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Dysphagia > Unit 1 > Flashcards

Unit 1 Flashcards

1
Q

What is dysphagia?

A

A swallowing disorder

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2
Q

What is oral intake?

A

placement of food in the mouth for nutrition or hydration

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3
Q

What is the bolus?

A

The food, liquid, or other material placed in the mouth for ingestion

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4
Q

What is aspiration?

A

Occurs when food/liquid (bolus) penetrates the airway BELOW the true vocal folds

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5
Q

What is laryngeal penetration?

A

Occurs when food/liquid penetrates the portion of the airway ABOVE the true vocal folds

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6
Q

What is a functional swallow?

A

A swallow which may be abnormal but does not result in aspiration

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7
Q

What is injestion/swallow?

A

Refers to all processes associated with bolus introduction, preparation, transfer, and transport

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8
Q

What is deglutition?

A

Refers only to acts associated with bolus transfer and transport

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9
Q

Where are the faucial arches?

A

Both sides of the uvula

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10
Q

What is the important of the faucial arches?

A

When a bolus passes the faucial arches area, it stimulates the swallow

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11
Q

What is behind the faucial arches?

A

Faucial tonsils

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12
Q

What are the 3 pharyngeal constrictors?

A

Superior, Medial, Inferior

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13
Q

What is the purpose of pharyngeal constrictors?

A

They contract from top to bottom to move the bolus downward

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14
Q

What are other names for the cricopharyngeus muscle?

A

Upper esophageal sphincter, P-E segment, pharyngeal esophageal juncture

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15
Q

What is the most inferior structure of the pharynx?

A

cricopharyngeus muscle

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16
Q

At rest, the cricopharyngeus is…

A

At a state of tonic contraction- closed

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17
Q

Why is the cricopharyngeus naturally closed?

A
  1. Prevents air from entering the esophagus during respiration
  2. prevents material from refluxing into the pharynx
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18
Q

What happens to the cricopharyngeus during swallow?

A

It opens and allows the bolus down into the esophagus

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19
Q

The space formed by the inferior pharyngeal constrictor fibers attaching to the sides of the thyroid cartilage anterior is called what?

A

The pyriform sinuses

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20
Q

Why are the pyriform sinuses important during a swallow?

A

Sometimes, in an insufficient swallow the bolus will get stuck in the pyriform sinuses and show up on the xray

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21
Q

What are the two layers of muscle of the esophagus?

A
  1. inner circular

2. outer longitudinal

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22
Q

Describe the muscle of the lower, middle, and upper third portions of the esophagus

A

Lower third- smooth
Middle third- striated and smooth
Upper third- striated

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23
Q

Where is the lower esophageal sphincter?

A

At the bottom of the esophagus

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24
Q

What is the LES also reffered to as?

A

gastroesophageal juncture

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25
Q

What is the purpose of the LES

A

After the bolus passes through it into the stomach, it closes to prevent reflux

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26
Q

What is the main purpose of the larynx?

A

A valve to prevent aspiration

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27
Q

What is the epiglottis?

A

The top most structure of the larynx- rests against the base of the tongue

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28
Q

A wedge-shaped space that is formed between the epiglottis and the tongue is called…

A

Valleculae

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29
Q

The _______________ and the __________________ are known as the pharyngeal recesses

A

Valleculae and pyriform sinuses

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30
Q

What is the opening of the larynx called?

A

Laryngeal vestibule

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31
Q

Where is the hyoid bone?

A

Suspended from the base on the tongue

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32
Q

What are the 5 stages of the swallow?

A
  1. Anticipatory
  2. Oral preparatory
  3. Oral
  4. Pharyngeal
  5. Esophageal
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33
Q

What happens during the anticipatory stage?

A

The patient makes cognitive judgments about oral intake (rate, amount per bite, temperature precautions)

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34
Q

What is the purpose of the oral preparatory stage?

A

To break down food and mix it with saliva

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35
Q

What is buccal musculature?

A

Check tension that prevents food from getting caught in the the cheeks

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36
Q

The oral prep stage is under ______________________ control.

