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61 Cards in this Set

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  • Back
What are the phases of the swallow mechanism?
Oral

Pharyngeal

Esophageal
The swallow mechanism involves what cranial nerves? Pharyngeal? Esophageal phase?
Swallow mechanism = 5, 7, 12

Oral = not given

Pharyngeal = 5, 10, 11, 12

Esophageal = Not given
What things occur during the Swallow mechanism?
Oral prep phase --> Under voluntary control, uses CNs 5, 7, 12 --> Chewed food mixes with bolus --> Chewed food mixes with saliva to make bolus --> Bolus sitting between tongue and hard palate in groove formed by tongue
What occurs during the oral phase of swallowing?
Tongue begins ant. to post. pumping motion to move bolus post. --> bolus passes ant. tonsillar pillars --> Diseases in this phase can result with tongue dysfunction, inadequate dentition (impairs bolus formation)
What CNs are active during the pharynegeal phase of swallowing
5, 10, 11, 12
Wat occurs during pharyngeal phase of swallowing?
Larynx rises --> vocal folds close --> epiglottis closes --> soft palate separates nasal cavity from pharynx --> Blous passes through pharyngoesophageal sphincter (UES) into esophagus --> velopharyngeal spincter closes, preventing bolus regurgitation --> tongue and pharyngeal muscles propel bolus --> Larynx is closed off to bolus

Disease here caused by palatal dysfunction, pharyngeal constriction, laryngeal or epiglottic dysfunction
What occurs during the esophageal phase of swallowing?
Food travels to stomach --> Pharyngoesophageal sphincter (PES) open to allow bolus into esophagus

Disease here may be motility disorder or mass/anatomical lesion
Total time it takes for food to get from mouth to stomach?
9 sec
What kinds of things assoc. with swallowing can be affected as we age
Motility of upper esophageal sphincter, Motility of esophageal body, motility of lower esophageal sphincter, changes in sensory function
What things involved in swallowing can change as we age?
Thickening of mucosal coat, swallowing occurs more slowly, initiation of laryngeal and pharyngeal events takes longer, bolus may pool in pockets in pharyngeal recess, food bolus not well prepared to be swallowed, taste/temp/tactile sense change with age, intake may be too rapid, fatigue, change in endurance = inc. rick of aspriation, muscle atrophy
Define Presbyphagia
Changes in mechanism of swallowing of otherwise healthy adult
Does aging itself confer risk of aspiration?
NO, presence of other co-morbidities do
Whats the incidence of dysphagia in elderly?
15%
The causes of dysphagia are divided into what two categories?
Oropharyngeal Dyaphagia (=tongue, pharynx, UES)

Esophageal Dysphaiga (=abnormalities affecting esophagus)
A pt tells you they have trouble swallowing, and food gets stuck in their neck. Is this Oropharyngeal or Esophageal Dysphagia?
Oropharyngeal (or just pharyngeal, since that's where food is sticking)
A pt tells you they have trouble swallowing, and food gets stuck in their sternal area. Is this Oropharyngeal or Esophageal Dysphagia?
Esophageal Dysphagia
Pt had a stroke 3 months ago. What CN's may be affected that could also affect their ability to swallow?
5, 7, 9, 10, 12
T/F: Evidence of swallowing disorder is noted in 51% of pts who had had a stroke
TRUE
A pt presents with myasthenia gravis. What aspect of this disease can affect their swallowing?
Bulbar muscle weakness can cause dysphagia and dysarthria

Atrophy of tongue
T/F: Dysphagia develops in 50% of Parkinson's pts
TRUE
Pt presents with Parkinson's. Which phase of swallowing will be affected?
Pharyngeal
Pt presents with mutiple sclerosis. What aspect of swallowing will be affected?
Bulbar (= a portion of the brain that contains specific CNs 9, 10, 11, 12)
Idiopathic Upper Esophageal Sphincter Dysfunction is a problem with what in terms of swallowing?
Cricopharyngeal dysfunction

Muscles can't synchronize with other aspects of swallowing
List some examples of Local Structural Lesions that can affect swallowing
Head and Neck tumors, abcess, congenital web, previous sx, enlarged thyroid, cervial osteoarthopathy
Define Zenker Diverticulum
Out-pouching in Post. pharyngeal wall above UES
Which is Zenker diverticulum more common in, males or females?
males
Symptoms of Zenker divertuculum?
Cough, fullness/gurgling in neck, postprandial (=after meal) regurgitation, aspiration

If large enough, can produce a visible mass
Define Vascular Compression
When the aorta compresses the esophagus
Define Dysphagia Aortica
Hypertensive pts Aorta compresses esophagus
Esophagus is indented on radiograph. Barium swallow shows partial esophageal obstruction, pulsatile movement of barium synchronous with aortic pulsation. Endoscopy notes stenosis, band-like pulsatile extrinsic compression, and kinking of the esophagus. Dx?
Vascular compression via aorta of esophagus
T/F: Meds can cause esophageal injury for many reasons like sustained-release preps, large pills, sticky, pts. position at time of ingestion, vol. of fluid ingested with drug
TRUE
T/F: Alendronate, given to pts for osteoporosis, can cause esophageal dysfunction
TRUE
Pt complains of dysphagia for ONLY solids. Is this a structural or motor disorder?
Solids = Structural disorder

