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Swallowing > Swallowing Test 1 > Flashcards

Swallowing Test 1 Flashcards

1
Q

dysphagia definition

A

-medical definition of swallowing disorders
- involves 4 stages (oral prep, oral, pharyngeal, and esophageal.
-can have issues with liquids, soft, or solid foods.

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2
Q

deglutition

A

the process of swallowing

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3
Q

feeding

A

limited to the placement of food in the mouth, manipulation of food in the oral cavity before the initiation of swallowing

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4
Q

swallowing

A

entire act of deglutition from the placement of food in the mouth through the oral and pharyngeal stages of the swallow until the food enters the esophagus into the cricopharyngeal juncture.

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5
Q

Is dysphagia a medical diagnosis? Why?

A

No. It is a symptom of an underlying condition such as neurological disorder, ALS, etc.

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6
Q

Signs and Symptoms of dysphagia

A

coughing, clearing throat, over swallowing, not eating as much, sounding like there is food/liquid in throat.

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7
Q

Complications of dysphagia

A

pneumonia, in elderly people can be deadly, weight loss, malnutrition, dehydration, weakness (falling)

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8
Q

Patients with dysphagia may have experienced…

A
  • Strokes. left-hemisphere aphasia –> food stuck on numb side
    -TBI
  • Parkinson’s
    -ALS
    MS
    -MG myasthenia gravis > more the muscle is used the worse it becomes; diet management.
  • Dementia
  • Head/Neck Cancer
  • Respiratory - Bronchitis, Pneumonia
  • Premature Infants
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9
Q

Who are some professionals you may work with? (13)

A
  • Physician > order for swallowing eval
  • Nurse > patient status
  • Speech Pathologists > swallow evals, determine if safe to eat
  • Physical Therapist > strengthen stability of muscles to help sit up straight to eat/drink
  • Occupational Therapist > feeding/personal skills
  • Social Worker
  • Dietician > patient gets calories and nutrients they need
  • Family > encourage family to motivate patient, puree won’t be forever
  • Neurologist > diagnosis & recommending treatments
  • Respiratory Therapist > patients on oxygen, trach, copd
  • Gastroenterologist > reflux, gerd
  • ENT > trachs/laryngectomies
  • Radiologist > modified barium swallows
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10
Q

What are some facilities you may work in? (7)

A
  • acute care hospitals > EMMC
  • acute rehab hospitals > 3 hrs therapy/day
  • NICU
  • skilled facilities > after acute rehab 1hr therpy/day
  • long term care facilities > patients that don’t get better enough to go home
  • home health > once or twice a week
  • outpatient clinics
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11
Q

What does successful aging look like? What are some things that can happen when aging?

A

Aging that is not harmful. losing strength, losing teeth, losing smell and taste, dry mouth, are all things that can negatively impact you when aging.
- Frailty/Undernutrition from losing taste & smell
- Sarcopenia > muscle mass and strength/speed are decreased with age
* early detection is important
*nutritional supplements, therapy, swallowing disorder, denture fitting

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12
Q

How long is the Oral Prep Stage?

A

2-4/1-3 seconds & it is voluntary

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13
Q

What can you sense during this phase?

A
  • temperature of food and liquid
  • flavors
  • where the bolus is formed
  • chewing/mastication takes place here
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14
Q

Primary muscles of chewing…

A
  • masseter, temporalis, pterygoid
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15
Q

Masseter

A

closes jaw

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16
Q

temporalis

A

moves jaw up, forward, and back

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17
Q

pterygoid medial

A

elevates tongue (mandible) and shifts jaw to the opposite side

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18
Q

lateral pterygoids

A

pulls jaw down or forward and moves jaw or chin to opposite side

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19
Q

both pterygoid muscles are used for…

A

grinding in mastication

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20
Q

hypoglossal nerve

A

innervates tongue via intrinsic muscles for shape, contour and function (senses size of the bolus and helps to shape tongue)

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21
Q

facial nerve

A

innervates buccinator and obicularis oris to press the lips and flatten the cheeks to move food across the teeth

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22
Q

taste receptors

A
  • located on tongue, hard, and soft palate and supralaryngeal region
    -taste activated by saliva
    -saliva activated by actions of jaw, tongue, and hyoid bone during bolus prep
  • saliva is important in oral hygiene and regulation of acids in stomach and esophagus
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23
Q

taste sensation is sent to…

A

nucleus tractus in medulla
taste often linked with smell which is stimulated in the nasal cavity by chewing.

24
Q

How is the bolus moved?

