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Anatomy > The Phrynx And Esophagus > Flashcards

The Phrynx And Esophagus Flashcards

1
Q

___ is a region that shares the space for respiration, swallowing, and phonation.

A

Pharynx

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2
Q

Where is the nasopharynx located?

A

Behind the nasal cavity above the soft palate (velum)

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3
Q

____ of the naso-pharynx are related to the basilar occipital bone and the arch of the atlas.

A

The posterior and superior aspect.

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4
Q

What part of the pharynx is continuous with the nasal passages anteriorly?

A

Nasopharynx

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5
Q

Where is the oropharynx located?

A

It extends from the soft palate to the epiglottis

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6
Q

What is the anterior border of the oropharynx?

A

The posterior 1/3 of the tongue

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7
Q

What part of the pharynx is continuous with the oral region?

A

The oropharynx

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8
Q

Where is the lanryngo(hypo)pharynx?

A

Lies posterior to the larynx

Extends from the epiglottis to the lower border of the cricoid cartilage

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9
Q

____ opens anteriorly into the oropharynx cavities and continuous inferiorly into the larynx and the esophagus.

A

The laryngopharynx

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10
Q

The pharynx is opposed posteriorly by the ______.

A

Prevertebral fascia of the somatic neck.

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11
Q

What forms the posterior limit of the pharynx?

A

The 3 constrictor muscles

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12
Q

The superior constrictor muscle is apposed by what?

A

The Buccinator muscle

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13
Q

Where is the superior constrictor apposed by the Buccinator?

A

At the pterygo-mandibular Raphae

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14
Q

Where does the middle constrictor insert on?

A

The hyoid bone

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15
Q

Where does the inferior constrictor insert on?

A

The thyroid cartilage

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16
Q

What constrictor muscle is continuous with the esophagus?

A

The inferior

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17
Q

What is the posterior region of the constrictor muscles associated with?

A
  1. Thyroid gland
  2. The sympathetic chain and superior cervical ganglion
  3. The vagus and the glossopharyngeal nerve
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18
Q

Where does the naso-pharynx being?

A

At the nasal choanae

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19
Q

_________ opens to the lateral wall of the naso-pharynx at the level of the middle meatus of the nasal cavity and terminates at the anterior wall of the middle ear.

A

Pharyngo-tympanic (eustachion) tube

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20
Q

What part of the eustachian tube s made of bone? ( the rest is made of cartilage)

A

The ~1/3 proximal to the middle ear

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21
Q

The ___ is an elevation of the cartilaginous wall of the tube at the nasal mucosa.

A

Torus tubarius

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22
Q

What equalizes pressure between the middle ear and the atmosphere?

A

The Eustachian tube

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23
Q

______ is trauma to the tympanic membrane due to excess pressure. E.g. During scuba diving

A

Barotitus

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24
Q

What drains mucous from the middle ear to prevent infections?

A

Eustachian tube

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25
Q

The Eustachian tube opens upon swallowing or yawning by contraction of what muscles?

A

The tensor veli palatini and the levator veli palatini muscle

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26
Q

What tonsil is located posterior to the opening of the Eustachian tube?

A

Tubal tonsil

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27
Q

Infection in the naso-pharynx can track up along the Eustachian tube to produce?

A

Otis media

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28
Q

What can happen with hypertrophy or edema of the tubal tonsil?

A

They may occlude the auditory tube with an accumulation of secretions

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29
Q

What is the action of the salpingopharyngeus muscle?

A

Raises the pharynx during swallowing

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30
Q

What is the origination and insertion of the salpingophrangeus muscle?

A

O: from the end of the auditory tube and inserts into the pharyngeal muscles

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31
Q

What innervates the salpingopharyngeus muscle?

A

Vagus

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32
Q

What overlies the salpingopharyngeus muscle?

A

salpingopharyngeus fold

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33
Q

What is located In the roof of the nasopharynx just inferior to the sphenoid sinus and anterior to the basi-occiput.

