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60 Cards in this Set

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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.
Oral phase
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.
Pharyngeal phase
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.
Esophageal phase
PASSAGE OF FOOD OR NON-FOOD MATERIAL BELOW THE LEVEL OF THE VOCAL FOLDS
ASPIRATION
swallowing disorders are ___________encountered more frequently in rehabilitation medicine than in most other medical specialties.
Neurologic
_________is the leading cause of neurologic dysphagia
Stroke
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.
51-73%
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.
34%
Esophageal-to-pharyngeal backflow due to esophageal abnormality
Tracheoesophageal fistula
Zenker diverticulum
Reflux
symptoms and disorders of the esophageal phase
*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
Differences in Adults vs Infants
Inspiratorystridor(Supraglottic& glottic)
Stridor
Breathing Passage
-Airway protection
-Aid in the clearance of secretion
-Vocalization
Laryngeal Function
Airway obstruction
-Feeding difficulties
-Abnormalities of Phonation
Symptoms of Laryngeal Anomalies
-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
Airway protection
-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
Laryngomalacia
MOVEMENT OF CONTENTS OF THE STOMACH UP AND OUT OF THE STOMACH INTO THE ESOPHAGUS
GASTROESOPHAGEAL REFLUX DISEASE (GERD)
Awake flexible fiberopticlaryngoscopy
Diagnosis of Laryngomalacia
Observation-most cases resolve spontaneously
Treatment of Laryngomalacia
cecal pouch of mucous membrane in anterior roof of the laryngeal ventricle
Saccule
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
Laryngoceles
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
Saccular Cyst
-Intermittent hoarseness and dyspnea
-Weak cry or aphonia
Symptoms of Laryngocele
-respiratory distress with inspiratorystridor
-inaudible or muffle cry
-occasionally dysphagia
Symptoms of Saccular cyst
Treatment of Laryngoceles& SaccularCyst
Third most common congenital laryngeal anomaly producing stridor
Vocal Cord Paralysis
Awake flexible fiberopticlaryngoscopy
Vocal Cord Paralysis Diagnosis
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
Causes of feeding and swallowing problems(infants and children)
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)
Symptoms(infants and children)
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
Treatment(infants and children)
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
feeding therapy(infants and children)
INFLAMMATION OF THE LUNGS
PNEUMONIA
A PROCEDURE IN WHICH AN ENDOSCOPE IS PASSED TRANSNASALLY INO THE PHARYNX FOR ASSESSSMENT OF SWALLOWING
FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING (FEES)
INDICATES THAT SOME SUBSTANCE HAS PASSED INTO THE LUNGS AND IS VIEWED ON X-RAY ; DOES NOT NECESSARILY MEAN THAT IT IS ASPIRATED SUBSTANCE
INFILTRATES (PULMONARY INFILTRATES)
SURGICAL PLACEMENT OF A FEEDING TUBE INTO THE STOMACH FOR NUTRITIONAL PURPOSES
PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG)
AS WE AGE (PRESBY-) THE CONTRACTIONS OF THE ESOPHAGEAL MUSCLES MAY SLOW DOWN
PRESBYESOPHAGUS
IF A PERSON ASPIRATES INTO THE TRACHEA AND DOES NOT COUGH WE REFER TO THSI AS SILENT ASPIRATION
ASPIRATION SILENT
IF A PERSON ASPIRATES AND COUGHS WE REFER TO THIS AS AN AUDIBLE ASPIRATION
ASPIRATION, AUDIBLE
_____________________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.
Diagnostic procedures
this test uses an instrument that measures pressure to identify patterns of muscle contraction that point to various causes of dysphagia
esophagoscopy/endscopy
allows the doctor to examine esophagus through a fiberoptic scope inserted in the nose.
video endoscopic swallowing study(vess)
a liquid containing barium to drink, and a series of x-rays are taken
barium swallow,upper GI series
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
esophageal manometry
A DISORDER OF SWALLOWING
DYSPHAGIA
TUBE FEEDING GIVEN IN A CONCENTRATED DOSE RATHER THAN SPREAD OUT ON A SLOWER DRIP OVER TIME
BOLUS FEEDING TUBE
A CONDITION IN WHICH A PATIENT IS NOT GETTING ENOUGH FLUIDS TO KEEP CELLS HYDRATED
DEHYDRATION
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
MALNUTRITION
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
PARENTERAL NUTRITION
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
UPPER ESOPHAGEAL SPHINCTER (UES)
DRYNESS OF MOUTH
XEROSTOMIA
TONIC CONTRACTION OF THE MUSCLES OF MASTICATION THAT PREVENTS OR MAKES THE MOUTH OPENING DIFFICULT
TRISMUS
a liquid containing barium to drink, and a series of x-rays are taken
barium swallow,upper GI series
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
esophageal manometry
A DISORDER OF SWALLOWING
DYSPHAGIA
TUBE FEEDING GIVEN IN A CONCENTRATED DOSE RATHER THAN SPREAD OUT ON A SLOWER DRIP OVER TIME
BOLUS FEEDING TUBE
A CONDITION IN WHICH A PATIENT IS NOT GETTING ENOUGH FLUIDS TO KEEP CELLS HYDRATED
DEHYDRATION
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
MALNUTRITION
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
PARENTERAL NUTRITION
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
UPPER ESOPHAGEAL SPHINCTER (UES)
DRYNESS OF MOUTH
XEROSTOMIA
TONIC CONTRACTION OF THE MUSCLES OF MASTICATION THAT PREVENTS OR MAKES THE MOUTH OPENING DIFFICULT
TRISMUS