The Phrynx And Esophagus Flashcards
1
Q
___ is a region that shares the space for respiration, swallowing, and phonation.
A
Pharynx
2
Q
Where is the nasopharynx located?
A
Behind the nasal cavity above the soft palate (velum)
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.
4
Q
What part of the pharynx is continuous with the nasal passages anteriorly?
A
Nasopharynx
5
Q
Where is the oropharynx located?
A
It extends from the soft palate to the epiglottis
6
Q
What is the anterior border of the oropharynx?
A
The posterior 1/3 of the tongue
7
Q
What part of the pharynx is continuous with the oral region?
A
The oropharynx
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
9
Q
____ opens anteriorly into the oropharynx cavities and continuous inferiorly into the larynx and the esophagus.
A
The laryngopharynx
10
Q
The pharynx is opposed posteriorly by the ______.
A
Prevertebral fascia of the somatic neck.
11
Q
What forms the posterior limit of the pharynx?
A
The 3 constrictor muscles
12
Q
The superior constrictor muscle is apposed by what?
A
The Buccinator muscle
13
Q
Where is the superior constrictor apposed by the Buccinator?
A
At the pterygo-mandibular Raphae
14
Q
Where does the middle constrictor insert on?
A
The hyoid bone
15
Q
Where does the inferior constrictor insert on?
A
The thyroid cartilage
16
Q
What constrictor muscle is continuous with the esophagus?
A
The inferior
17
Q
What is the posterior region of the constrictor muscles associated with?
A
- Thyroid gland
- The sympathetic chain and superior cervical ganglion
- The vagus and the glossopharyngeal nerve
18
Q
Where does the naso-pharynx being?
A
At the nasal choanae
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
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
21
Q
The ___ is an elevation of the cartilaginous wall of the tube at the nasal mucosa.
A
Torus tubarius
22
Q
What equalizes pressure between the middle ear and the atmosphere?
A
The Eustachian tube
23
Q
______ is trauma to the tympanic membrane due to excess pressure. E.g. During scuba diving
A
Barotitus
24
Q
What drains mucous from the middle ear to prevent infections?
A
Eustachian tube
25
The Eustachian tube opens upon swallowing or yawning by contraction of what muscles?
The tensor veli palatini and the levator veli palatini muscle
26
What tonsil is located posterior to the opening of the Eustachian tube?
Tubal tonsil
27
Infection in the naso-pharynx can track up along the Eustachian tube to produce?
Otis media
28
What can happen with hypertrophy or edema of the tubal tonsil?
They may occlude the auditory tube with an accumulation of secretions
29
What is the action of the salpingopharyngeus muscle?
Raises the pharynx during swallowing
30
What is the origination and insertion of the salpingophrangeus muscle?
O: from the end of the auditory tube and inserts into the pharyngeal muscles
31
What innervates the salpingopharyngeus muscle?
Vagus
32
What overlies the salpingopharyngeus muscle?
salpingopharyngeus fold
33
What is located In the roof of the nasopharynx just inferior to the sphenoid sinus and anterior to the basi-occiput.
The adenoids (pharyngeal tonsils)
34
An ___ can contribute to sleep apnea, which is a problem when breathing stops for 20 seconds or larger
Enlarged adenoid
35
Hypertrophy of the adenoids can interfere with?
Nasal respiration, alter phonation and cause ongoing middle ear infection (especially in kids)
36
The ____ are present at birth, enlarge until 5-7 years,and then diminish in the teen age years
Adenoids
37
Tumors of the adenoids can invade what space?
Nasopharyngeal space
38
The ___ muscle descends vertically from the auditory tube, lateral to the opening, to reach the hamulus of the pterygoid bone.
Tensor veli palatini
39
Where does the tendon of the tensor veli palatini insert after turning medically over the hamulus of the pterygoid bone?
The velum (soft palate)
40
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.
