Pathophysiological Of Swallowing In Infants & Adults

Front 1

Oral-phase disorders affecting the oral preparatory and oral propulsive phases usually result from impaired control of the tongue. Patients may have difficulty chewing solid food and initiating swallows. When drinking a liquid, patients may find it difficult to contain the liquid in the oral cavity before swallowing. As a result, liquid spills prematurely into the unprepared pharynx, often resulting in aspiration.

Back 1

Oral phase

Front 2

If pharyngeal clearance is impaired severely, a patient may be unable to ingest sufficient amounts of food and drink to sustain life. In people without dysphasia, small amounts of food commonly are retained in the valleculae or pyriform sinus after swallowing. In case of weakness or lack of coordination of the pharyngeal muscles, or poor opening of the upper esophageal sphincter, patients may retain excessive amounts of food in the pharynx and experience overflow aspiration after swallowing.

Back 2

Pharyngeal phase

Front 3

Impaired esophageal function can result in retention of food and liquid in the esophagus after swallowing. This retention may result from mechanical obstruction, motility disorder, or impaired opening of the lower esophageal sphincter.

Back 3

Esophageal phase

Front 4

PASSAGE OF FOOD OR NON-FOOD MATERIAL BELOW THE LEVEL OF THE VOCAL FOLDS

Back 4

ASPIRATION

Front 5

swallowing disorders are ___________encountered more frequently in rehabilitation medicine than in most other medical specialties.

Back 5

Neurologic

Front 6

_________is the leading cause of neurologic dysphagia

Back 6

Stroke

Front 7

Approximately ____ of patients with stroke have dysphagia, which is the most significant risk factor for development of pneumonia; this can also delay the patient's functional recovery.

Back 7

51-73%

Front 8

Pneumonia accounts for about ____ of all stroke-related deaths and represents the third highest cause of death during the first month after a stroke, although not all these cases of pneumonia are attributable to aspiration of food.

Back 8

34%

Front 9

Esophageal-to-pharyngeal backflow due to esophageal abnormality
Tracheoesophageal fistula
Zenker diverticulum
Reflux

Back 9

symptoms and disorders of the esophageal phase

Front 10

*1/3 size at birth
*Narrow dimensions of subglottisand glottis
*subglottisis the narrowest (4-5mm in diameter)
*Higher in the neck
*C4 at birth vsC6-7 at 15 y/o
*Epiglottis is narrower

Back 10

Differences in Adults vs Infants

Front 11

Inspiratorystridor(Supraglottic& glottic)

Back 11

Stridor

Front 12

Breathing Passage
-Airway protection
-Aid in the clearance of secretion
-Vocalization

Back 12

Laryngeal Function

Front 13

Airway obstruction
-Feeding difficulties
-Abnormalities of Phonation

Back 13

Symptoms of Laryngeal Anomalies

Front 14

-First level-Epiglottis, aryepiglotticfolds & arytenoids
-Second level-False vocal folds
-Third level-True vocal folds
-Anomalies of any of this structures lead to aspiration and swallowing dysfunction
-Symptoms-coughing, choking and gagging episodes, stasis of secretion, and recurrent pneumonia

Back 14

Airway protection

Front 15

-Most common congenital laryngeal anomaly (50-75%)
-Most frequent cause of stridorin children
-Male predominance 2:1
-Flaccidity of supraglotticlaryngeal tissues
-Characterized by inward collapse of supraglotticstructures during inspiration

Back 15

Laryngomalacia

Front 16

MOVEMENT OF CONTENTS OF THE STOMACH UP AND OUT OF THE STOMACH INTO THE ESOPHAGUS

Back 16

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Front 17

Awake flexible fiberopticlaryngoscopy

Back 17

Diagnosis of Laryngomalacia

Front 18

Observation-most cases resolve spontaneously

Back 18

Treatment of Laryngomalacia

Front 19

cecal pouch of mucous membrane in anterior roof of the laryngeal ventricle

Back 19

Saccule

Front 20

Dilation or herniationof the saccule
-Communicateswith the lumen of the larynx
-Filled by air or mucous
-Internal-extend posterosuperiorinto the aryepiglotticfold
-External-protrude through the thyrohyoidmembrane
-Combined-External + internal

Back 20

Laryngoceles

Front 21

Congenital cyst of the larynx or laryngeal mucocele
-No communicationwith the laryngeal lumen
-Filled with mucous (no air)
-Developmental-failure to maintain patencyof the saccular orifice
-Two types
-Anterior saccularcyst-
-Protrudes into the ventricle
-Lateral saccularcyst
-extends into the false vocal cords and aryepiglotticfolds

