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72 Cards in this Set
- Front
- Back
Dysphagia
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disorder of swallowing
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Swallowing
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entire act of deglutition; from placement of food into the mouth through the oral pharyngeal and esphageal stages until material enters the stomach through the gastroesphageal junction
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Deglutition
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the act or process of swallowing
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Feeding
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oral prepatory and oral stage of swallow; placement of food in the mouth
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Oral Cavity
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lips, teeth, hard and soft palate, uvula, mandible, floor and roof of mouth, anterior and lateral sulci, tongue, and faucial arches
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Floor of Mouth
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muscles attach to the mandible anteriorly and to the hyoid bone posteriorly
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Floor of Mouth
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a. myohyoid
b. geniohyoid c. anterior belly of digastric d. anterior and lateral sulci- pockets b/t the lip and mandible |
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Tongue has 2 portiona
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Oral tongue (front of tongue) includes:
tip, blade, front, center, back ends @ circumvallate papillae active during speech and oral stage od swallow cortical or voluntary control |
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2nd portion of tongue
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Pharyngeal (base)
begins @ circumvallate papillae involuntary neural control coordinated in brainstem |
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what is the foundation of the tongue?
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hyoid bone
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formed by maxilla (hard palate), velum (soft palate), and uvula
- purpose of velar elevation |
roof of mouth
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what provides midline bulk on nasal side of velum that contarcts posterior pharyngeal wall during the swallow
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intrinsic muscle
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extrinsic muscles
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tensor veli palatini, levator veli palatinin, palatopharyngeus, palatoglossus
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tenses and elevates anterior velum
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tensor veli palatini
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moves velum superiorly and posteriorly
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levator veli palatini
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pulls velum inferiorly makes up the posterior faucial pillars
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palatopharyngeus
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pulls velum down and forward; makes up the anterior faucial pillars
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palatoglossus
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what are the 3 salivary glands
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parotid; submandibular;sublingual
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account for 2/3 of salica production when stimulated
produce serous (thin) and watery fluid |
parotid
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produce saliva during rest
produce serous and viscid (mucus-like) fluid |
submandibular
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produces both types of saliva
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sublingual
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what are the purposes of saliva
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keep oral cavity moist
buffer destructive acid produced by bacteria reduce tooth decay by washing away plaque add moisture to bolus during oral stage neutralizes stomach acid that has refluxed into the esphagus |
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the cricopharyngeal muscle attaches to the cricoid lamina to form the
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upper esophageal sphinceter (UES), aka cricopharyngeal regio (CP) and pharyngeoesphageal sphincter (PE segment)
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what is the most inferior structure of the pharynx
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cricopharyngeal muscle
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what forms the posterior and lateral walls
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superior constrictors, medial constrictors, and inferior constrictors.
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the anterior wall is formed by constrictor fiber that attach to what
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pterygoid plates on the sphenoid bone
sodr palate base of tongue mandible hyoid bone thyroid cartilage cricoid cartilage |
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upper esophageal sphinter (UES)
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a. top valve of the esophagues ALWAYS CLOSED
b. reduces refux from esphagues into pharynx c. pressure vlave-greatest pressure during inspiration and immediately prior to swallow.. opens to allow bolus into esophagus |
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what is the upper most structure of the larynx
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epiglottis
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how many levels of sphincters of the larynx are there
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3
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what is the space btwn base of tongue and epiglottis divided by the hyoepiglottic ligament
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valleculale
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what s the opening into the larynx; bound by epiglottis, aryepiglottic folds and artenoid cartilages
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laryngeal vestibule
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a. lateral walls of larybgeal vestibuls
b. attached laterally to epiglottis and extend posteriorly to surround arytenoid cartilages --part of supraglottis |
aryepiglottic folds
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the elbows!
