Dysphagia

Front 1

What is dysphagia?

Back 1

Nonspecific description for swallowing difficulty

Front 2

Where does swallowing start? Where does it end?

Back 2

Lips
stomach

Dysphagia can result from problems anywhere along this path

Front 3

What do you want to ask about dysphagia?

Back 3

Solids vs. liquids
History of tobcco, EtOH
PMH
PSH
Weight loss
Meds

Front 4

What are some diagnositc tests for dysphgia?

Back 4

Esophagram
Modified barium swallow
Flexible endoscopic evaluation of swallowing
Manometry

Front 5

What is manometry good to test for?

Back 5

Achlasia
Diffuse esophageal spasm

Front 6

What are afferent nerves in swallowing? Efferent?

Back 6

Afferent: V, VII, IX, X

Efferent: V, VII, IX, X, XII

Front 7

What is the origion of the pharyngeal plexs?

Back 7

CNX

Front 8

What does CNX innervate?

Back 8

Cricopharyngeus
Thyroarytenoid
Posterior cricoarytenoid
Transverse/oblique arytenoid
Posterior/lateral cricoarytenoid
Thyroepiglottic

Front 9

What does CNV innervate?

Back 9

Temporalis
Masseter
Medial/lateral pterygoid
Tensor veli palatini
Mylohyoid, anterior belly of the digastric

Front 10

What does CNIX innervte?

Back 10

Stylopharyngeus

Front 11

What does CNXII innervate?

Back 11

Intrinsic/extrinsic tongue muscles

Front 12

What does CNVII innervate?

Back 12

Buccal granch: obisularis oris, buccinator

Front 13

What are the 4 stages of swallowing?

Back 13

Oral preparatory phase
Oral stage
Pharyngeal stage
Esophageal stage

Front 14

What occurs in the oral preperatory phase of swallowing?

Back 14

Lip closure to hold food in the mouth anteriorly.
Tension in the labilal, buccal musculature to close the anterior and lteral sulci
Rotary motion of the jaw for chewing
LATERAL ROLLING MOTION OF THE TONGUE to position food on teeth
Bulging forward of the soft palate for a seal

Front 15

What occurs during the oral stage of swallowing?

Back 15

Tongue shapes, lift, and squeezes the bolus upward and back along the hard palate until food reaches the pharynx

Front 16

Where in the brain mediates the pharyngeal stage of swallowing?

Back 16

Lower brainsteam adjacent to the respiratory center

Front 17

What nerve triggers the pharyngeal stage of swallowing?

Back 17

Glossopharyngeal
Superior laryngeal

Front 18

What are the 5 parts of the pharyngeal stage of swallowign?

Back 18

1. Velopharyngeal closes to prevent backflow of material into nose
2. Tongue base retraction to propel the bolus through pharynx
3. Pharyngeal contraction to clear residue through the pharynx
4. Airway protection: elevation and closure of larynx
5. Cricopharyngeal or UES opening to allow bolus to pass into esophagus

Front 19

How long does the esophageal stage of swallowing take place?

Back 19

8-20 stages

Front 20

What part of the esophagus has voluntary muscle?1

Back 20

Upper 1/3

The lower 2/3 has involuntary muscle

Front 21

What's the best way to test swallowing function?

Back 21

Modified barium swallow

Front 22

What are the goals of a modified barium swallow?

Back 22

1. Look for abnormalities
2. Identify, evaluate treatments

Front 23

What are the categories of oropharyngeal dysphagia?

Back 23

Neurologic
Infectious
Tumor/mlignancies
Systemic disorders
Anatomic abnormalities
Pharmoacologic
Idiopathic

Front 24

What's the most common neurologic cause of oropharyngeal dysphagia?

Back 24

Cerebrovascular accident

Front 25

What are the abnormalities in a cerebrovascular accident?

Back 25

Delayed initiation of pharyngeal stage of swallow
Decreased pharyngeal transit time
Aspiration pneumonia

Front 26

What are the most common nerves injured that cause dysphagia?

Back 26

CNIX, X

CNVII

Front 27

Where would a tumor be located that could cause damage to CNIX or X?

Back 27

Skull base

Front 28

What are causes of CNVII paralysis?

Back 28

Bell's
Trauma
Infeciton
Tumor

Front 29

What is the impact of CNVII paralysis on swallowing?

Back 29

Impaired oral closure, bolus control

Front 30

What is Ludwig's angina?

Back 30

Cellulitis in the submandibular space: pushes the tongue into the airway

Front 31

What are findings in ludwg's angina?

Back 31

Facial,"", muscle, connective tissue involvement
Dysphagia
"Hot potato" voice
Trooling

Tachypnea
Dyspnea
Stridor

Front 32

What are the findings in peritonsillar abscess?

Back 32

Fever
Malaise
Dysphagia
Hot-potato voice
Bulging of superior tonsil pole and soft palate

Front 33

What are causes of dysphagia from cancer?

Back 33

Surgery
Radiotherapy

Front 34

What are some systemic diseases that can cause problems swallowing?

Back 34

Iron deficiency: Plummer-Vinson syndrome
Sjogren's: not enough saliva for you to swallow well.

Front 35

What are some anatomic causes of dysphagia?

Back 35

Laryopharyngeal reflux
GERD
Zenker's diverticulum
Cervical spine osteophytes
Tracheotomy

Front 36

What is Reinke's edema?

Back 36

Edema/floppiness of the vocal folds

Front 37

What are some otolaryngologic manifestations of GERD?

Back 37

Edema
Nodules
Stenosis
Sinusitis
Caries

Front 38

What happens in cricopharyngeal achalasia?

Back 38

Prominent cricopharyngeus causes dysphagia by a failure of adequate opening of the pharyngoesophageal segment

Front 39

Where does Zenker's diverticulum occur?

Back 39

Posteriorly

In Killian's triangle between inferior constrictor and cricoparyngeus

Front 40

What's a classic history for Zenker's diverticulum?

Back 40

Coughing up of food that they had 3 hours ago with undigested food

Dysphagia

Special maneuvers to dislodge food

Front 41

What is the pathophys of Zenker's?

Back 41

Abnormal time of deglutition
Incomplete CP muscle relaxation

Front 42

What's the treatment for Zenker's diverticulum?

Back 42

Cricopharyngeal myotomy alone (most common!)

Front 43

What are some meds that can cause dysphagia?

Back 43

Antibiotics
Anticholinrgics
Antihypertensives