A

The adenoids (pharyngeal tonsils)

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34
Q

An ___ can contribute to sleep apnea, which is a problem when breathing stops for 20 seconds or larger

A

Enlarged adenoid

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35
Q

Hypertrophy of the adenoids can interfere with?

A

Nasal respiration, alter phonation and cause ongoing middle ear infection (especially in kids)

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36
Q

The ____ are present at birth, enlarge until 5-7 years,and then diminish in the teen age years

A

Adenoids

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37
Q

Tumors of the adenoids can invade what space?

A

Nasopharyngeal space

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38
Q

The ___ muscle descends vertically from the auditory tube, lateral to the opening, to reach the hamulus of the pterygoid bone.

A

Tensor veli palatini

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39
Q

Where does the tendon of the tensor veli palatini insert after turning medically over the hamulus of the pterygoid bone?

A

The velum (soft palate)

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40
Q

The __ arises from the under surface of the apex of the petrous part of the temporal bone and from the medial lamina of the cartilage of the auditory tube.

A

Levator veli palatini

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41
Q

The ___ is a thick, rounded muscle situated lateral to the choannae

A

Levator veli palatini

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42
Q

What two muscles form the velo-pharyngeal seal during swallowing?

A

The tensor veli palatini

The levator veli palatini

Note: they also opten the Eustachian tube

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43
Q

The ___ narrows at the level at which the velum establishes the velo-pharyngeal seal.

A

Pharynx

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44
Q

What is the motor innervation to the muscles that raise velum?

A

Tensor- V3

Levator- nucleus ambiguas (pharyngeal branch of X)

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45
Q

What supplies sensory to the velum?

A

IX

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46
Q

What is the posterior border of the oropharynx?

A

The middle constrictor

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47
Q

What are the two muscles that make up the retropharyngeal isthmus? (Fauces)

A

Palatoglossus

Palatopharyngeous muscles

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48
Q

What covers the palatoglossus muscle?

A

The palatoglossal (mucosal) fold

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49
Q

What is the origin and insertion of the palatoglossus muscle?

A

O: palate
I: tongue

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50
Q

What is the action of the palatoglossus muscle?

A

To raises the palatoglossal arches anteriorly on the lateral wall of the oro-pharynx

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51
Q

What is the origin and insertion of the palatopharyngeous muscles?

A

O: laterally from the palate

I: pharyngeal musculature

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52
Q

What covers the palatopharyngeous muscle?

A

The palatopharyngeal fold

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53
Q

What muscles act as a sphincter, along with the base of the tongue, between the oral cavity and the pharynx?

A

Palatoglossus and palatopharyngeous

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54
Q

The Palatoglossus and palatopharyngeous are innervated by?

A

The vagus nerve via the pharyngeal plexus

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55
Q

A triangular __ lies between the diverging fauces on each side.

A

Tonsillar fossa

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56
Q

The tonsilar fossa extends from the base of the tongue to the edge of the soft palate and contains a mass of lymphoid tissue, called the _____?

A

Palatine tonsil

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57
Q

When are these structures in danger of being injured: the superior pharyngeal constrictor, the pterygomandibular raphe, the middle pharyngeal constrictor, and the glossopharyngeal nerve

A

During tonsillectomy

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58
Q

What supplies blood the the palatine tonsils?

A 
Lesser palatine branch (maxillary)
Ascending palatine branch (facial)
Dorsal lingual branch (lingual)
Ascending pharyngeal
Facial artery proper
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59
Q

What is the principle vein of the palatine tonsil?

A

The lingual vein

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60
Q

Severe bleeding of the palatine tonsils can occur via the connections to the ?

A

External palatine vein

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61
Q

By generating antibodies, the ___ provide protection from a variety of viruses and bacteria. Removal of the tonsils was once done routinely in children until it as determined that the removal diminished the ability to fight infections

62
Q

The ____ tonsil, which lies in the posterior 1/3 of the tongue, can become enlarged due to infection, acid reflux, cysts, and cancer.

63
Q

What can lingual tonsil enlargement cause?

A

Sensitized gag reflex and dysphagia (difficulty swallowing )

64
Q

What is Waldeyer’s ring?