Back 21

Saccular Cyst

Front 22

-Intermittent hoarseness and dyspnea
-Weak cry or aphonia

Back 22

Symptoms of Laryngocele

Front 23

-respiratory distress with inspiratorystridor
-inaudible or muffle cry
-occasionally dysphagia

Back 23

Symptoms of Saccular cyst

Back 24

Treatment of Laryngoceles& SaccularCyst

Front 25

Third most common congenital laryngeal anomaly producing stridor

Back 25

Vocal Cord Paralysis

Front 26

Awake flexible fiberopticlaryngoscopy

Back 26

Vocal Cord Paralysis Diagnosis

Front 27

Prematurity Cerebral palsy Autism Head and neck abnormalities Muscle weakness in the face and neck Gastroesophageal reflux Multiple medical problems Respiratory difficulties Medications that may cause lethargy or decreased appetite Problems with parent-child interactions at mealtime

Back 27

Causes of feeding and swallowing problems(infants and children)

Front 28

Poor feeding Difficulty chewing Difficulty drinking from a bottle or cup Difficulty breast feeding Refusing food or liquid Coughing or choking while eating or drinking Excessive drooling and food spilling from the mouth Liquid leaking out the nose Gagging Vomiting during meals Increased congestion during meals Increased fussiness or crying during meals Accepting only certain types of food (only pureed foods or only crunchy foods) Poor weight gain Frequent respiratory infections or pneumonia (may occur when food or liquid is aspirated into the airway, rather than swallowed effectively)

Back 28

Symptoms(infants and children)

Front 29

Medical intervention, as needed Direct feeding therapy designed to meet your child's individual needs Nutritional changes Postural or positioning changes (different seating, etc.) Behavior management techniques Desensitization to new foods or textures Food temperature and texture changes Referral to other disciplines, such as psychology or a dentist

Back 29

Treatment(infants and children)

Front 30

Strengthening the muscles of the mouth Increasing tongue movement Improving chewing patterns Increasing tolerance of different foods or liquids Improving sucking /drinking ability Coordinating the suck-swallow-breathe pattern (for infants) Altering food textures and liquid viscosity to ensure safe swallowing Other interventions depending on your child's specific needs

Back 30

feeding therapy(infants and children)

Front 31

INFLAMMATION OF THE LUNGS

Back 31

PNEUMONIA

Front 32

A PROCEDURE IN WHICH AN ENDOSCOPE IS PASSED TRANSNASALLY INO THE PHARYNX FOR ASSESSSMENT OF SWALLOWING

Back 32

FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING (FEES)

Front 33

INDICATES THAT SOME SUBSTANCE HAS PASSED INTO THE LUNGS AND IS VIEWED ON X-RAY ; DOES NOT NECESSARILY MEAN THAT IT IS ASPIRATED SUBSTANCE

Back 33

INFILTRATES (PULMONARY INFILTRATES)

Front 34

SURGICAL PLACEMENT OF A FEEDING TUBE INTO THE STOMACH FOR NUTRITIONAL PURPOSES

Back 34

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG)

Front 35

AS WE AGE (PRESBY-) THE CONTRACTIONS OF THE ESOPHAGEAL MUSCLES MAY SLOW DOWN

Back 35

PRESBYESOPHAGUS

Front 36

IF A PERSON ASPIRATES INTO THE TRACHEA AND DOES NOT COUGH WE REFER TO THSI AS SILENT ASPIRATION

Back 36

ASPIRATION SILENT

Front 37

IF A PERSON ASPIRATES AND COUGHS WE REFER TO THIS AS AN AUDIBLE ASPIRATION

Back 37

ASPIRATION, AUDIBLE

Front 38

_____________________used in children suspected of oral, pharyngeal, or esophageal motor disorders may include radiography (particularly esophagram or videofluoroscopic swallowing study), manometry, endoscopy of the esophagus or airway (including fiberoptic endoscopic evaluation of swallowing with sensory testing), scintigraphy, esophageal pH-metry or impedance, or central nervous system imaging.

Back 38

Diagnostic procedures

Front 39

this test uses an instrument that measures pressure to identify patterns of muscle contraction that point to various causes of dysphagia

Back 39

esophagoscopy/endscopy

Front 40

allows the doctor to examine esophagus through a fiberoptic scope inserted in the nose.