Levator veli palatini
41
The ___ is a thick, rounded muscle situated lateral to the choannae
Levator veli palatini
42
What two muscles form the velo-pharyngeal seal during swallowing?
The tensor veli palatini
The levator veli palatini
Note: they also opten the Eustachian tube
43
The ___ narrows at the level at which the velum establishes the velo-pharyngeal seal.
Pharynx
44
What is the motor innervation to the muscles that raise velum?
Tensor- V3
Levator- nucleus ambiguas (pharyngeal branch of X)
45
What supplies sensory to the velum?
IX
46
What is the posterior border of the oropharynx?
The middle constrictor
47
What are the two muscles that make up the retropharyngeal isthmus? (Fauces)
Palatoglossus
Palatopharyngeous muscles
48
What covers the palatoglossus muscle?
The palatoglossal (mucosal) fold
49
What is the origin and insertion of the palatoglossus muscle?
O: palate
I: tongue
50
What is the action of the palatoglossus muscle?
To raises the palatoglossal arches anteriorly on the lateral wall of the oro-pharynx
51
What is the origin and insertion of the palatopharyngeous muscles?
O: laterally from the palate
I: pharyngeal musculature
52
What covers the palatopharyngeous muscle?
The palatopharyngeal fold
53
What muscles act as a sphincter, along with the base of the tongue, between the oral cavity and the pharynx?
Palatoglossus and palatopharyngeous
54
The Palatoglossus and palatopharyngeous are innervated by?
The vagus nerve via the pharyngeal plexus
55
A triangular __ lies between the diverging fauces on each side.
Tonsillar fossa
56
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 _____?
Palatine tonsil
57
When are these structures in danger of being injured: the superior pharyngeal constrictor, the pterygomandibular raphe, the middle pharyngeal constrictor, and the *glossopharyngeal nerve*
During tonsillectomy
58
What supplies blood the the palatine tonsils?
```
Lesser palatine branch (maxillary)
Ascending palatine branch (facial)
Dorsal lingual branch (lingual)
Ascending pharyngeal
Facial artery proper
```
59
What is the principle vein of the palatine tonsil?
The lingual vein
60
Severe bleeding of the palatine tonsils can occur via the connections to the ?
External palatine vein
61
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
Tonsils
62
The ____ tonsil, which lies in the posterior 1/3 of the tongue, can become enlarged due to infection, acid reflux, cysts, and cancer.
Lingual
63
What can lingual tonsil enlargement cause?
Sensitized gag reflex and dysphagia (difficulty swallowing )
64
What is Waldeyer's ring?
The rings of tonsils that protect the oro-nasal region from infection
65
What is the posterior border of the laryngo-pharynx?
The middle and inferior constrictors at the level of the C4-C6 vertebrae
66
What marks the upper surface of the larynx and guards the opening into the air passage?
The epiglottis
67
A median ____ extends from the base of the tongue to the epiglottis with a vallecular recess on each side.
Glosso-epiglottic fold
68
What recess extends inferior to the lateral glossoepiglottic folds on either side of the larynx?
Piriform recesses
69
Where do most hypopharyngeal cancers develop?
60-85% in the piriform recess
Note: 65 year old mean who smoke and drink (MC)
Symptoms: hoarseness and dysphagia
70
What is the MC type of carcinoma in the piriform recess?
Squamous cell carcinoma
71
Where does the superior constrictor attach anteriorly?
The pterygomandibular raphe that it shares with the Buccinator
72
Where does the superior constrictor attach posteriorly?
To the pharyngeal tubercle of the basi-occipital bone and the posterior pharyngeal raphae
73
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
Superior constrictor
74
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?
The middle constrictor
75
What passes through the gap formed from the superior and middle constrictor?
Stylopharyngeous muscle
The pharyngeal branch of the glossopharyngeal nerve
The lingual nerve and artery
76
The __ is fan shaped superiorly but tubular inferiorly
Inferior constrictor
77
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.
