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23 Cards in this Set
- Front
- Back
Oral phase
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The oral phase begins when the tongue moves the bolus posteriorly and ends when the bolus passes the anterior tonsillar pillars.
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Pharyngeal phase
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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. |
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Esophageal phase
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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. |
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Oral phase dysfunction
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Weakness of the labial or cheek muscles leads to malpositioning
Any decreased sensation Tongue dysfunction |
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Pharyngeal phase dysfunction
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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. |
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Aspiration
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Aspiration is a symptom of dysphagia; it can result from dysfunction in either the oral or pharyngeal phases.
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Factors contributing to dysphagia
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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 |
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Disorders associated with dysphagia
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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. |
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History
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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, |
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Physical examination
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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 |
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Videofluoroscopy
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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.
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Barium swallow
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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. |
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Endoscopy
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laryngoscopy, nasopharyngoscopy, oropharyngoscopy, esophagoscopy, and bronchoscopy.
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Treatment
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underlying disorder
Esophageal lesions such as strictures or webs are treated by dilatation. upper esophageal sphincterotomy (often called a cricopharyngeal myotomy) |
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Algorithm
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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 |
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Algorithm 2
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Suspected achalasia
Barium swallow Achalasia-manometry Proximal stricture-endoscopy Abnormal-rings, webs, cancer, Normal-manometry-scleroderma, des, nemd, normal |
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Oral
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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 |
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Symptoms
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○ Loss apetite
○ Nausea ○ Vomiting ○ Weight loss ○ Regurgitation ○ Heartburn ○ Hematemesis ○ Pain |
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Diseases
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○ Diabetes mellitus
○ Scleroderma ○ Sjogren ○ Overlap ○ AIDS |
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Neuromuscular disorders
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○ Stroke
○ Parkinson ○ Myastenia gravis ○ Muscular dystrophy ○ MS |
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Medication
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○ KCl
○ Alendronate ○ FeSo4 ○ Vit C ○ Tetracycline ○ NSAID |
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Odynophagia-pain
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○ Neoplasia
○ Infection ○ Regurgitation ○ Structural change ○ Aspiration |
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Systemic disorders
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○ Neurologic abnormalities
○ Gastrointestinal disfunction ○ Reumatologic |