Physiology Of Normal Swallow (Part 3) - Exam 2

Front 1

What is the supper digestive tract? What is it made up of?

Back 1

a series of tubes and valves.

2 main cavities: Oral cavity and Pharynx

Front 2

what are the functions of the valves from the supper digestive tract?

Back 2

Directingthe food in the appropriate way to keep it from going down the airway or up thenose.

2. Applying pressure to the food to propel italong.

Front 3

What valves consist the upper digestive tract? What are their functions?

Back 3

1. The lips anteriorly to keep food in themouth.

2. The oral portion of the tongue – makescontact with the hard or soft palate and approximates the palate to any degree.

3. Velopharyngeal region – closes off to keepfood from entering the nose.

4. Larynx – prevents food from entering thetrachea.

5. Tongue base and Pharyngeal wall - make contact during the pharyngeal swallow togenerate pressure and push the bolus cleanly through the pharyngeal area.

6. Cricopharyngealregion – opens at the appropriate time to allow the bolus into theesophagus.

7. Lower esophageal sphincter – Muscularsphincter that allows food into the stomach

Front 4

What if the lips don't work? What happens to the swallow?

Back 4

there will be spillage and food coming out of mouth

Front 5

What if oral cavity doesn’t work?

Back 5

Bolus is not going to form into a cohesive mass if they swallow all that is in the mouth

Front 6

What if the velopharyngeal region doesn’t work?

Back 6

bolus going to come out the nose

Front 7

What if the larynx doesn’t work?

Back 7

going to aspirate or penetrate

Front 8

What if tongue base and pharyngeal wall doesn’t work?

Back 8

there’s going to be residue because it won’t push through

Front 9

What if cricopharyngeal doesn’t work?

Back 9

residue in the pharynx, will build it up and go into the airway

Front 10

What if LES doesn’t work?

Back 10

food stuck in the esophagus, pressure there, will reflux

Front 11

Describe the ability to masticate food for older adults.

Back 11

mastication remains high in normalindividuals regardless of age

increase number of chewing strokes (especially in patients with dentures or poor dentition)

Important to wear dentures for bedside swallow

Front 12

should you give solids to patients with no dentures in bedside swallows? why?

Back 12

Should still give solid food to those with no denture

Ask what kind of diet did they have at home - if they had solids at home, test it out

Front 13

What changes are there in cartilages in older adults? What happens to the larynx?

Back 13

Calcification of the thyroid and cricoidcartilages and the hyiod boneincreases.

70 years old and above, the larynx beginsto lower in the neck.

Front 14

Why is it important to know there is calcification of the thyroid and cricoid cartilage and hyoid bone?

Back 14

it will appear dark in the barium swallow, can get mixed up as the bolus or residue

Front 15

What changes occur in the neck in older adults?

Back 15

Arthritic changes in the neck may impingethe pharyngeal wall resulting in decrease pharyngeal constriction

result inthe need for a second swallow

Front 16

What changes in swallowing occur in older adults? List them.

Back 16

Increased use of the dipper swallow.Slightly longer oral stage and a “normal”delay in the initiation of the pharyngeal swallow.

Slight increase in the oral andpharyngeal residue.

Increase in penetration of the laryngealvestibule but no increase in aspiration.

Esophageal transit time and clearance isslower and less efficient.

Front 17

What happens to the cricopharyngeal opening in older adults?

Back 17

Cricopharyngealopening has less flexibility and change in response to bolus size.

Front 18

Why is it a problem if there's a reduction in reserve and flexibility in neuromuscular control found in older adults as they age?

Back 18

putsolder patients at increased risk of developing swallowing problems if theybecome ill, even if the head and neck are not involved

Front 19

What is taste?

Back 19

Tasteis a chemical sense in the oropharyngeal region and is activated during eatingand drinking

Front 20

What happens to taste when adults age? How does this affect them?

Back 20

Taste and smell are reduced with age.

Also affected in a patient with a trachesotomy.

