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Adult Dysphagia > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What is swallowing

A

highly integrated process of moving food, liquid, saliva through the upper aero digestive tract (500 milliseconds to swallow)

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2
Q

Oral preparatory stage

A

containment and mastication (containing bolus)

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3
Q

Oral Transit stage

A

transit from mouth to oropharynx (back of mouth)

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4
Q

Oral/Pharyngeal (oropharyngeal) stage

A

transit from oropharynx to esophagus
-most complex stage
-pass food from airway to esophagus
-velopharyngeal sphincter needs to be closed and airway

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5
Q

Esophageal stage

A

transit through the esophagus to the stomach

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6
Q

additional stage that has been proposed

A

visual appreciation stimulates saliva production (some ASD or dementia patients don’t appreciate food)

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7
Q

premature spillage

A

when bolus passes through the oropharynx and you are still chewing

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8
Q

what happens to the muscles when elevating mandible

A

muscles are agonists and depressing muscles are antagonists

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9
Q

what happens to the muscles when depressing the mandible

A

muscles are agonists and the elevating muscles are antagonists

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10
Q

muscles included in the oral preparatory stage

A

orbicularis oris, masseter, temporalis, medial pterygoid, lateral pterygoid, buccinator

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11
Q

orbicularis oris

A

innervation: facial
action: closes and opens lips

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12
Q

masseter

A

innervation: trigeminal
action: elevates mandible and retracts the mandible

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13
Q

temporalis

A

innervation: trigeminal
action: elevates mandible (closing mouth)

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14
Q

medial pterygoid

A

innervation: trigeminal
action: elevates mandible

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15
Q

lateral pterygoid

A

innervation: trigeminal
action: depressor of mandible (open mouth); protrudes mandible; permits side to side movement of mandible

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16
Q

buccinator

A

innervation: facial
action: flattens cheek; holds food in contact with teeth; retracts angles of the mouth

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17
Q

muscles of oral/pharyngeal stage

A

levator veli palatini, tensor veli palatini, palatoglossus, palatopharyngeus, uvulae, mylohyoid, digastric (anterior belly), geniohyoid, stylohyoid, hyoglossus, genioglossus, styloglossus, palatoglossus

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18
Q

levator veli palatini

A

innervation: vagus and accessory (two slings below soft palate)
action: raises soft palate

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19
Q

tensor veli palatini

A

innervation: trigeminal (making balance between pressure inside middle air and outside atmosphere)
action: stretches soft palate and not highly involved in swallowing

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20
Q

palatoglossus

A

innervation: vagus and accessory
action: raises back of the tongue during the first stage of swallowing
-soft palate depressor and this is important to raise the posterior tongue to keep food in oral cavity

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21
Q

palatopharyngeus

A

innervation: vagus and accessory
action: shuts off nasopharynx during second part of swallowing (shortening pharynx and squeezing it)

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22
Q

uvulae

A

innervation: vagus and accessory
action: shortens and raises uvula

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23
Q

mylohyoid

A

innervation: trigeminal
action: elevates tongue and floor of mouth; depresses jaw when hyoid bone is fixed

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24
Q

digastric anterior belly

A

innervation: trigeminal
action: raises hyoid bone if jaw is in fixed position; depresses jaw when hyoid bone is fixed

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25
Q

geniohyoid

A

innervation: C1 and C2 via hyoglossus
action: draws hyoid bone forward; depresses mandible when hyoid bone is in fixed position

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26
Q

stylohyoid

A

innervation: facial
action: elevates hyoid and tongue base during swallowing

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27
Q

hyoglossus

A

innervation: hypoglossal (facilitates bolus transfer)
action: gibers inserted into mandible and depresses the tongue

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28
Q

genioglossus

A

innervation: hypoglossal
action: protrusion and depression of the tongue

29
Q

styloglossus

A

innervation: hypoglossal
action: elevates up and back of tongue

30
Q

palatoglossus

A

innervation: glossopharyngeal, vagus, and accessory
action: narrows faces and elevates posterior tongue

31
Q

intrinsic lingual muscles

A

insertion/origin: inside tongue
-change the shape of the tongue
-superior, inferior, longitudinal, transverse, vertical

32
Q

superior and inferior longitudinal muscles

A

superior: in tongue and elevates the tip
inferior: muscle for tongue top depressor

