Swallowing and Vomiting

Question 1

What is the technical term for swallowing?

Answer 1

deglutition

Question 2

How many phases are there in swallowing?

Answer 2

3

Question 3

What are the phases of swallowing?

Answer 3

Oral, Pharyngeal and Esophageal

Question 4

Which of the swallowing phases are voluntary?

Answer 4

oral phase

Question 5

Which of the swallowing phases are involuntary?

Answer 5

pharyngeal and esophageal

Question 6

How long does the entire swallowing process take on average?

Answer 6

6 seconds

Question 7

Where is the soft palate positioned at the start of the oral phase of swallowing?

Answer 7

down and forward

Question 8

What is the position of the food bolus in the start of the oral phase of swallowing?

Answer 8

pressed against the hard palate

Question 9

Which cranial nerves are involved in the oral phase of swallowing?

Answer 9

Trigeminal, Facial, Hypoglossal

Question 10

Where is the food bolus towards the end of the oral phase of swallowing?

Answer 10

pushed posteriorly towards the soft palate

Question 11

What marks the end of the oral phase and the start of the pharyngeal phase of swallowing?

Answer 11

the elevation of the hyoid bone

Question 12

What five things occur simultaneously in the pharyngeal phase?

Answer 12

elevation of the soft palate, contraction of palatine-pharyngeal folds, pulling together of the vocal cords, contraction of pharyngeal constrictor muscles, inhibition of the oesophageal sphincter by the vagal nerve

Question 13

What is the purpose of the elevation of the soft palate in the pharyngeal phase of swallowing?

Answer 13

allows food bolus to move to the base of the tongue

Question 14

What is the purpose of the contraction of the palatine-pharyngeal folds in the pharyngeal phase of swallowing?

Answer 14

pushes the food bolus down

Question 15

What is the purpose of the pulling together of the vocal cords in the pharyngeal phase of swallowing?

Answer 15

prevents food entering the trachea and protects the airways

Question 16

What is the purpose of the contraction of the pharyngeal constrictor muscles in the pharyngeal phase of swallowing?

Answer 16

pushes food to the esophagus

Question 17

What is the purpose of the inhibition of the esophageal sphincter by the vagal nerve in the pharyngeal phase of swallowing?

Answer 17

prevents food entering the esophagus before it should

Question 18

What are the suprahyoid muscles?

Answer 18

digastric, stylohyoid, mylohyoid, geniohyoid

Question 19

Aside from the suprahyoid muscles, which muscles of the pharynx are involved with raising the hyoid bone?

Answer 19

palatopharyngeus and stylopharyngeus

Question 20

Where is the epiglottis positioned in the oesophageal phase of swallowing?

Answer 20

down to close the airway

Question 21

What is the purpose of the posterior cricoid cartilage in the oesophageal phase of swallowing?

Answer 21

it works with the posterior pharyngeal wall to create a pharyngeal oesophageal segment where the food bolus waits for the sphincter to open

Question 22

What type of epithelium lines the oesophagus?

Answer 22

stratified epithelium

Question 23

How long is the oesophagus?

Answer 23

20cm

Question 24

What type of muscle forms the upper third of the oesophagus?

Answer 24

striated muscle fibres

Question 25

What type of muscle forms the middle third of the oesophagus?

Answer 25

mixed striated and smooth muscle fibres

Question 26

What type of muscle forms the lower third of the oesophagus?

Answer 26

smooth muscle fibres

Question 27

Is the striated muscle of the oesophagus under voluntary or involuntary control?

Answer 27

involuntary

Question 28

What marks the end of the oesophageal phase of swallowing?

Answer 28

the opening of the upper oesophageal sphincter

Question 29

How does the upper oesophageal sphincter open?

Answer 29

contraction of the suprahyoid muscles causing lifting of the hyoid bone and larynx

Question 30

Which cranial nerves supply innervation for the motor sections of swallowing?

Answer 30

glossopharyngeal, vagus, accessory

Question 31

Which cranial nerves supply innervation for the sensory sections of swallowing?

Answer 31

hypoglossal, glossopharyngeal, vagus

Question 32

Which brainstem nucleus is responsible for the motor portion of swallowing?

Answer 32

nucleus ambiguus

Question 33

Which brainstem nucleus is responsible for the sensory portion of swallowing?

Answer 33

nucleus solitarius

Question 34

How is swallowing controlled?

