Njengoba kulula njengoba kungase kubonakale, ukugwinya empeleni kungenye yezenzo eziyinkimbinkimbi kakhulu ezenziwa imizimba yethu. Isenzo esibonakala sengathi silula futhi sizenzekelayo sihilela uchungechunge lwezenzo okumelwe zenzeke ngokulandelana ngokulandelana ngokulandelana kwezinhlangothi ezintathu, okubandakanya izindawo eziningi zesistimu yezinzwa.
Kunezinyathelo zokuzikhethela, noma izinyathelo zokuzibophezela ezihilelekile ekugwineni, kanye nokuzibandakanya, noma izenzo zokucabanga ezihilelekile ekugwineni.
Izigaba ezintathu zokugwinya zichazwe ngezansi:
I-Oral Phase
Ukuhlunga kuqala ngesigaba somlomo. Lesi sigaba siqala lapho ukudla kufakwa emlonyeni futhi kuhambelana namathe. Ukudla okumanzi kubizwa ngokuthi i-bolus yokudla.
I-bolus yokudla ihlolwe ngokuzithandela ngamazinyo alawulwa yimisipha ye-mastication (ukuhlafuna). Phakathi nalesi sigaba, ukudla "kulungiselelwe" kube usayizi omncane ogcwala kahle ukuze ukwazi ukudluliswa kalula kusuka phambili ukuya emhlane. I-bolus yokudla isuke ishukunyiswa ngokuzithandela ngokuqhubekayo ku-oropharynx (engxenyeni engenhla yomphimbo).
Kusukela ku-oropharynx, i-bolus yokudla ihanjiswa phambili ngemuva kolimi nezinye izinhlanzi engxenyeni engezansi ye-pharynx (umphimbo). Lesi sinyathelo sidinga ukuphakama okuzithandela kwelava elithambile ukuze kuvinjelwe ukudla ukungena ekhaleni.
Imisipha elawula isigaba somlomo sokugwinya ishukunyiswa yizinzwa ezitholakala ku-brainstem, okuthiwa izinzwa zomzimba.
Izinzwa ezithintekayo ekuxhumaniseni lesi sigaba zihlanganisa i-trigeminal nerve, i-facial neerve, ne-hypoglossal nererve.
Isigaba se-Pharyngeal
Njengoba i-bolus yokudla ifinyelela ku-pharynx, izinzwa ezikhethekile zemisipha zivuselela isigaba sokuzibandakanya sokugwinya. I-reflex yokugwinya, ehlangene nesikhungo sokugwinya endaweni ye-medulla (ingxenye engezansi ye-brainstem), yenza ukuba ukudla kuphinde kuqhutshekwe emuva ku-pharynx kanye ne-esophagus (ipayipi yokudla) ngokulinganisa okulinganiselwe nokuzibandakanya kwemisipha eminingana ngemuva komlomo, pharynx, nesophagus.
Ngenxa yokuthi umlomo nomphimbo kuyindlela yokudla kokubili nomoya, umlomo unikeza umzila womoya ukuze ungene emiphakathini nasemaphashini, futhi unikeza umzila wokudla ukuze ungene ngaphakathi kwesisu nangesisu.
Ingxenye ebaluleke kakhulu yesigaba se-pharyngeal ukuvalwa okungenasisekelo kwe-larynx yi-epiglottis namacambo omlomo, nokuvimbela okwesikhashana ukuphefumula. Lezi zinyathelo zivimbela ukudla ekuhambeni "phansi phansi ipayipi engafanele" ku-trachea (i-windpipe).
Ukuvalwa kwe-larynx yi-epiglottis kuvikela amaphaphu ekulimazeni, njengoba ukudla nezinye izinhlayiya ezingena emaphashini kungaholela ekutheleleni okuqinile nokucasula kwamathishu emaphaphu. Izifo ezithathelwanayo ezibangelwa izinkinga ngesigaba se-pharyngeal se-reflex yokugwinya esivame ukubizwa ngokuthi i- aspiration pneumonia .
Isigaba Esophageal
Njengoba ukudla kushiya i-pharynx, kungena emgodleni, isakhiwo esinjenge-tube-like muscular esiholela ekudleni ngesisu ngenxa yezinhlangothi zokuxuba ezinamandla ezididiyelwe. Ukudla kokudla ngokusebenzisa lesi sigaba kulesi sigaba kudinga isenzo esihlanganisiwe se- vagus nererve , isisindo se-glossopharyngeal, kanye namagundane wezinzwa kusukela ohlelweni lomzwelo oluzwelayo.
Umswakama unemisipha emibili ebalulekile evulekile futhi evale ngokucabangela njengoba i-bolus yokudla idilizwa ngenkathi igwinya. Lezi zinhlanzi, okuthiwa i-sphincters, zivumela ukuthi i-bolus yokudla igele phambili phambili ngenkathi ivimbela ukuba ingene endleleni engafanele (ukuphindaphinda).
Zombili lezi zitshalo ezisezingeni eliphansi, kuqala ezingenhla, bese ziphansi, zivulekile ekuphenduleni umfutho we-bolus yokudla futhi zivale ngemva kokudlula kokudla kwe-bolus.
I-sphincter ephezulu ye-esophageal ivimbela ukudla noma amathe ukuba ingabuyiselwa emuva emlonyeni, kuyilapho i-sphincter ephansi e-esophageal iqinisekisa ukuthi ukudla kuhlala esiswini, ukuvimbela ukuphindaphinda emuva endaweni.
Ngokwenza kanjalo, ama-sphincters angama-esophageal asebenza njengesivimbela ngokomzimba ekudleni okuphindwe kabusha.
Dysphagia
Ngokuvamile, abantu abanempilo bangagwinya ngomcabango nokuzikhandla okukhulu. Uma isimiso sezinzwa sisaphazamiseka ngenxa yesifo noma esinye isifo, izinkinga ngokugwinya zingenzeka. Ukunciphisa ubunzima kuthiwa yi-dysphagia. I-Dysphagia ingaholela ezinkingeni ezinjengokukhahla, ukuntuleka kwesifiso nokulahlekelwa isisindo, kanye nesifiso se-pneumonia.
Izwi elivela
Uma uye wabhekana nesifo sokushaya isifo noma esinye isifo sezinzwa, ungase uhlole ukugwinya ukuze unqume ukuthi unayo yini i-dysphagia. Uma unezibonakaliso ze-dysphagia, kuzodingeka ube nenkulumo futhi ugweme ukwelashwa ukuze imisipha yakho yokugwinya ingaba nethuba lokuthuthukisa ngangokunokwenzeka.
> Imithombo:
> Ubuhlobo phakathi kweDysphagia, ama-National Institutes of Health Stroke Score Scale, kanye nama-Predictors of Pneumonia emva kwesifo se-Ischemic, Ribeiro PW, Cola PC, Gatto AR, da Silva RG, Luvizutto GJ, Braga GP, Schelp AO, de Arruda Henry MA, Bazan R , J Stroke Cerebrovasc Dis. 2015 Sep; 24 (9): 2088-94