33
Q

transverse muscle

A

narrows tongue

34
Q

vertical muscles

A

flattens tongue

35
Q

extrinsic lingual muscles

A

move the body of the tongue
origin: somewhere outside the lingual muscles

36
Q

pharyngeal muscles

A

pharyngeal constrictors (intrinsic)
palatopharyngeus, stylopharyngeus, salpingopharyngeus, cricopharyngeus (extrinsic)

37
Q

pharyngeal constrictors

A

innervation: vagus and accessory
action: constrict the pharynx

38
Q

palatopharyngeus

A

shortens the pharynx
action: draws the pharynx up and draws the velum down

39
Q

stylopharyngeus

A

innervation: glossopharyngeus
action: elevates the pharynx

40
Q

salpingopharyngeus

A

innervation: accessory nerve and pharyngeal plexus
action: draws the lateral walls of the pharynx up, balance air pressure of Eustachian tube and relaxes the pharynx

41
Q

cricopharyngeus

A

innervation: vagus
action: acts as a sphincter, relaxing during passage of the bolus from the pharynx into the esophagus
-constriction is causing the upper part of the esophagus to be closed and relaxes during swallowing
-if open all the time, it could cause the food from the stoma to come up and cause acid reflux

42
Q

ventral surface of the tongue

A

underneath part

43
Q

what is the only part of the pharynx that is visible during an oral mech

A

oropharynx

44
Q

hyoid and laryngeal elevation is supported by what

A

FOM muscles (flow of mouth) and attached to the hyoid

45
Q

hyoid and laryngeal depressors after the swallow are likely

A

passive

46
Q

hyoid and laryngeal depressors more likely act as what to the muscles used in elevation

A

antagonists (sternohyoid, sternothryoid, omohyoid)

47
Q

during swallowing, what happens to the esophageal lumen

A

it is collapsed

48
Q

proximal esophageal muscle

A

upper 4th 1/3
striated and innervated by RLN and sympathetic plexus (autonomic input)

49
Q

distal esophageal muscle

A

smooth and enervated by autonomic input
-inner (circular fibers)
-outer (longitudinal fibers)

50
Q

course of the esophagus

A

-esophagus runs lateral +posterior to left ventricle of the heart
-after esophagus passes the diaphragmatic hiatus, it connects to the body of the stomach at the level of the LAS

51
Q

why is the bend important in the esophagus

A

if a person is dealing with enlarged heart muscles, the heart may press the esophagus and make it harder for food to pass

52
Q

epiglottis

A

flexible cartilage covering airway during swallowing

53
Q

what triggers the swallow reflex

A

the food accumulates in the the vallecula area and then when it gets large enough the reflex is triggered

54
Q

what happens when the material passes the epiglottis level

A

aspiration

55
Q

what happens when the material enters the airway through the vocal cords

A

penetration

56
Q

swallowing is controlled by

A

peripheral and central nervous system

57
Q

what are the layers of protection during swallowing action

A

-epiglottis bends over airway
-vocal cords must be abducted during swallowing
-coughing mechanism

58
Q

what is medullary control known as

A

swallowing pattern generator

59
Q

multimodal sensory impulses are sent to what

A

nucleus tractus solitarius (NTS) to initiate the pharyngeal swallow

60
Q

what is the motor function mediated by during medullary control

A

nucleus ambiguous (NA) via multiple cranial nerves

61
Q

dysphagia in the brainstem lesion area is characterized by

A

incoordination between stages and between swallowing and respiration- damage to swallowing center
-muscular weakness- damage to corticobulbar system
-results in an incomplete swallow (significant residue)

62
Q

supra nuclear controls

A

higher control centers involved in continuing, modifying, and monitoring swallowing and responding to input variability

63
Q

examples of higher control centers

A

feedback loops continuing the repetitive chewing behavior
-volitional modification (taking pills, feeding rate, expectorating unwanted bolus)
-responding to different sensory stimuli

64
Q

which muscle lowers the mandible

A

lateral pterygoid

65
Q

contraction of which muscle elevates the hyoid

A

mylohyoid

66
Q

the cricopharynxgeus muscle contracts during pharyngeal stage

A

false

67
Q

this muscle holds food in contact with molars during chewing

A

buccinator

68
Q

nucleus tractus solitaries receives sensory information in medulla

A

false

Adult Dysphagia (4 decks)

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