A

The rings of tonsils that protect the oro-nasal region from infection

65
Q

What is the posterior border of the laryngo-pharynx?

A

The middle and inferior constrictors at the level of the C4-C6 vertebrae

66
Q

What marks the upper surface of the larynx and guards the opening into the air passage?

A

The epiglottis

67
Q

A median ____ extends from the base of the tongue to the epiglottis with a vallecular recess on each side.

A

Glosso-epiglottic fold

68
Q

What recess extends inferior to the lateral glossoepiglottic folds on either side of the larynx?

A

Piriform recesses

69
Q

Where do most hypopharyngeal cancers develop?

A

60-85% in the piriform recess

Note: 65 year old mean who smoke and drink (MC)
Symptoms: hoarseness and dysphagia

70
Q

What is the MC type of carcinoma in the piriform recess?

A

Squamous cell carcinoma

71
Q

Where does the superior constrictor attach anteriorly?

A

The pterygomandibular raphe that it shares with the Buccinator

72
Q

Where does the superior constrictor attach posteriorly?

A

To the pharyngeal tubercle of the basi-occipital bone and the posterior pharyngeal raphae

73
Q

The lateral superior edge of the ____ is free and does not meet the cranium. The auditory tube passes through this hiatus to open into the naso-pharynx

A

Superior constrictor

74
Q

Anteriorly it arises from the styloid ligament and the greater
and lesser horns of the hyoid bone. Its fibers pass posteriorly, external to those of the superior constrictor to insert into the pharyngeal raphae. What muscle is it?

A

The middle constrictor

75
Q

What passes through the gap formed from the superior and middle constrictor?

A

Stylopharyngeous muscle

The pharyngeal branch of the glossopharyngeal nerve

The lingual nerve and artery

76
Q

The __ is fan shaped superiorly but tubular inferiorly

A

Inferior constrictor

77
Q

What muscles arises from the oblique line on the lamina of the thyroid cartilage and
from the circoid cartilage. The fibers pass posteriorly, external to the middle constrictor to insert into the pharyngeal raphe.

A

Inferior constrictor

78
Q

What is the cricoid portion of the inferior constrictor called?

A

Cricopharyngeus

79
Q

What is the function of the cricopharyngeus?

A

A sphincter at the superior end of the esophagus

80
Q

Failure of the ______ to relax during sealing can cause the mucosa to herniate through the inferior constrictors forming a diverticulum.

A

Cricopharyngeus

81
Q

The ______________ are potential spaces defined by fascial layers behind the constrictors. There is some evidence that infections of the teeth, gums, etc. can spread down these spaces to the mediastinum.

A

The “danger area” and retropharyngeal space

82
Q

What muscle originates from the styloid process and passes through the hiatus between the superior and middle constrictors to interdigitate with the pharyngeal
musculature.

A

Styopharyngeus

83
Q

What is the action of the stylopharyngeus?

A

raises the pharynx during swallowing and is the only muscle innervated by the glossopharyngeal nerve.

84
Q

What is the stylopharyngeus muscle innervated by?

A

Glossopharyngeal nerve

85
Q

Axons from the neurons whose cells bodies are in the _____ convert visceral afferent information that is not perceived.

A

Inferior (petrosal) ganglion

86
Q

Visceral afferent from the pharynx and velum goes to the?

A

Inferior (petrosal) ganglion (1st order)

87
Q

Visceral afferent information from the carotid sinus and carotid body at the bifurcation go to the?

A

Inferior petrosal ganglion (1st order)

88
Q

Visceral afferent information from the inferior (petrosal) ganglion that is not perceived goes to?

A

The solitary nucleus

89
Q

Where are the 1st order neurons for pin and touch from the pharynx and velum?

A

The jugular ganglion

90
Q

These 2 nuclei receive all pain and touch signals from the entire orofacial region, even those regions that are innervated by nerves that are not part of the trigeminal system. What two ganglion are they?

A

Spinal for pain

Pontine for touch

91
Q

Sensation from inner ear is conveyed to the spinal and pontine nucleus via?

