Unit 1 Flashcards
1
Q
What is dysphagia?
A
A swallowing disorder
2
Q
What is oral intake?
A
placement of food in the mouth for nutrition or hydration
3
Q
What is the bolus?
A
The food, liquid, or other material placed in the mouth for ingestion
4
Q
What is aspiration?
A
Occurs when food/liquid (bolus) penetrates the airway BELOW the true vocal folds
5
Q
What is laryngeal penetration?
A
Occurs when food/liquid penetrates the portion of the airway ABOVE the true vocal folds
6
Q
What is a functional swallow?
A
A swallow which may be abnormal but does not result in aspiration
7
Q
What is injestion/swallow?
A
Refers to all processes associated with bolus introduction, preparation, transfer, and transport
8
Q
What is deglutition?
A
Refers only to acts associated with bolus transfer and transport
9
Q
Where are the faucial arches?
A
Both sides of the uvula
10
Q
What is the important of the faucial arches?
A
When a bolus passes the faucial arches area, it stimulates the swallow
11
Q
What is behind the faucial arches?
A
Faucial tonsils
12
Q
What are the 3 pharyngeal constrictors?
A
Superior, Medial, Inferior
13
Q
What is the purpose of pharyngeal constrictors?
A
They contract from top to bottom to move the bolus downward
14
Q
What are other names for the cricopharyngeus muscle?
A
Upper esophageal sphincter, P-E segment, pharyngeal esophageal juncture
15
Q
What is the most inferior structure of the pharynx?
A
cricopharyngeus muscle
16
Q
At rest, the cricopharyngeus is…
A
At a state of tonic contraction- closed
17
Q
Why is the cricopharyngeus naturally closed?
A
- Prevents air from entering the esophagus during respiration
- prevents material from refluxing into the pharynx
18
Q
What happens to the cricopharyngeus during swallow?
A
It opens and allows the bolus down into the esophagus
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
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
21
Q
What are the two layers of muscle of the esophagus?
A
- inner circular
2. outer longitudinal
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
23
Q
Where is the lower esophageal sphincter?
A
At the bottom of the esophagus
24
Q
What is the LES also reffered to as?
A
gastroesophageal juncture
25
What is the purpose of the LES
After the bolus passes through it into the stomach, it closes to prevent reflux
26
What is the main purpose of the larynx?
A valve to prevent aspiration
27
What is the epiglottis?
The top most structure of the larynx- rests against the base of the tongue
28
A wedge-shaped space that is formed between the epiglottis and the tongue is called...
Valleculae
29
The _______________ and the __________________ are known as the pharyngeal recesses
Valleculae and pyriform sinuses
30
What is the opening of the larynx called?
Laryngeal vestibule
31
Where is the hyoid bone?
Suspended from the base on the tongue
32
What are the 5 stages of the swallow?
1. Anticipatory
2. Oral preparatory
3. Oral
4. Pharyngeal
5. Esophageal
33
What happens during the anticipatory stage?
The patient makes cognitive judgments about oral intake (rate, amount per bite, temperature precautions)
34
What is the purpose of the oral preparatory stage?
To break down food and mix it with saliva
35
What is buccal musculature?
Check tension that prevents food from getting caught in the the cheeks
36
The oral prep stage is under ______________________ control.
Voluntary
37
Steps of the oral prep stage
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
38
What is the linguavelar seal?
The back of the tongue is elevated and soft palate is pulled anteriorly agianst tongue to keep material in the oral cavity
39
What happens during the oral stage?
The tongue propels food posteriorly with a rolling or stripping action
40
What is the normal transit time for the oral stage?
approximately 1 second
41
When is the oral stage complete?
When the bolus passes the anterior faucial arches and the pharyngeal response is triggered
42
The oral stage is under _________________ control.
Voluntary
43
What are 3 physiological reasons why the pharyngeal stage is important?
1. airway protection
2. opening of the esophagus
3. downward propulsion of the bolus
44
How does the pharyngeal stage begin?
Triggering of the pharyngeal response
45
After the response triggers what 5 steps occur simultaneously/?
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
What is the purpose of velopharyngeal closure
Prevents things from going up into the nose
47
What are the 3 levels that laryngeal closure occurs?
1. epiglottic folds
2. false folds
3. true folds
48
What causes the cricopharyngeus to open?
Relaxation of the UES tone, elevation of the larynx, and pulsion force of the bolus
49
What is the transit time of the pharyngeal stage?
1 second
50
The pharyngeal stage is _____________ control
Involuntary
51
What is the transit time of the esophageal stage?
