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By: Abduljabbar Hamid Jabbar: University of Baghdad-College of Medicine M. B. Ch. B
By: Abduljabbar Hamid Jabbar: University of Baghdad-College of Medicine M. B. Ch. B
• The efferent (motor) nerve fibers from the swallowing center are conducted through:
Trigeminal (5th cranial nerves),
Glossopharyngeal (9th cranial nerves),
Vagus (10th cranial nerves),
Hypoglossal (12th cranial nerves),
Few of the superior cervical nerves to the pharynx and upper esophagus
5. At the same time that the larynx is raised and the upper
esophageal sphincter is relaxed, the superior constrictor
muscle of the pharynx contracts, giving rise to a rapid
peristaltic wave passing downward over the pharyngeal
muscles and into the esophagus, which also propels the
food into the esophagus.
Swallowing becomes a great concern for the elderly since strokes and Alzheimer's disease can interfere with the
autonomic nervous system.
there are multiple areas of the central nervous system which, if affected by a stroke, could disrupt the ability to swallow.
This is especially true for strokes of the medulla, as this is a relatively small area that contains multiple structures that are
critical in carrying out the swallowing reflex.
In fact, people with medullary strokes frequently require temporary or permanent feeding tube placement
[C] Esophageal stage of swallowing: The esophagus functions to conduct food from
the pharynx to the stomach. The movement of food down the esophagus is an active
process (primary esophageal peristalsis integrated at swallowing center) that does
not depend on gravity for its normal function. The upper esophageal sphincter and
lower esophageal sphincter are closed in normal resting state.
Closure of the upper esophageal sphincter prevents air from being drawn from the
mouth into the esophagus during inspiration. Closure of the lower esophageal
sphincter prevents gastric contents to move back from the stomach to the
esophagus.
Because most of the esophagus is contained within the thoracic cavity, the pressure
in the lumen of the resting esophagus is approximately equal to intra-thoracic
pressure (atmospheric or slightly below atmospheric) when the upper esophageal
sphincter and lower esophageal sphincter are closed (normal resting state). During
pulmonary inspiration, the intra-esophageal pressure will be sub-atmospheric.
The event is limited to the smooth muscle component of the esophagus and is the
result of activation of enteric nerves. Initiation of secondary peristalsis does not
involve extrinsic neural reflexes and, thus, is not accompanied by the oral-pharyngeal
phase of swallowing.
[D] Relaxation of lower esophageal sphincter: The lower
esophageal sphincter is not anatomically separate identifiable
muscles.
Greatly increased intra-abdominal pressure caves the esophagus inward at this point at the same time that the
abdominal pressure also increases the intragastric pressure, preventing the high pressure in the stomach
from forcing stomach contents into the esophagus.
Esophageal reflux: Reflux of stomach acid to the esophagus causes esophageal pain (heartburn) and may
lead to esophagitis. An increase in the intraabdominal pressure (by the ingestion of a very large meal,
production of intestinal gas, pregnancy, an abdominal mass such as a tumor, bending at the waist, straining
against a closed glottis as in defecation) will facilitate gastro-esophageal reflux if the LES is not contracted or
there is distortion of the valve-like mechanism. Esophageal reflux may occur if:
[A] If the intragastric pressure raises high enough to force the lower esophageal sphincter open.
[B] If the lower esophageal sphincter is unable to maintain its normal tone.
[C] If the lower esophageal sphincter is forced through the diaphragm and into the thoracic cavity as in hiatal
hernia, in which the oblique entrance of the esophagus to the stomach is distorted, and consequently the
valve-like mechanism is impaired.
Belching (eructation): Following a heavy meal or the ingestion of large amounts of gas (e.g., from carbonated
beverages), the gas bubble that is usually in the fundus of the stomach is displaced to the cardia.
When lower esophageal sphincter relaxes during the swallowing process, gas enters the esophagus and is
regurgitated.
Dysphagia: Difficulty in swallowing. Persons with dysphagia usually report choking, coughing, or an abnormal sensation of
food sticking in the back of the throat or upper chest when they swallow. If swallowing is painful, it is referred to as
odynophagia. Dysphagia can result from altered nerve function or from disorders such as:
Lesions of the central nervous system (CNS), such as a stroke, often involve the cranial nerves that control swallowing.
Strictures and cancer of the esophagus and strictures resulting from scarring can reduce the size of the esophageal
lumen and make swallowing difficult.
Achalasia: In which the lower esophageal sphincter fails to relax; food that has been swallowed has difficulty
passing into the stomach, and the esophagus above the lower esophageal sphincter becomes enlarged.
One or several meals may lodge in the esophagus and pass slowly into the stomach. There is danger of
aspiration of esophageal contents into the lungs when the person lies down.
Thank You
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