A

The tympanic plexus

92
Q

Carotid reflexes come from the ?

A

Carotid body (O2-CO2 levels) and the sinus (baroreception)

93
Q

Afferent via CN IX. Elicited by touching the velum or pharynx. Efferent via CN X.]

What reflex?

A

GAG reflex

94
Q

What are the results of the GAG reflex?

A

Elevation of palate and gagging

95
Q

Pain tickling etc. from the ear is sometimes attributed to the _____.

A

Throat, and viscera

96
Q

Are the oral, pharyngeal and esophageal phases of deglutition voluntary/involuntary?

A

Oral is voluntary

Other 2 are involuntary

97
Q

The ____ ms contracts to center the bolus of food

A

Buccinator

98
Q

What two muscles raise tongue to the roof of the mouth?

A

Elevation of the hyoid bone by the digastric DNA mylohyoid

99
Q

The ____ muscle elevates the base of the tongue to squeeze the food through the fauces into the pharynx

A

Palatoglossus

100
Q

What two muscles close the oro-pharyngeal isthmus behind the bolus?

A

The palatoglossus and palatopharyngeus muscle

101
Q

The soft palate is elevated by the action of the levator veli palatini and tensor veli palatini muscle to form the?

A

Velo-pharyngeal seal

102
Q

What muscles reinforce the velo-pharyngeal seal by drawing the upper portions of the pharynx upwards over the bonus?

A

Superior constrictor

Palatopharyngeus

Salpingopharyngeus

103
Q

The larynx raises to close itself against the epiglotis and the arytenoid cartilages are addicted closing off the larynx in what phase?

A

Pharyngeal phase

104
Q

The inferior constrictor and cricopharyngeus squeeze the bonus into the esophagus in what phase?

A

Esophageal phase.

105
Q

What action moves the bolus to the stomach?

A

Peristalsis

106
Q

Swallowing requires exquisite coordination among ___ cranial nerves, the cervical plexus and more than 12 muscles

107
Q

What are the functions of the esophagus?

A

To propel food to the stomach

To keep stomach contents out of esophagus and larynx

108
Q

What is the most muscular part of the digestive tract

A

The esophagus

109
Q

In the thoracic region, _____ is juxtaposed to the heart and the right atrium can be visualized via a trans-esophageal echocardiogram obtained from a transducer lowered into the ______.

110
Q

What enters the abdominal cavity on an oblique angle through the esophageal hiatus of the diaphragm at T10, turns left, and joins the stomach?

A

The esophagus

111
Q

What muscles forms the upper sphincter of the esophagus?

A

Cricopharyngeus muscle

112
Q

_____ forms a C-shaped muscular band that produces maximum tension in the anteroposterior direction

A

Upper sphincter of the esophagus (cricopharyngeus muscle)

113
Q

What is the narrowest part of the esophagus?

A

The upper sphincter

114
Q

Where does the lower esophageal sphincter (LES) lie?

A

At the entrance of the abdomen

115
Q

What are the two constrictions besides the UES and LES in the esophagus?

A

Arch of the aorta

Impression of the left main bronchus

116
Q

Where are weak spots in the esophagus? (Zenkers diverticulum)

A

Where the inferior constrictor meets the cricopharyngeus muscle

117
Q

Herniation through the point of least resistance ( the killian-laimer triangle) results in an outpouring of the posterior pharyngeal wall just above the cricopharyngeal muscle resulting in?

A

Zenker’s diverticulum

118
Q

What is the main symptom of Zenker’s diverticulum? MC affected?

A

Dysphagia (difficulty swallowing)

2-3x men and those >60

119
Q

What are the two muscle layers of the abdomen?

A

Longitudinal and circular

120
Q

Food reaches the cardiac sphincter in _____ seconds.

121
Q

The inherent rhythm of peristalsis is regulated by the _______ system and this occurs in the absence of extrinsic innervation.

122
Q

The gut provides afferent information to the ____ nucleus, but other than nausea, most does not reach consciousness

123
Q

The ___ of peristalsis is regulated by parasympathetic and sympathetic inputs to the gut.