positioned posteriorly on the cricoid cartilages muscular pull on these controls movement of true vocal cords |
arytenoid cartilages
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shelves of soft tissue superior but parallel with true vocal folds;aka ventricular folds
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false vocal folds
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space between false and true vocal folds
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laryngeal ventricles
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glottic level
last level of airway protection composed of vocalis and thryoarytenoid muscle attached from vocal processes of arytenoids posteriorly; throid lamina laterally; to thyroid notch anteriorly |
true vocal folds
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name the intrinsic muscles
4 pairs 1 single |
a. thyroarytenoids
b.cricothroids c.lateral cricoarytenoid muscles d. posterior cricoarytenoid muscles e. interarytenoid muscle |
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which intrinsic muscle makes up the bulk of vocal cord; and innervated by the recurrent laryngeal branch of the vagus nerve (CN X)
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thyroarytenoids
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which intrinsic muscle elongates the thryoartenoid muscle - and is the ONLY intrinsic laryngeal muscle innervated by the superior laryngeal branch of the vagus (X)
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cricothyroids
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which intrinsic muscle adducts the vocal folds by rotating the arytenoids dorward and is innervated by the recurrent laryngeal nerve
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lateral cricoarytenoid muscles
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which instrinsc muscles oppose the lateral cricothyroids - abduct the vocal folds by rotating the arytenoids away from midline and is innervated by the recurrent larungeal nervee
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posterior cricoartenoid
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which msucle attaches attaches between the arytenoid cartilages and adducts the arytenoids to close the vocal folds - innervated by the recurrent laryngeal nerve
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interarytenoid muscle
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a. connect the larynx to other structures in the head, neck, and chest
b. suspend and stabilize thyroid cartilage in the neck c. elevates or depresses larynx as a whole these are also known as strap muscles |
extrinsic muscles
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name the three valve levels for airway protection
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a. epiglottis and aryepiglottic folds
b. arytenoids and false vocal folds c. true vocal cords opens from the bottom up |
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name and describe the four phases of swallowing
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1. oral prep phase: food is manipulated in the mouth to reduce food to a consistency which can be swallowed
2. oral phase: the tongue propels the bolus posteriorly until pharyngeal swallow is triggered 3. pharyngeal phase: once pharyngeal swallow is triggered bolus is transfered through pharynx 5. esophageal phase:bolus goes from UES through the esophagus to LES |
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describe the oral prep phase
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-sensory info is pricessed throughout the mouth
-labial seal is maintaines and nasal airway is open -volume of bolus swallowed varies with viscosity of the food -bolus is either maintained as it went in or chewed -if no chewing velum pulled down and forward to close off oral cavity from pharynx -if bolus is chewed :tension in buccal musculature closes off lateral sulci - soft palateis not pulled down and forward - premature spillage is common and normal |
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as bolus viscosity increases max volume swallowed
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decreases
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Oral Phase
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initated when tongue begins posterior propulsion of the bolus:
Req: -intact labial musculature to maintain seal -intact lingual movement to propel the bolus backward -intact buccal tension to prevent pooling in the lateral sulci 0normal palatal muscles0ability to breathe thru the nose tongue tip and sides are anchored to alveolar ridge and groove is formed to push the bolus backward as viscosity increases GREATER lingual pressure is need to propel bolus TAKES LESS thank 1 to 1.5 sec |
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NO pharyngeal swallow will occur until
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the pharyngeal swallow is triggered
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oral stage ends whn
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the bolus passes btwn the anterior faucial arches and or where the tongue base crosses the lower rim of the mandible - triggering the pharybgeal swallow
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True or false :
having something in teh mouth triggers a swallow |
FALSE
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6 steps of the Pharyngeal Phase
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1. complete closure of velopharyngeal port
2. elevation and anterior movement of hyoid and larynx 3. closure of larynx 4. cricopharyngeal opening 5. complete contact is made btwn the tongue base and pressure builds - comete contact is btwn the tongue base and posterior pharungeal wall and bolus is pushed to the ues 6. progressive to to bottom contraction in the pharyngeal constrictors. |
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bolus enters thru the cricopharyngeal juncture or UES
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ESOPHAGEAL PHASE
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true or false
videofluoroscopic study usually does not involve examination of esophagus; referred for a standard barium swallow or upper G-I series |
TRUE
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if pharyngeal trigger does not occur
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bolus may be propelled into the pharynx and rest in the valleculae or pyriform sinuses
0if liquid, it may get into the airway if patient's sensitivity is in tact coughing will occur to expectorate the bolus |
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what are the variations of normal swallowing
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-volume effect
-increasing viscosity -cup drinking -pharyngeal swallow with no oral phase-premature spillage -chugging |
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explain chugging
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pull larynx forward, open ues volitionally, hold breath to close airway, then dump by gravity into pharynx and down the esophagus
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what are some of the changes in older adults
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-reduction in strength of pharyngeal contraction may cause 2nd swallow
- slightly longer oral phase - reduced smell and taste |
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what causes a 2nd swallow in older adults
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-ossification of the cartilages
-cervical arthritis -lowering of larynx in the neck |
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what are some of the consequences of swallowing impairment
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-aspiration pneumonia
-malnutrition -dehydration -death |
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pt complains food sticks high in throat -points to base of tongue
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material likely hesitates in valleculae @ tongue base
reduced hyoid/laryngeal elevation |
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pt complains food gets stuck in throat below larynx
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material likely pooling in pyriform sinuses
possible esophageal disorder |
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pt complains cough and choke
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laryngeal penetration adn or aspiration
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pt says liquids are easier than solids to swallow
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poor oral control lingual weakness
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pt says dry and thick foods hard to swallow
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poor oral hydration-lingual weakness
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pt says food spreads in mouth
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poor bolus formation/propulsion
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choke on liquids - do better w thicker consistencies
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delayed triggering of pharyngeal swallow
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pt says food/liquid coming out of nose
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poor velar closure during swallow
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pt says food/liquid falling from mouth
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poor lip seal/oral containment
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something stuck in throat
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globus sensation
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pt says throat burns on swallow
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reflux
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pt says food returns to mouth in orgnal condition
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pharyngeal pocket/ zenker's diverticulum
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