Back 40

video endoscopic swallowing study(vess)

Front 41

a liquid containing barium to drink, and a series of x-rays are taken

Back 41

barium swallow,upper GI series

Front 42

under sedation, a small tube containing a pressure gauge is guided through the mouth and into the esophagus.The pressure inside the esophagus is then measured to evaluate the esophageal motility

Back 42

esophageal manometry

Front 43

A DISORDER OF SWALLOWING

Back 43

DYSPHAGIA

Front 44

TUBE FEEDING GIVEN IN A CONCENTRATED DOSE RATHER THAN SPREAD OUT ON A SLOWER DRIP OVER TIME

Back 44

BOLUS FEEDING TUBE

Front 45

A CONDITION IN WHICH A PATIENT IS NOT GETTING ENOUGH FLUIDS TO KEEP CELLS HYDRATED

Back 45

DEHYDRATION

Front 46

THE PATIENT IS NOT GETTING ENOUGH FOOD TO MAINTAIN ADQUATE HEALTH OR THE PATIENT'S BODY MAY NOT BE ABLE TO ASBORB AND DISTRIBUTE THE NUTRITION THE PATIENT IS RECEIVING

Back 46

MALNUTRITION

Front 47

A PATIENT'S TOTAL CALORIC NEEDS ARE BEING MET BY INTRAVENOUS ROUTE. A DEEP LINE IS SURGICALLY PLACED INTO THE SUBCLAVIAN ARTERY AND NUTRITION IN A CLEAR SOLUTION IS DELIVERED DIRECTLY INTO THE CHAMBER OF THE HEART; SOMETIMES CALLED TOTAL PARENTERAL NUTRITION (TPN) OR PARENTERAL HYPERALIMANTATION

Back 47

PARENTERAL NUTRITION

Front 48

THE UES IS A GROUP OF MUSCLES AT THE TOP OF THE ESOPHAGUS THAT REMAINS TIGHTLY CLOSED DURING BREATHING, RELAXES BRIEFLY WHEN WE SWALLOW TO ALLOW FOOD TO ENTER THE ESOPHAGUS AND REMAINS TIGHTLY CLOSED AFTER SWALLOWING TO PREVENT FOOD AND LIQUID FROM REGURGITATING BACK INTO THE PHARYNX

Back 48

UPPER ESOPHAGEAL SPHINCTER (UES)

Front 49

DRYNESS OF MOUTH

Back 49

XEROSTOMIA

Front 50

TONIC CONTRACTION OF THE MUSCLES OF MASTICATION THAT PREVENTS OR MAKES THE MOUTH OPENING DIFFICULT

Back 50

TRISMUS

Front 51

a liquid containing barium to drink, and a series of x-rays are taken

Back 51

barium swallow,upper GI series

Front 52

under sedation, a small tube containing a pressure gauge is guided through the mouth and into the esophagus.The pressure inside the esophagus is then measured to evaluate the esophageal motility

Back 52

esophageal manometry

Front 53

A DISORDER OF SWALLOWING

Back 53

DYSPHAGIA

Front 54

TUBE FEEDING GIVEN IN A CONCENTRATED DOSE RATHER THAN SPREAD OUT ON A SLOWER DRIP OVER TIME

Back 54

BOLUS FEEDING TUBE

Front 55

A CONDITION IN WHICH A PATIENT IS NOT GETTING ENOUGH FLUIDS TO KEEP CELLS HYDRATED

Back 55

DEHYDRATION

Front 56

THE PATIENT IS NOT GETTING ENOUGH FOOD TO MAINTAIN ADQUATE HEALTH OR THE PATIENT'S BODY MAY NOT BE ABLE TO ASBORB AND DISTRIBUTE THE NUTRITION THE PATIENT IS RECEIVING

Back 56

MALNUTRITION

Front 57

A PATIENT'S TOTAL CALORIC NEEDS ARE BEING MET BY INTRAVENOUS ROUTE. A DEEP LINE IS SURGICALLY PLACED INTO THE SUBCLAVIAN ARTERY AND NUTRITION IN A CLEAR SOLUTION IS DELIVERED DIRECTLY INTO THE CHAMBER OF THE HEART; SOMETIMES CALLED TOTAL PARENTERAL NUTRITION (TPN) OR PARENTERAL HYPERALIMANTATION

Back 57

PARENTERAL NUTRITION

Front 58

THE UES IS A GROUP OF MUSCLES AT THE TOP OF THE ESOPHAGUS THAT REMAINS TIGHTLY CLOSED DURING BREATHING, RELAXES BRIEFLY WHEN WE SWALLOW TO ALLOW FOOD TO ENTER THE ESOPHAGUS AND REMAINS TIGHTLY CLOSED AFTER SWALLOWING TO PREVENT FOOD AND LIQUID FROM REGURGITATING BACK INTO THE PHARYNX

Back 58

UPPER ESOPHAGEAL SPHINCTER (UES)

Front 59

DRYNESS OF MOUTH

Back 59

XEROSTOMIA

Front 60

TONIC CONTRACTION OF THE MUSCLES OF MASTICATION THAT PREVENTS OR MAKES THE MOUTH OPENING DIFFICULT

Back 60

TRISMUS