For ex., pt has trouble swalling biscuit in AM, but NOT AM tea.
Pt complains of dysphagia for solids AND Liquids. Is this a structural or motor disorder?
Motor
You see "bird's beak" on barium swallow. Dx?
Dysphagia (Achalalsia)
How does peptic stricture present?
Esp. occurs in older men

Progressive dysphagia for solid food with history of heartburn and other symptoms of GERD
Your pt has a stroke, has neurodegenerative disease (Alzheimers, parkinson's, MS, myopathies), Meds, esophageal/laryngeal peristalsis, delayed neuromuscular response, esophageal injury/inflamm
These are all risk factors for dysphagia
T/F: Alendronate is a drug that can cause Dysphagia
TRUE
Most common symptoms of Dysphagia
Choking, pocketing of food/pills, delay in triggering swallow, neck pain, chest pain, heart burn, weight loss, spitting, drooling, rocking tongue back and forth, lasting low grade fever, pneumonia, malnutrition/dehydration
Solid food stops in your pts mouth. Is this a mechanical or neuromuscular dysfunction?
Mechanical
Pt complains of solid and liquid food dysfunction when they try and swallow. Is this a mechanical or neuromuscular dysfunction?
neuromuscular

Solids = structural disorder, solids AND liquids = motor disorder
What question do you ask to screen your pt for dysphagia?
Do you have trouble eating?
Tests for Dysphagia?
Modified barium swallow, Standard barium swallow, Fiberoptic endoscopy
Whats the best first test for dysphagia? [IF pt does NOT have Hx of surgery for laryngeal or esophageal cancer, Hx of radiation/caustic injury, or you suspect achalasia (=esophageal dysfunction)]
endoscopy (otherwise do barium swallow)

NO dysphagia = rings symmetrical, no whiteness
What will we see in endoscopy when a pt has a long Hx of GERD?
irritated esophagus, whiteness, less pronounced rings
Iron deficiency can cause what in the esophagus?
Webs
Whats the goal of Dysphagia treatment?
Optimize safety, maintain adequate nutrition and hydration, improve oral hygiene
What types of things can the oral pathologist do with a pt?
oral stimulation, pharyngeal and laryngeal stimulation, position/posture, direct swallow exercises, compensatory strategy education, on-going restorative interventions
What are some of the things involved in treating Dysphagia?
Dietary modification
Agressive oral care
modify eating environment
oral hygiene
interdisciplinary
speech pathologist, dietician, OT, PT, nurse, oral hygienist, dentist, etc.
Meds, evaluate quality of life, ACE inhibitors,
What is SWAL-QOL?
"SWAL-QOL= swallow quality" ....Dysphagia-specific patient-centered quality of life instrument

(monitor longitudinal course of treatment for both function and quality of life)
What are some treatment options for Achalasia = esophageal dysfunction?
soft food, anticholinergics, calcium channel blockers

Invasive: dilation, botulinim toxin injections, heller's myotomy
Whats the main goal of non-fixable dysphagia treatment?
enhanced quality of life

May have to tube feed
What are some complications of dyphagia?
pneumonia, aspiration
Whats the leading cause of death in residents of nursing homes?
aspiration pneumonia
Describe the F309 Rule
Each resident must receive and the facility must provide the necessary care and services to attain the highest practicable physical, mental and psychosocial well-being, in accordance with the comprehensive assessment and plan of care. Very encompasing, highest possible functioning and well-being, limited by individual recognized pathology and normal aging process. Unavoidable or avoidable decline, lack of improvement
Describe the F325 Rule
Based on comprehensive assessment of resident, facility must ensure resident maintains acceptable parameters of nutritional status, such as body weight and protein levels, unless resident's clinical condition makes this not possible.

Address risk factors for malnutrition, meet resident's ordinary and special dietary needs, treatable causes, monitor progress
T/F: Oropharyngeal dysphagia may be life-threatening
TRUE
IF a pt has a Hx of surgery for laryngeal or esophageal cancer, Hx of radiation/caustic injury, or you suspect achalasia (=esophageal dysfunction)...whats the best first study?
Barium swallow
Question: Pt. has a stroke and infarction, and a tube is placed for 2 weeks, b/c of pneumonia. They are in hospital and have a dec. Gag reflex. What test can you do for them?
Video flouroscopy
If pt does NOT have Hx of surgery for laryngeal or esophageal cancer, NO Hx of radiation/caustic injury, or you do NOT suspect achalasia (=esophageal dysfunction)...whats the best first study to do?
Endoscopy
As we age, what happens to auerbach plexus and mesenteric plexus?
Changes in auerbach's plexus ie mesenteric plexus = muscle don't work as well = don't contract as well = cut food up into smaller pieces