Lecture 7 Flashcards
Describe swallowing?
It is a highly complex reflex, that needs to be preciser else choking and aspiration can occur.
What are the three phases of swallowing?
- Oral.
- Pharyngeal.
- Oesophageal.
What are the motor and sensory component of swallowing in the oral phase?
It is a voluntary control. The muscles are striated.
What are the motor and sensory component of swallowing in the pharyngeal phase?
It is an involuntary control. The muscles are striated.
What are the motor and sensory component of swallowing in the oesophageal phase?
It is an involuntary control. the muscles are striated and smooth.
What is swallowing controlled by?
Both cortex and brainstem (medulla).
What happens at the swallowing centre?
The swallowing centre in the brainstem receives sensory input from receptors in posterior mouth and upper pharynx and also innervates swallowing muscles via cranial nerves.
What is the anterior and lateral boundary of the oral cavity?
Labium (lip).
Cheek.
Body of the tongue.
What is the superior boundary of the oral cavity?
Hard palate.
Soft palate.
What is the inferior boundary of the oral cavity?
The geniohyoid and mylohyoid muscles supporting the floor of the mouth.
What is the posterior boundary of the oral cavity?
Uvula.
Palatine tonsil.
Root of the tongue.
Lingual tonsil.
How many phases does the oral phase consist of?
- Preparatory phase - formation of the bolus.
2. Transfer phase - bolus is propelled into the pharynx.
What is mastication of the oral preparatory phase?
Food is broken down into size, shape and consistency suitable for transport.
What do the teeth, tongue and cheeks do in the mastication of the oral preparatory phase?
Teeth = They grind the food down.
Tongue, cheeks = position solids over the grinding surfaces.
What does saliva do in the oral preparatory phase?
It lubricates and helps dissolve the food.
What happens in the oral transfer phase?
The tip of the tongue moves into contract with the hard palate, it closes off the anterior oral cavity. The bolus is then pushed into the back of the mouth.
How long does the pharyngeal phase last for?
Slightly less than 1 second.
What has to be closed for the pharyngeal to work?
Mouth.
Upper airway.
Lower airway.
Where does the bolus enter and exit in the pharyngeal phase?
Pharynx from the back of the mouth and exits the upper oesophageal sphincter.
What is the 1st step of the pharyngeal phase?
The tongue pushes against the palate to seal the back of the mouth i.e. oropharynx.
What is the 2nd step of the pharyngeal phase?
The soft palate elevates and proximal pharyngeal wall moves medially to seal off the upper airway i.e. nasopharynx.
What is the 3rd step of the pharyngeal phase?
The epiglottis swings down and vocal cords and arytenoids adduct to seal off the lower airway i.e. laryngeal vestibule leading into the trachea.
How fast does bolus descent through the pharynx?
30-40cm/s via peristalsis.
What is the Upper Oesophageal Sphincter (UOS) composed of?
Group of muscles, which act as a barrier between the pharynx and the oesophagus.
What is the UOS doing most of the time?
Contracting and closed.
What is the normal pressure when the UOS is contracted?
30-200mmHg.
What does the UOS prevent?
- Air insufflating (distending) the stomach.
2. Reflux of contents into the pharynx and larynx during oesophageal peristalsis.
What happens to UOS during swallowing?
When it relaxes it opens. UOS also opens when belching or vomiting.
What does the UOS consist of?
Cricopharyngeus.
Inferior pharyngeal constrictor.
Cervical oesophagus.
How does the UOS close?
When it is resting, via tonic contraction.
How long does UOS stay open for?
0.5seconds.
What causes UOS to open (especially during swallowing)?
The cricopharyngeus relaxes, the supra hyoid and thyroid muscles contract. The pressure of the descending bolus distends the UOS.
Where does the oesophagus run from?
It extends from the upper oesophageal sphincter (UOS) to the lower oesophageal sphincter (LOS).
How long is the oesophagus?
20-25cm long. It depends on how tall the person is.
What is the mucosa of the oesophagus?
Stratified squamous epithelium.
What is the muscle of the upper 1/3 of the oesophagus?
Striated muscle.
What is the muscle of the lower 2/3 of the oesophagus?
Smooth muscle.
What is the 1st step of the oesophageal phase?
The UOS relaxes, bolus enters the oesophagus, and oesophageal peristalsis is initiated.
What is primary peristalsis in the oesophageal phase?
It is initiated by swallowing. It is a continuation of pharyngeal contraction wave. It’s slower than pharyngeal peristalsis: 3-5cm/s.
What is secondary peristalsis in the oesophageal phase?
It is initiated by distension (e.g. food stuck or gastric acid). Stretch receptors are stimulate, this initiates local reflex response triggering peristalsis.