8-20 seconds
52
When does breathing resume during the swallow?
After the bolus is passed down the esophagus
53
What is peristalsis?
The rhythmic contraction of muscles to move things through a tube
54
What is primary peristalsis?
It is initiated by the pharyngeal response and laryngeal elevation occurs which opens the UES, the top of the esophagus already starts peristalsis
55
What is secondary peristalsis?
A response to local distention (senses something is in there). It distends and stretches
56
The esophageal stage is involuntary or voluntary?
involuntary
57
What two stages are part of feeding?
Oral preparatory and oral
58
What is deglutition?
It only refers to the process of moving the bolus from the oral cavity inot the esophagus
59
What triggers a gag?
A noxious or foreign stimulus
60
What is the purpose of a gag?
To eliminate foreign stimuli
61
What is the protective reflex for the swallow?
The cough
62
What are two reasons why the gag cannot predict presence or adequacy of swallow?
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
Why is observing the gag useful?
Observing pharyngeal and palatal contraction --> detect unilateral pharyngeal weakness
64
What is the curtain effect?
Everything is pulled to one side and can detect unilateral pharyngeal weakness
65
What are 9 anatomical differences between the adult and newborn mouth and pharynx?
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
What is an adaptive reflex?
assist in the acquisition of food and nutrition
67
What is a protective reflex?
designed to protect the airway
68
The cough is considered a __________ reflex
Protective
69
When the corner of an infant's mouth is stimulated, the baby turns its face towards stimulation. What reflex is this?
Rooting reflex
70
Touch or taste stimulation is applied to the lateral border of the tongue. What is the reflex?
transverse (lateral) tongue reflex
71
The rhythmic closing and opening of jaws in response to stimulation. What is the reflex?
Phasic bite reflex
72
What reflex serves as a protective function in infants, preventing infants from ingesting solid food before they are ready?
Gag reflex
73
What is the purpose of nutritive sucking?
obtain nourishment
74
What is the purpose of non-nutritive sucking?
state regulation, satisfy sucking desire, exploration
75
Nutritive sucking is _____ suck per second
1
76
Non-nutritive sucking is ___ sucks per second
2
77
Positive pressure method for obtaining food is...
suckling
78
negative pressure method for obtaining food is...
sucking
79
What is aspiration?
Action of material penetrating the larynx and entering the airway below the level of the true VF
80
Once material enters the airway, what are two possible reactions?
1. bolus is expectorated- cough reflex
| 2. silent aspiration
81
Which population has a high incidence of silent aspiration?
neurologically impaired patients
82
What are the 3 circumstances that material can be aspirated
1. BEFORE
2. DURING
3. AFTER
83
What are the 3 valves of the larynx?
True VF, false VF, aryepiglottic folds
84
What is the lowest valve of the larynx?
True VF
85
How is timing of aspiration measured?
When the aspiration occurs in relation to when the pharyngeal response occurs
86
On an x-ray, what is used to visualize a pharyngeal response?
Elevation of the hyoid
87
What 3 factors result in the opening of the cricopharyngeus?
1. relaxation of the UES
2. elevation of the larynx
3. pulsion force of the bolus
88
what is another name for residue?
Stasis
89
What are disorders related to the oral preparatory phase?
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
What results from reduced lip closure?
food falling from the mouth anteriorly
91
What results from a reduced range of tongue motion or coordination?
Inability to form a bolus
92
What results from reduced tongue shaping and coordination?
Difficulty holding a bolus and risk of aspiration BEFORE the swallow
93
What results from labial tension or tone?
materials falls into anterior sulcus
94
Where is the floor of the mouth?
underneath the tongue
95
Where is the anterior sulcus?
between the gums and lips
96
What happens during the oral phrase?
The bolus is in a form that is ready to swallow and the tongue propels the bolus back to the pharynx
97
What is a delayed pharyngeal swallow?
It occurs when the head of the bolus reaches the valleculae and the pharyngeal swallow has not been triggered.
98
How is a swallow delay timed?
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
How is an absent pharyngeal swallow defined?
A pharyngeal response delay of greater than 10 seconds
100
During the pharyngeal stage, reduced velopharyngeal closure results in...?
A risk of nasal penetration during swallow
101
What are cervical osteophytes?
Bony outgrowth form the cervical vertebrae that can be large enough to interfere w/ the swallow by narrowing the pharynx
102
what is the only pharyngeal stage disorder that results in a risk of aspiration DURING the swallow?
Reduced laryngeal closure
103
Where are the pyriform sinuses located in relation to the UES?
Superior to UES
