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23 Cards in this Set

  • Front
  • Back
Oral phase
The oral phase begins when the tongue moves the bolus posteriorly and ends when the bolus passes the anterior tonsillar pillars.
Pharyngeal phase
begins when the food bolus passes the anterior tonsillar pillars and ends when the bolus passes through the upper esophageal sphincter into the esophagus.
palate elevates and retracts
The laryngeal valves close and the suprahyoid muscles elevate the larynx under the base of the tongue.
During the pharyngeal phase respiration is inhibited.
Esophageal phase
begins when the bolus enters the esophagus and ends when it passes through the lower esophageal sphincter into the stomach.
The upper esophageal sphincter is a zone of high pressure between the pharynx and the esophagus that prevents air from entering the esophagus and helps prevent esophageal contents from refluxing into the pharynx.
Oral phase dysfunction
Weakness of the labial or cheek muscles leads to malpositioning
Any decreased sensation
Tongue dysfunction
Pharyngeal phase dysfunction
limitation in palatal motion
decreased propulsion of the bolus by the pharynx.
poor function of the tongue, decreased pharyngeal constrictor muscle activity, or dysfunction in opening of the upper esophageal sphincter.
Aspiration
Aspiration is a symptom of dysphagia; it can result from dysfunction in either the oral or pharyngeal phases.
Factors contributing to dysphagia
Insertion of a tracheotomy tube
Hyposalivation makes it difficult to initiate a swallow. Radiation therapy often causes hyposalvation and may also lead to tissue edema and fibrosis,
The effect of medications
Disorders associated with dysphagia
Neurologic deficits
Muscular disorders
Zenker's diverticulum is an outpouching of the pharynx, usually between the upper border of the cricopharyngeus muscle and the lower border of the inferior constrictor muscle (Fig. 2). Impaired opening of the upper esophageal sphincter may contribute to its etiology.
Cricopharyngeal achalasia is a rare entity defined as isolated incomplete relaxation
Structural lesions, such as esophageal webs, rings, or strictures, often cause solid food dysphagia.
History
odynophagia is pain on swallowing and is often associated with either neoplasia or infection
The presence of referred pain, such as otalgia, may be caused by a hyopharyngeal lesion.
coughing
Nasal regurgitation and voice change may indicate problems with palatal and vocal cord function,
Physical examination
muscles of facial expression, tongue mobility and strength, and palatal elevation and sensation
A full examination of the nasopharynx, hypopharynx, and larynx is important to determine whether there are any structural or neurologic lesions
Videofluoroscopy
The patient is seated in an upright position and given small quantities of barium in liquid, paste, and solid forms. A camera is focused on the oral and pharyngeal regions throughout the swallow, recording the images on videotape.
Barium swallow
cineradiographic study of the esophagus
Suspected reflux can be accentuated by procedures such as the Valsalva maneuver.
Any patient with dysphagia for solid foods should also undergo a barium swallow as a structural esophageal lesion may not be seen on videofluoroscopy.
Endoscopy
laryngoscopy, nasopharyngoscopy, oropharyngoscopy, esophagoscopy, and bronchoscopy.
Treatment
underlying disorder
Esophageal lesions such as strictures or webs are treated by dilatation.
upper esophageal sphincterotomy (often called a cricopharyngeal myotomy)
Algorithm
Oropharyngeal ot esophageal
Esophageal
Liquid
* Motor
* Intermittent-DES-diffuse esophageal spasm, NEMD-nonspecific motility disorder
* Progressive-heartburn scleroderma, regurgitation-achalasia
Solid
* Mechanical
* Intermittent-esophageal rings
* Progressive-chronic heartburn-peptic stricture
* Elderly, weight loss, anemia- cancer
Algorithm 2
Suspected achalasia
Barium swallow
Achalasia-manometry
Proximal stricture-endoscopy
Abnormal-rings, webs, cancer,
Normal-manometry-scleroderma, des, nemd, normal
 
Oral
Oral
* Muscle weakness
Pharyngeal
* Lead to nasal regurgitation
* Tongue disfunction
* Sphincter disfunction
* Aspiration
* Pharyngeal disfunction
Disorders
* Neurologic deficit
* Muscle disorders
* Dystrphy
* Polimyositis
* Zenker diverticula
* Crycopharingeal achalasia
* Structural lesions
* Webs
* Rings
* Stricture
Symptoms
○ Loss apetite
○ Nausea
○ Vomiting
○ Weight loss
○ Regurgitation
○ Heartburn
○ Hematemesis
○ Pain
Diseases
○ Diabetes mellitus
○ Scleroderma
○ Sjogren
○ Overlap
○ AIDS
Neuromuscular disorders
○ Stroke
○ Parkinson
○ Myastenia gravis
○ Muscular dystrophy
○ MS
Medication
○ KCl
○ Alendronate
○ FeSo4
○ Vit C
○ Tetracycline
○ NSAID
Odynophagia-pain
○ Neoplasia
○ Infection
○ Regurgitation
○ Structural change
○ Aspiration
Systemic disorders
○ Neurologic abnormalities
○ Gastrointestinal disfunction
○ Reumatologic