Swallowing, Coughing And Vomiting Flashcards
What are the 3 protective mechanisms
Mucosa and mucociliary action
Immunological defences e.g. IgA, IgE
Neuromuscular reflexes e.g. swallowing, sneezing
How is the neuromuscular protective mechanism carried out
Mechano/chemoreceptors in the upper aerodigestive tract
Afferent pathways involving cranial nerves V and X
Complex brain stem interactions
Co ordinated largely involuntary response involving several discrete muscle groups
What are the 3 swallowing phases
Oral (preparatory) phase
Pharyngeal phase
Oesophageal phase
Which phase of swallowing is voluntary
Oral phase
What happens during the oral swallowing phase
Food is chewed with saliva to form bolus
Tongue pushes backwards to pharynx
Teeth brought together by muscles of mastication
Lips seal (normally)
Intrinsic tongue muscles push tip of tongue against palatal surface of upper incisors - a groove forms in tongue
Aided by Buccinator muscle to propel bolus back
Where is the nucleus ambiguus located
In cell bodies of motor nerves that innervate ipsilateral muscles of soft palate, pharynx, larynx and upper oesophagus
What are the 4 steps to the pharyngeal phase of swallowing
Sensory input (X and others)
Nucleus of the tractus solitarius
Nucleus ambiguus in the brain stem ‘swallowing centre’
Co ordinated swallowing response
What happens with a larger bolus
The upper oesophageal sphincter is open longer and movement of hyoid and larynx is greater and of longer duration
Which cranial nerves are affected by the nucleus solitarius
Facial, glossopharyngeal, vagus (taste)
Glossopharyngeal sensation pharynx
Vagus sensation larynx
Which cranial nerve is sensation for the tongue, oral cavity, hard and soft palate
Trigeminal
Which muscles are involved in swallowing
Temporalis
Masseter
Stylopharyngeus
Pharyngeal m
Strap muscles - C1-3
What happens during the pharyngeal phase of swallowing
Inhibition of respiration
Elevation of soft palate
Glottis closes sealing laryngeal opening
Elevation of larynx pulled upwards to position where food is less likely to enter
Vocal cords adducted
Contraction of aryepiglottic m pulling epiglottis over laryngeal opening
Opening os pharyngo oespohageal sphincter to allow passage of food
Activation of pharyngeal muscles in swallowing
What happens during the oesophageal phase of swallowing
Food propelled towards stomach by peristalsis
Wave of contraction of circular smooth muscle of oesophagus which is preceded by wave of relaxation
Gastro oesophageal sphincter opens
Food enters stomach
Gravity contributes to process
What is another word for swallowing difficulties
Dysphagia
What is achalasia
The failure of sphincter smooth muscle relaxation to allow bolus through
What is diffuse oesophageal spasm
Varies in severity and leads to inefficient movement of food and liquids along oesophagus
Can lead to regurgitation and chest pain
What is gastro oesophageal reflux
Inflammation and scarring of oesophageal wall due to acid contents of stomach leaking upwards
Symptoms include coughing during swallowing or on waking
May be due to pathology or behaviour
What does oesophageal cancer present as
Generally squamous cell carcinoma
What happens during sneezing
Irritation of receptors in the nasal mucosa
Deep inspiration
Glottis closes
Uvula and soft palate depressed
Diaphragm contracts against a closed glottis
Glottis opens release of pressure
What are the 3 stages of anatomy of the cough reflex
Receptors
Cough centre
Effector musculature
What receptors take place in the anatomy of the cough reflex
Laryngeal and tracheobronchial, diaphragm, pleura, oesophagus rapidly adapting irritant receptors, non myelinated C fibres
What happens at the cough centre of the cough reflex
Integration of afferent fibres in the medulla, separate to centres which control breathing
What is involved in the effector musculature in the cough reflex
Expiratory muscles, diaphragm, larynx, bronchial SM
What is stimulated by foreign bodies in coughing
Internal branches of recurrent laryngeal nerves which are afferent limbs of cough reflex
How much air is taken in short inspiration during coughing
2.3 litres followed by immediate closure of rima glottidis to entrap air within lungs
How much pressure is formed during forceful expiration during coughing
100mmHg below the vocal folds
What can vomiting be induced by
Gastric irritation/distension
Mechanical stimulation of pharynx
Some drugs
Emotion
What are the 3 stages of vomiting
Nausea
Retching/gagging
Emesis
Where are the sensory signals that initiate vomiting
Pharynx
Oesophagus
Stomach
Upper portions of small intestines
Why does nausea occur
Makes you think you are going to vomit
Due to loss of smooth muscle tone in stomach wall
Irritation impulses from GIT
Impulses that originate in lower brain associated with motion sickness
Impulses from cerebral cortex to initiate vomiting
What is retching and gagging
Unpleasant/spasmodic and abortive respiratory movements against closed glottis
What happens during emesis
Deep breath
Raising of hyoid bone and larynx
Relaxation of gastrointestinal oesophageal cardiac sphincter
Closure of epiglottis to prevent vomitus flow into lungs
Lifting of soft palate to close posterior nares
What does the velopharyngeal mechanism do
Permits production of differentiated oral speech sounds without air escaping through nose
Which cranial nerves are used for articulator in speech
V, VII, XII
Which cranial nerves are used for the resonator of speech
X and IX
Which cranial nerve is used for the vibrator in speech
X
What does the laminate propria do in the vocal cord folds
Attaches mucosa loosely to muscle and contains vocal ligament
What does the mucosal epithelium do in the vocal cord folds
Produces fluid and mucous to trap dust and keep lining and air moist and flexible and warm
If speech is louder what happens
Higher airflow
Faster closure of folds
Greater impact and risk of damage
What is rienkes space
Fluid retention in lamina propria
What is laryngitis
The swelling of vocal folds reinkes oedema results in hoarseness and can have many causes
Curving edge of swollen folds elephant ear appearance
Where does the articulator project from
Lips and tongue
Where does the resonator project from
Mouth and throat
Where does the vibrator project from
Larynx