A

Voluntary

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37
Q

Steps of the oral prep stage

A
  1. lip seal is maintained
  2. mastication occurs
  3. buccal musculature tension is maintained
  4. food is collected into a bolus
  5. bolus is held anteriorly and laterally by the tongue against the hard palate
  6. linguavelar seal
  7. airway is open
  8. larynx and pharynx are at rest
  9. Movements vary depending on amount and consistency of food
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38
Q

What is the linguavelar seal?

A

The back of the tongue is elevated and soft palate is pulled anteriorly agianst tongue to keep material in the oral cavity

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39
Q

What happens during the oral stage?

A

The tongue propels food posteriorly with a rolling or stripping action

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40
Q

What is the normal transit time for the oral stage?

A

approximately 1 second

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41
Q

When is the oral stage complete?

A

When the bolus passes the anterior faucial arches and the pharyngeal response is triggered

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42
Q

The oral stage is under _________________ control.

A

Voluntary

43
Q

What are 3 physiological reasons why the pharyngeal stage is important?

A
  1. airway protection
  2. opening of the esophagus
  3. downward propulsion of the bolus
44
Q

How does the pharyngeal stage begin?

A

Triggering of the pharyngeal response

45
Q

After the response triggers what 5 steps occur simultaneously/?

A
  1. Tongue base moves posteriorly to contact the anteriorly moving posterior pharyngeal wall
  2. Velum elevates to achieve velopharyngeal closure
  3. pharyngeal contraction begins
  4. elevation and anterior displacement with laryngeal closure occurs at 3 levels
  5. Opening of the cricopharyngeus
46
Q

What is the purpose of velopharyngeal closure

A

Prevents things from going up into the nose

47
Q

What are the 3 levels that laryngeal closure occurs?

A
  1. epiglottic folds
  2. false folds
  3. true folds
48
Q

What causes the cricopharyngeus to open?

A

Relaxation of the UES tone, elevation of the larynx, and pulsion force of the bolus

49
Q

What is the transit time of the pharyngeal stage?

A

1 second

50
Q

The pharyngeal stage is _____________ control

A

Involuntary

51
Q

What is the transit time of the esophageal stage?

A

8-20 seconds

52
Q

When does breathing resume during the swallow?

A

After the bolus is passed down the esophagus

53
Q

What is peristalsis?

A

The rhythmic contraction of muscles to move things through a tube

54
Q

What is primary peristalsis?

A

It is initiated by the pharyngeal response and laryngeal elevation occurs which opens the UES, the top of the esophagus already starts peristalsis

55
Q

What is secondary peristalsis?

A

A response to local distention (senses something is in there). It distends and stretches

56
Q

The esophageal stage is involuntary or voluntary?

A

involuntary

57
Q

What two stages are part of feeding?

A

Oral preparatory and oral

58
Q

What is deglutition?

A

It only refers to the process of moving the bolus from the oral cavity inot the esophagus

59
Q

What triggers a gag?

A

A noxious or foreign stimulus

60
Q

What is the purpose of a gag?

A

To eliminate foreign stimuli

61
Q

What is the protective reflex for the swallow?

A

The cough

62
Q

What are two reasons why the gag cannot predict presence or adequacy of swallow?

A
  1. the force of the gag is opposite of the swallow

2. normal subjects exhibit no gag reflex but have a normal and intact swallow

63
Q

Why is observing the gag useful?

A

Observing pharyngeal and palatal contraction –> detect unilateral pharyngeal weakness

64
Q

What is the curtain effect?

A

Everything is pulled to one side and can detect unilateral pharyngeal weakness

65
Q

What are 9 anatomical differences between the adult and newborn mouth and pharynx?

A
  1. Oral space of newborn is smaller
  2. lower jaw of newborn is smaller and retracted (does not line up)
  3. sucking pads are present in infants
  4. Tongue takes up more space in an infant’s oral cavity
  5. Restricted infant tongue movement
  6. newborns = nose breathers
  7. The newborn’s epiglottis and velum approximate
  8. Larynx is higher in newborns
  9. Eustatian tube is horizontal in newborns, vertical angle for adults
66
Q

What is an adaptive reflex?

A

assist in the acquisition of food and nutrition

67
Q

What is a protective reflex?