Inferior constrictor
78
What is the cricoid portion of the inferior constrictor called?
Cricopharyngeus
79
What is the function of the cricopharyngeus?
A sphincter at the superior end of the esophagus
80
Failure of the ______ to relax during sealing can cause the mucosa to herniate through the inferior constrictors forming a diverticulum.
Cricopharyngeus
81
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.
The “danger area” and retropharyngeal space
82
What muscle originates from the styloid process and passes through the hiatus between the superior and middle constrictors to interdigitate with the pharyngeal
musculature.
Styopharyngeus
83
What is the action of the stylopharyngeus?
raises the pharynx during swallowing and is the only muscle innervated by the glossopharyngeal nerve.
84
What is the stylopharyngeus muscle innervated by?
Glossopharyngeal nerve
85
Axons from the neurons whose cells bodies are in the _____ convert visceral afferent information that is not perceived.
Inferior (petrosal) ganglion
86
Visceral afferent from the pharynx and velum goes to the?
Inferior (petrosal) ganglion (1st order)
87
Visceral afferent information from the carotid sinus and carotid body at the bifurcation go to the?
Inferior petrosal ganglion (1st order)
88
Visceral afferent information from the inferior (petrosal) ganglion that is not perceived goes to?
The solitary nucleus
89
Where are the 1st order neurons for pin and touch from the pharynx and velum?
The jugular ganglion
90
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?
Spinal for pain
Pontine for touch
91
Sensation from inner ear is conveyed to the spinal and pontine nucleus via?
The tympanic plexus
92
Carotid reflexes come from the ?
Carotid body (O2-CO2 levels) and the sinus (baroreception)
93
Afferent via CN IX. Elicited by touching the velum or pharynx. Efferent via CN X.]
What reflex?
GAG reflex
94
What are the results of the GAG reflex?
Elevation of palate and gagging
95
Pain tickling etc. from the ear is sometimes attributed to the _____.
Throat, and viscera
96
Are the oral, pharyngeal and esophageal phases of deglutition voluntary/involuntary?
Oral is voluntary
Other 2 are involuntary
97
The ____ ms contracts to center the bolus of food
Buccinator
98
What two muscles raise tongue to the roof of the mouth?
Elevation of the hyoid bone by the digastric DNA mylohyoid
99
The ____ muscle elevates the base of the tongue to squeeze the food through the fauces into the pharynx
Palatoglossus
100
What two muscles close the oro-pharyngeal isthmus behind the bolus?
The palatoglossus and palatopharyngeus muscle
101
The soft palate is elevated by the action of the levator veli palatini and tensor veli palatini muscle to form the?
Velo-pharyngeal seal
102
What muscles reinforce the velo-pharyngeal seal by drawing the upper portions of the pharynx upwards over the bonus?
Superior constrictor
Palatopharyngeus
Salpingopharyngeus
103
The larynx raises to close itself against the epiglotis and the arytenoid cartilages are addicted closing off the larynx in what phase?
Pharyngeal phase
104
The inferior constrictor and cricopharyngeus squeeze the bonus into the esophagus in what phase?
Esophageal phase.
105
What action moves the bolus to the stomach?
Peristalsis
106
Swallowing requires exquisite coordination among ___ cranial nerves, the cervical plexus and more than 12 muscles
5
107
What are the functions of the esophagus?
To propel food to the stomach
To keep stomach contents out of esophagus and larynx
108
What is the most muscular part of the digestive tract
The esophagus
109
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 ______.
Esophagus
110
What enters the abdominal cavity on an oblique angle through the esophageal hiatus of the diaphragm at T10, turns left, and joins the stomach?
The esophagus
111
What muscles forms the upper sphincter of the esophagus?
Cricopharyngeus muscle
112
_____ forms a C-shaped muscular band that produces maximum tension in the anteroposterior direction
Upper sphincter of the esophagus (cricopharyngeus muscle)
113
What is the narrowest part of the esophagus?
