets, where food may fall and reside before or after the swallowing reflex is triggered
–> Residue can build up, cause infection especially when swallowing function is impaired in dysphagia

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18
Q

What is the laryngeal prominence?

A

Adams Apple

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19
Q

How many times to people swallow per day?

A

> 1000 times per day

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20
Q

Swallowing requires the coordination of ____ muscles and ___ cranial nerves

A

25

5-6

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21
Q

What is key in swallowing?

A

The coordination of swallowing plus breathing

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22
Q

What are the 4 phases of swallowing?

A
  • Oral phase preparatory
  • Oral phase transport
  • Pharyngeal
  • Esophageal
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23
Q

Explain the oral preparatory phase

A

Voluntary phase which involved the trigeminal, facial and hypoglossal nerves. Lips will seal, and soft palate drops down over base of tongue the prevent food spillage within the airway. Saliva is secreted, mastication and bolus is formed.

24
Q

Explain the oral transit phase

A

Under voluntary control, using the trigeminal, facila and hypoglossal nerves. The soft palate will seal the nasal cavity, while the posterior tongue depresses, allowing for the propelling of the bolus to the oropharynx. Meanwhile, the anterior of the tongue will be elevated and pressed against the hard palate and will contract in a wave like motion to propel the bolus into the oropharynx.

25
Q

Which phase is the epiglottis open?

A

Oral transit phase

26
Q

Explain the pharyngeal phase

A

Under autonomic control by the glossopharyngeal, vagus and hypoglossal nerves. The soft palate will continue to seal the nasocavity, while laryngeal muscles close off vocal cords and epiglottis covers the larynx (prevents any food or liquid into the trachea, breathing stops) The bolus is then propelled towards the esophagus. Requires closure of the aryepiglottic folds, false vocal folds, true cords to protect the airway.

27
Q

What propels the bolus towards the esophagus in the pharyngeal phase? (4)

A

1) Supra-hyoid muscles will elevate the hyoid bone, blocking the airways –> Pressure will help propel bolus
2) Cricoid cartilage contacts, and opens the upper esophageal sphincter
3) Pharyngeal peristalsis carries the bolus through the pharynx at the top of the esophagus at the cricopharyngeal sphincter
4) Finally, the cricopharyngeal sphincter relaxes, allowing the bolus to pass into the esophagus

28
Q

Summary of Pharyngeal phase? (NLE–>HC)

A
  • Nasal cavity sealed
  • Laryngeal muscles close vocal cords
  • Epiglottic blocks airways
  • Supra-hyoid bones elevate hyoid, help block airways
  • Cricoid cartilage pulls backs, and opens the UES
29
Q

Describe the esophageal phase?

A

This autonomic phase is controlled by the glossopharyngeal, vagus and hypoglossal nerves. When the cricopharyngeal muscles relax, the bolus is passed through the UES into the esophagus, peristalsis carries the bolus down to the LES and finally into the stomach.

30
Q

Motor function of trigeminal nerve?

A

Mastication

-In oral prep and transit

31
Q

Motor function of facial nerve?

A
  • All muscles of the facial expression and corneal reflex

- Oral prep and transit

32
Q

Motor function of the glossopharyngeal nerve?

A
  • Swallowing, gag reflex

- Pharyngeal and esophageal phase

33
Q

Motor function of the vagus nerve?

A
  • GI Activity
  • Cough reflex
  • Pharyngeal and esophageal phase
34
Q

Motor function of spinal accessory nerves?

A
  • Innervates the muscle that controls the velum, which constricts the pharynx
  • Pharyngeal phase
35
Q

Motor function of the hypoglossal nerves?

A

Tongue control

-Involved in all phases

36
Q

What are the nutritional considerations in the preparatory phase?

A
  • Sight
  • Hand and mouth coordination
  • Lip seal, tongue control
  • Dentition issues
  • Positioning and cognition
37
Q

What does saliva contain?

A

-98% water, but also contains electrolytes, mucus, antibacterial compound and various enzymes

38
Q

What is the digestive function of saliva?

A

To moisten food, which helps creat a food bolus which can be swallowed most easily

39
Q

Which enzyme does saliva contain?

A

Amylase which will break down starches into maltose and dextrin

40
Q

When is saliva involved in the swallowing mechanism?

A

-During the oral preparatory and transit phases

41
Q

Which glands is saliva produced from?

A
  • Parotid
  • Sublingual
  • Submandibular
42
Q

What are other functions of saliva?

A
  • Moistening and lubrication
  • Initial digestion of CHO
  • Enhances tase
  • Antibacterial protection and oral hygiene
  • help assist with speech
43
Q

Discuss the esophagus

A
  • Sphincters are present at each end
  • Four layers of tissue
  • Chief function is motility
  • Peristalsis begins after swallowing
44
Q

What are the four layers of tissue in the esophagus?

A

-Mucosa, submucosa, muscle and adventitia

45
Q

What does the UES consist mainly of?

A

Cricopharyngeal muscles

46
Q

Another name for the UES?

A

Pharyngeosophageal junction

47
Q

What does penetration refer to?

A

When the food bolus enters the trachea

48
Q

Signs and symptoms of dysphagia?

A
  • Drooling and excessive secretions
  • Pocketing of food
  • Poor control of tongue movements
  • Facial weakness and difficulty chewing
  • Slurred speech
  • Wet “gurgly” voice after swallowing
49
Q

When can oral dysphagia occur?

A

In the oral preparatory or transit phases, or in both

50
Q

What is oral dysphagia characterized by?

A

Weak tongue and lip muscles, which results in difficulty to propel food down the throat, and difficulties in initiating a swallow

51
Q

Signs of oral dysphagia?

A
  • Drooling, spillage of food or liquid from the mouth
  • Slow eating
  • Inability to complete meal due to weakness or fatigues
  • Slow eating
  • Pocketing of food in mouth, reduced lip closure
52
Q

Signs of pharyngeal dysphagia?

A
  • Delayed swallow reflux
  • Repeated swallowing and frequent throat clearing
  • Wet sounding voice
  • Complaints of food or liquid stuck in the throat
  • Coughing before, during or after swallowing food, liquids or medications
  • Repeated pneumonia
  • Chest and lung congestion
53
Q

What is esophageal dysphagia?

A

Includes the structural blockages, stenosis, strictures due to GERD or esophageal dysmotility

54
Q

Signs of esophageal dysphagia?

A
  • Pressure or discomfort in the chest
  • Lump or fullness in the throat
  • Chronic heartburn
55
Q

Assessment in dysphagia?

A

-Weight changes
-Pocketing of food under the tongue or cheek
Spitting food out
-Facial weakness
-Time to eat
-Progression or worsening of signs and symptoms

Clinical Nutrition 2 (21 decks)

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