A

designed to protect the airway

68
Q

The cough is considered a __________ reflex

A

Protective

69
Q

When the corner of an infant’s mouth is stimulated, the baby turns its face towards stimulation. What reflex is this?

A

Rooting reflex

70
Q

Touch or taste stimulation is applied to the lateral border of the tongue. What is the reflex?

A

transverse (lateral) tongue reflex

71
Q

The rhythmic closing and opening of jaws in response to stimulation. What is the reflex?

A

Phasic bite reflex

72
Q

What reflex serves as a protective function in infants, preventing infants from ingesting solid food before they are ready?

A

Gag reflex

73
Q

What is the purpose of nutritive sucking?

A

obtain nourishment

74
Q

What is the purpose of non-nutritive sucking?

A

state regulation, satisfy sucking desire, exploration

75
Q

Nutritive sucking is _____ suck per second

A

1

76
Q

Non-nutritive sucking is ___ sucks per second

A

2

77
Q

Positive pressure method for obtaining food is…

A

suckling

78
Q

negative pressure method for obtaining food is…

A

sucking

79
Q

What is aspiration?

A

Action of material penetrating the larynx and entering the airway below the level of the true VF

80
Q

Once material enters the airway, what are two possible reactions?

A
  1. bolus is expectorated- cough reflex

2. silent aspiration

81
Q

Which population has a high incidence of silent aspiration?

A

neurologically impaired patients

82
Q

What are the 3 circumstances that material can be aspirated

A
  1. BEFORE
  2. DURING
  3. AFTER
83
Q

What are the 3 valves of the larynx?

A

True VF, false VF, aryepiglottic folds

84
Q

What is the lowest valve of the larynx?

A

True VF

85
Q

How is timing of aspiration measured?

A

When the aspiration occurs in relation to when the pharyngeal response occurs

86
Q

On an x-ray, what is used to visualize a pharyngeal response?

A

Elevation of the hyoid

87
Q

What 3 factors result in the opening of the cricopharyngeus?

A
  1. relaxation of the UES
  2. elevation of the larynx
  3. pulsion force of the bolus
88
Q

what is another name for residue?

A

Stasis

89
Q

What are disorders related to the oral preparatory phase?

A
  1. Reduced lip closure
  2. Reduced range of tongue motion or coordination
  3. Reduced tongue shaping and coordination
  4. Reduced labial tension or tone
  5. Reduced buccal tension or tone
  6. Tongue thrust
  7. Reduced mandibular movement
90
Q

What results from reduced lip closure?

A

food falling from the mouth anteriorly

91
Q

What results from a reduced range of tongue motion or coordination?

A

Inability to form a bolus

92
Q

What results from reduced tongue shaping and coordination?

A

Difficulty holding a bolus and risk of aspiration BEFORE the swallow

93
Q

What results from labial tension or tone?

A

materials falls into anterior sulcus

94
Q

Where is the floor of the mouth?

A

underneath the tongue

95
Q

Where is the anterior sulcus?

A

between the gums and lips

96
Q

What happens during the oral phrase?

A

The bolus is in a form that is ready to swallow and the tongue propels the bolus back to the pharynx

97
Q

What is a delayed pharyngeal swallow?

A

It occurs when the head of the bolus reaches the valleculae and the pharyngeal swallow has not been triggered.

98
Q

How is a swallow delay timed?

A

Time begins at the point where the head of the bolus passes the point where the lower edge of the mandible crosses the tongue base; time stops when pharyngeal swallow is initiated (hyoid bone elevates)

99
Q

How is an absent pharyngeal swallow defined?

A

A pharyngeal response delay of greater than 10 seconds

100
Q

During the pharyngeal stage, reduced velopharyngeal closure results in…?

A

A risk of nasal penetration during swallow

101
Q

What are cervical osteophytes?

A

Bony outgrowth form the cervical vertebrae that can be large enough to interfere w/ the swallow by narrowing the pharynx

102
Q

what is the only pharyngeal stage disorder that results in a risk of aspiration DURING the swallow?

A

Reduced laryngeal closure

103
Q

Where are the pyriform sinuses located in relation to the UES?

A

Superior to UES

Dysphagia (4 decks)

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