Answer 34

via a central pattern generator in the nucleus of the solitary tract and the reticular formation

Question 35

Is swallowing or respiration dominant?

Answer 35

swallowing

Question 36

When does swallowing occur in the masticatory cycle?

Answer 36

when the jaws are closed

Question 37

Why does swallowing occur when the jaws are closed?

Answer 37

it stabilises the mandible and keeps the entrance to the pharynx stable

Question 38

In infants, where is the epiglottis positioned compared to adults?

Answer 38

superiorly

Question 39

What is the name for the collection of swallowing disorders?

Answer 39

dysphagia

Question 40

What is the definition of dysphagia?

Answer 40

delay or disrupted passage of solids/ liquids from the oral cavity to stomach

Question 41

Name four causes of dysphagia

Answer 41

muscle disorders, neuromusclar disorders, peripheral nerve disorders, CNS disorders

Question 42

What is the technical word for vomiting?

Answer 42

Emesis

Question 43

What is the definition of nausea?

Answer 43

a very unpleasant sensation that one may soon vomit

Question 44

What is the definition of retching?

Answer 44

muscular activity of the abdomen and thorax, often voluntary, leading to forced inspiration against a closed mouth and glottis

Question 45

What is dry heaving also known as?

Answer 45

retching

Question 46

What is the definition of vomiting?

Answer 46

involuntary contractions of the abdominal, thoracic and GI muscles leading to forceful expulsion of stomach contents from the mouth

Question 47

What is the definition of regurgitation?

Answer 47

effortless return of esophageal or gastric contents into the mouth unassociated with nausea

Question 48

What is the definition of rumination?

Answer 48

food that is regurgitated in the postprandial period, re-chewed, and then re-swallowed

Question 49

Is nausea always associated with vomiting?

Answer 49

no

Question 50

Which sphincter is open during retching?

Answer 50

upper esophageal sphincter

Question 51

What is the purpose to gagging?

Answer 51

to protect the airway

Question 52

Is the gagging response the same for everyone?

Answer 52

no, it can vary from a small contraction of the soft palate to spasm in the pharynx

Question 53

What is the purpose of vomiting?

Answer 53

rid the body of toxins

Question 54

What controls the vomiting reflec?

Answer 54

a central pattern generator

Question 55

What area of the brain is the chemoreceptor trigger zone?

Answer 55

area postrema

Question 56

What are some gastrointestinal signals that can trigger vomiting?

Answer 56

activation of the 5-HT receptors, chemoreceptors of toxins, mechanoreceptors of distention

Question 57

What are some central signals that can trigger vomiting?

Answer 57

area postrema activation

Question 58

Why is the area postrema relevant?

Answer 58

it detects emetic signals from the blood and cerebrospinal fluid as well as receiving information from vagus and vestibular complex

Question 59

What are some signals in the vestibular complex that can trigger vomiting?

Answer 59

motion stimuli can send signals to area postrema which can cause vomiting

Question 60

What are some other general things that can trigger vomiting?

Answer 60

pregnancy, postoperative, alcohol excess, eating disorders

Question 61

Is just one region in the brain responsible for the vomiting reflex?

Answer 61

no

Question 62

What is the position of the soft palate and glottis in retching/vomiting?

Answer 62

soft palate is raised and the glottis is closed

Question 63

Which cranial nerve controls the movement of the soft palate and glottis in retching and vomiting?

Answer 63

vagus

Question 64

What is the efferent pathway of muscles involved in retching?

Answer 64

duodenum contraction, movement to stomach, stomach squeezed between abdominal muscles and diaphragm, relaxed lower esophageal sphincter

Question 65

What is the efferent pathway of muscles involved in vomiting?

Answer 65

prolonged abdominal contraction, relaxed inner hiatal diagphram, relaxed oesophagus and lower oesophageal sphincter

Question 66

What are some complications of prolonged and excessive vomiting?

Answer 66

weight loss, acid erosion of teeth, potential development of barretts oesophagus, inflamation of the oesophagus, mallory-weiss tears, electrolyte imbalance, metabolic alkalosis, renal issues

Question 67

What receptors do emetics work on and how do they interact with them?

Answer 67

5-HT agonist, dopamine D2 agonist, opioids

Question 68

What receptors do anti-emetics work on and how do they interact with them?

Answer 68

5-HT anatgonist, D2 antagonist

Question 69

What imaging method can you use to investigate swallowing?

Answer 69

videofluorographic swallowing study