The upper sphincter
114
Where does the lower esophageal sphincter (LES) lie?
At the entrance of the abdomen
115
What are the two constrictions besides the UES and LES in the esophagus?
Arch of the aorta
| Impression of the left main bronchus
116
Where are weak spots in the esophagus? (Zenkers diverticulum)
Where the inferior constrictor meets the cricopharyngeus muscle
117
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?
Zenker's diverticulum
118
What is the main symptom of Zenker's diverticulum? MC affected?
Dysphagia (difficulty swallowing)
2-3x men and those >60
119
What are the two muscle layers of the abdomen?
Longitudinal and circular
120
Food reaches the cardiac sphincter in _____ seconds.
5-6
121
The inherent rhythm of peristalsis is regulated by the _______ system and this occurs in the absence of extrinsic innervation.
Enteric
122
The gut provides afferent information to the ____ nucleus, but other than nausea, most does not reach consciousness
Solitary
123
The ___ of peristalsis is regulated by parasympathetic and sympathetic inputs to the gut.
Rate
124
The vagas parasympathetic preganglionic cell bodies reside in the?
Dorsal motor nucleus
125
Stimulation by the vagus ___ the rate of peristalsis
Increases
126
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.
Anterior
Posterior
127
Where does the vagus nerve pierce through the abdomen.
Esophageal hiatus of the diaphragm
128
Sympathetic activation __ the rate of peristalsis and contraction of the sphincter
Reduces
Note: Para = rest and digest
Symp = flight or flight
129
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?
Emesis (vomiting)
130
What sphincter is normal closed, but opens to allow the bolus to enter the stomach?
The lower (cardiac) sphincter
131
Acid reflux, esophagitis, and gastro-esophageal disease (GERD) are results of?
Frequent transcend LES relaxations
132
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.
Those affected with GERD
133
A complication of GERD is _____?
Barret's esophagus
134
Fluoroscopy shows a space filled with gas or liquid in lower esophagus; barium meal confirms this.
What disease is this?
GERD
135
____ can predispose to esopheal ulcers, dysphagia, and adenocarcinoma.
GERD
136
Persistent GERD can lead to changes in the esopheal lining known as?
Barret's esophagus
137
Barrett's esophagus occurs more often in what sex?
Males
138
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.
Dysplasia
139
In what disease does the cardiac sphincter open too infrequently (1*) or is paralyzed (2*)?
Achalasia
140
____ aphasia is idiopathic with a possible involvement of autoimmunity.
Primary
141
______ achasia is related Chagas' disease, which is caused by damage to the myenteric plexus by Trypanomsoma cruzi.
Secondary
142
Where do the veins from the mucosa of the esophagus drain into?
The azygous and hemiazygous
143
How are esophageal varices formed?
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
Who has a high incident of esophageal varices and a high rate of mortality if they are ruptured?
Alcoholics
145
What is Mallory-Weiss syndrome?
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
Mallory-Weiss syndrome tears are limited to?
The mucosal layer
147
What do the treatments of Mallory-Weiss syndrome include?
Treatment includes vasoconstrictors, transfusion, and balloon
tamponade.
148
When a tear is through the entire esophageal wall in Mallory-Weiss syndrome, what's it called?
Boerhaave's syndrome
149
What is BoerHaave's syndrome cause by?
the sudden rupture of the esophagus allows the entry of air into the peritoneal (Pneumoperitoneum) or pericardial cavities (Pneumopericardium)
150
What are the symptoms of someone with Boerhaave's syndrome?
```
excruciating retrosternal chest pain and progressive
progressive dyspnea (shortness of breath), tachypnea (rapid breathing), shock and cyanosis
```
151
In What sex is Boerhaave's syndrome more common?
5x MC in men
Note: usually 50-70s yrs old with poor prognosis