124
Q

The vagas parasympathetic preganglionic cell bodies reside in the?

A

Dorsal motor nucleus

125
Q

Stimulation by the vagus ___ the rate of peristalsis

126
Q

Due to rotation of the gut the left vagus courses on the ____ surface of the esophagus where it branches extensively to form an esophageal plexus. The right vagus nerve forms a corresponding plexus on the ____ surface.

A

Anterior

Posterior

127
Q

Where does the vagus nerve pierce through the abdomen.

A

Esophageal hiatus of the diaphragm

128
Q

Sympathetic activation __ the rate of peristalsis and contraction of the sphincter

A

Reduces

Note: Para = rest and digest
Symp = flight or flight

129
Q

Inputs from the vagal and enteric nervous system also transmit information regarding the state of the gastrointestinal system to the brain, including the region that triggers?

A

Emesis (vomiting)

130
Q

What sphincter is normal closed, but opens to allow the bolus to enter the stomach?

A

The lower (cardiac) sphincter

131
Q

Acid reflux, esophagitis, and gastro-esophageal disease (GERD) are results of?

A

Frequent transcend LES relaxations

132
Q

heartburn, chest pain that worsens when patient stoops
down, belching after heavy meals and occasionally inability to swallow can be seen in what patients?

Age > 40 years.

A

Those affected with GERD

133
Q

A complication of GERD is _____?

A

Barret’s esophagus

134
Q

Fluoroscopy shows a space filled with gas or liquid in lower esophagus; barium meal confirms this.

What disease is this?

135
Q

____ can predispose to esopheal ulcers, dysphagia, and adenocarcinoma.

136
Q

Persistent GERD can lead to changes in the esopheal lining known as?

A

Barret’s esophagus

137
Q

Barrett’s esophagus occurs more often in what sex?

138
Q

Patients with Barrett’s esophagus may develop more changes in the esophagus called _____. When _____ is present, the risk of getting cancer of the esophagus increases.

139
Q

In what disease does the cardiac sphincter open too infrequently (1) or is paralyzed (2)?

140
Q

____ aphasia is idiopathic with a possible involvement of autoimmunity.

141
Q

______ achasia is related Chagas’ disease, which is caused by damage to the myenteric plexus by Trypanomsoma cruzi.

142
Q

Where do the veins from the mucosa of the esophagus drain into?

A

The azygous and hemiazygous

143
Q

How are esophageal varices formed?

A

the veins of the lower esophagus anastomose with the branches of the left gastric vein of the stomach. These can form a shunt in the event of portal hypertensions and result in swelling of the esophageal veins that can extend into the lumen of the esophagus as esophageal varices.

144
Q

Who has a high incident of esophageal varices and a high rate of mortality if they are ruptured?

A

Alcoholics

145
Q

What is Mallory-Weiss syndrome?

A

Longitudinal tear at esophago-gastric junction caused by retching or vomiting and is present in a high proportion of hiatal hernias and in severe cases of
morning sickness in pregnancy

146
Q

Mallory-Weiss syndrome tears are limited to?

A

The mucosal layer

147
Q

What do the treatments of Mallory-Weiss syndrome include?

A

Treatment includes vasoconstrictors, transfusion, and balloon
tamponade.

148
Q

When a tear is through the entire esophageal wall in Mallory-Weiss syndrome, what’s it called?

A

Boerhaave’s syndrome

149
Q

What is BoerHaave’s syndrome cause by?

A

the sudden rupture of the esophagus allows the entry of air into the peritoneal (Pneumoperitoneum) or pericardial cavities (Pneumopericardium)

150
Q

What are the symptoms of someone with Boerhaave’s syndrome?

A 
excruciating retrosternal chest pain and progressive
progressive dyspnea (shortness of breath), tachypnea (rapid breathing), shock  and cyanosis
151
Q

In What sex is Boerhaave’s syndrome more common?

A

5x MC in men

Note: usually 50-70s yrs old with poor prognosis

Anatomy (23 decks)

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