A

tongue and jaw move the bolus laterally to be manipulated, shaped, held, and transferred into the oropharynx

25
Q

How long is the oral pharyngeal stage?

A

1-3/2-4 seconds
involuntary

26
Q

Major structures in oral pharyngeal stage

A

vallecula, epiglottis, pyriform, sinus, larynx, posterior pharyngeal wall

27
Q

palatopharyngeal

A

depresses the soft palate, approximates the palate and constricts the palate
- muscles of the uvula shorten the soft palate

28
Q

hyoid bone

A

essential for posterior tongue, pharynx, and larynx
- anchors the tongue, in front of neck

29
Q

nasopharynx

A

palatoglossal and levator veli palatini elevate the soft palate and seal nasopharynx

30
Q

tensor veli palatini

A

tenses soft palate

31
Q

geniohyoid

A

raises hyoid bone up and forward, depresses the jaw

32
Q

mylohyoid

A

elevates hyoid bone and tongue and depresses the jaw

33
Q

anterior belly of digastric

A

depresses jaw or raises hyoid bone

34
Q

posterior belly of digastric

A

elevates or retracts hyoid bone

35
Q

stylohyoid

A

elevates the hyoid during the swallow

36
Q

hyoglossus and geniglossus

A

laryngeal elevators and depresses the tongue and help elevate the hyoid bone

37
Q

styloglossus

A

draws the tongue up and back during swallowing

38
Q

palatoglossus

A

raises the back of the tongue and lowers velum

39
Q

superior, middle, and inferior constrictor muscles

A

transport the bolus to the esophagus

40
Q

stylopharyngeus

A

elevates the pharynx and larynx

41
Q

salpingopharyngeus

A

draws lateral walls of pharynx up

42
Q

palatopharyngeus

A

brings velum down

43
Q

cricopharyngeal

A

single muscle acting as a sphincter relaxing at distal portion of pharynx to allow bolus to pass to esophagus

44
Q

vallecula

A

depressions at base of tongue (just above epiglottis)

45
Q

pyriform sinus

A

pear shaped depression in the lower pharynx

46
Q

Where does oral pharyngeal start and stop?

A

starts with bolus at the level of the vallecula and ends at PES

47
Q

beginning of Oral pharyngeal stage

A
  • hyoid bone moves forward and upward toward mandible
  • epiglottic cartilage descends to cover airway
  • breathing stops, true and false vocal chords close, airway is covered and bolus divides through vallecula toward PES
48
Q

middle of oral pharyngeal stage

A
  • superior, middle, and inferior constrictor muscles shorten pharynx triggering posterior pharyngeal wall peristalsis
  • hyoid forward motion aids in PES opening
  • as bolus passes through PES esophageal peristalis begins
49
Q

Esophageal Stage lasts how long?

A

8-20 seconds
involuntary

50
Q

how long is the esophagus

A

21-27 cm long tube

51
Q

PES

A

pharyngoesophageal sphincter separates pharynx from the esophagus

52
Q

LES

A

lower esophageal sphincter separates the esophagus from the stomach

53
Q

Muscle smoothness

A
  • proximal end muscles are striated
  • middle third contains combination of smooth and striated muscles
  • lower 2/3 are smooth muscles
54
Q

What happens in the esophageal stage?

A
  • cervical portion and hypopharynx allows PES to relax and distend depending on the bolus size
  • begins rapidly and slows as the bolus moves through the esophagus
  • cervical esophagus has strongest activity and begins drop in pressure in LES
55
Q

peristalsis muscles

A

primary- contraction as bolus enters esophagus
secondary - transport of the solid bolus
tertiary - random and not peristaltic or efficient > often seen in older adults or those with GERD.

56
Q

neural controls

A

pharyngeal swallow - stimulation of receptors on faucial pillars, tonsils, soft palate, base of tongue, posterior pharyngeal wall, and anterior surface of epiglottis
nucleus tractus - sensory portion of swallowing center
nucleus ambigus - motor portion of swallowing center

57
Q

cranial nerves & swallowing

A

-facial nerve 7- bolus containment, bolus control, oral bolus propulsion
-hypoglossal nerve 12 - bolus control, mastication, hyolaryngeal elevation
-trigeminal nerve 5 - mastication, oral bolus propulsion
-vagus nerve 10 - oral bolus propulsion, velopharyngeal closure, laryngeal protection, pharyngeal elevation and constriction
-glossopharyngeal nerve 9 - velopharyngeal closure, pharyngeal elevation and constriction

Swallowing (1 decks)

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