Also affected in head and neck cancerpatients.Lossof interest in food may develop in a patient with decreased taste and smell

Front 21

What is the apneic period? What is the duration of it?

Back 21

airwayclosure during the swallow when there is no respiration during the pharyngealswallow

duration increases as bolus volume increases

Front 22

what is the predominant pattern of swallow respiration coordination?

Back 22

interruptionof the apneic phase occurs during exhalation and the patient returns toexhalation after the swallow

Front 23

Why is coordination of respiration and swallowing important?

Back 23

allows slight airflow through larynx after swallow, which can help clear any mild residue

dysphagicpatients may more often interrupt inhalation to swallow, which may increasetheir risk of aspiration

Front 24

How does changing bolus volume affect changes in swallow?

Back 24

A small bolus (1 to 3ml) - normal oral phase followed by pharyngealphase, and esophageal phase.

A larger bolus (10 to 20ml) –simultaneous oral and pharyngeal activity. timing of tongue base retraction to contact posteriorpharyngeal wall occurs later in swallow.

For all volumes, tongue base and pharyngeal wall move towards each other and make contact when tail of bolus reaches the tongue base. generates pressure on the bolus.

Front 25

How does increasing viscosity affect swallowing?

Back 25

Increasedoral tongue pressure

Increasedtongue base pressure

Increasedpharyngeal wall pressureIncreasedmuscular activity

Increasedduration of velopharyngeal closureIncreasedduration of upper esophageal opening

Increasedduration of laryngeal closure.

Front 26

What is sequential cup drinking?

Back 26

early airway closure and pre elevation ofthe larynx as the cup is approaching the lips.

Airway closure extends across all of thesequential swallows.

Can last 5 – 10 seconds depending on thenumber of sequential swallows.

difficult for patients with dysphagia.

Front 27

What happens during sequential cup drinking swallows?

Back 27

velopharyngealarea is closed

Lipsmaintain a seal around the cup

Oraltongue repeatedly propels the liquid back

Tonguebase and the pharyngeal wall make contact at the tail of each bolus

UESopens repeatedly each time a bolus approaches

Front 28

What is straw drinking?

Back 28

when bolus is brought into mouth through suction created in oral cavity

Front 29

How is the suction created in straw drinking?

Back 29

soft palate lowered against back of tongue

muscles of cheek and face contract (creases suction intraorally which brings material into mouth)

Front 30

When does suction discontinue in straw drinking?

Back 30

when the material reaches the mouth

Palate then elevates and the oral stageof the swallow begins.

Somepatients begin sucking on inhalation which can result in aspiration

Front 31

what is "chug-a-lug"?

Back 31

drinka soda or other beverage without swallowing

offersgood potential for patients with oral/pharyngeal dysphagia to developvolitional control and compensate

Front 32

what are the steps in chug-a-lug?

Back 32

Pulltheir larynx forward – which opens the upper esophageal sphincter volitionally

Holdtheir breath – which closes off their airway at the level of the larynx.

Dumpmaterial through the oral cavity and pharynx into the esophagus and stomach

Front 33

what happens if secretions or materials begin building up in the valleculae and pyriform sinuses?

Back 33

aperson may be observed producing a pharyngeal swallow with little to no oralswallow

representsvolitional control over the pharyngeal swallow

Front 34

What did researchers think of swallowing in the past?

Back 34

In the past, the swallow was classifiedas a reflex.

Now most researchers agree thatswallowing is a pattern-elicited response.

Thegag reflex is a good example of a reflex

Front 35

When is gag reflex triggered?

Back 35

any time that a noxious substance touchesthe back of the tongue, back of the pharynx, or soft palate

present or absent gag reflex is not a prognostic indicator for swallowstrength and efficiency

Front 36

What is the gag reflex controlled by?

Back 36

swallow response cannot be initiated bytouching one particular area.

partially controlled by the brain stem.

receives cortical input and input from muscle spindles including in thetongue via the hypoglossal nerve