13 - Dysphagia

Question 1

What is dysphagia?

Answer 1

Difficulty chewing or swallowing

Question 2

What is a risk factor for dysphagia?

Answer 2

GERD

Question 3

How is dysphagia diagnosed?

Answer 3

• Evaluation by a speech language pathologist

- Official diagnosis by a physician based on evaluation by SLP

Question 4

What are the 3 phases of swallowing?

Answer 4

1) Oral
2) Pharyngeal
3) Esophageal

Question 5

What occurs in the oral phase of swallowing?

Answer 5

• Food is chewed and mixed w/ saliva to form bolus
• Voluntary swallowing is initiated and tongue pushes bolus posterior towards pharynx, stimulating several receptors to start swallowing process

Question 6

What occurs in the pharyngeal phase of swallowing?

Answer 6

• Swallowing response stops breathing and raises larynx for bolus to pass
• Bolus transported by peristalsis across closed vocal folds and epiglottis into esophagus through cricopharyngeal sphincter

Question 7

What occurs in the esophageal phase?

Answer 7

Peristalsis drives bolus through lower esophageal sphincter into stomach

Question 8

What are the 3 main sources of dysphagia?

Answer 8

1) Neurological
2) Physical/structural disease or injury
3) Psychogenic conditions

Question 9

What are acquired neurological causes?

Answer 9

Coming from or relating to a disease, condition, or characteristic that develops after birth

Question 10

What are some acquired neurological causes of dysphagia?

Answer 10

• CVA (stroke)
• Head trauma
• Polio

Question 11

What are some congenital neurological causes of dysphagia?

Answer 11

• Cerebral palsy

- Musculoskeletal abnormalities at birth

Question 12

What are some degenerative neurological causes of dysphagia?

Answer 12

• ALS
• Parkinson’s
• Huntington’s
• MS

Question 13

What are some physical/structural diseases or injuries that cause dysphagia?

Answer 13

• Trauma
• Poorly fitting dentures
• Gum disease
• Generalized weakness

Question 14

What are some psychogenic causes of dysphagia?

Answer 14

• Emotional disturbances
• Developmental delay
• Medication induced
• Psychiatric diagnosis

Question 15

What some oral stage symptoms?

Answer 15

• Poor lip closure
• Drooling or excessive secretions
• Reduced chewing ability
• Pocketing of food on weak side
• Reduced tongue functino
• Dry mouth
• Food and liquid residue remains on tongue and/or roof of mouth after swallowing
• Increased time to complete meal safely and enjoyably
• Fatigue as meal progresses

Question 16

What are some pharyngeal stage symptoms?

Answer 16

• Choking
• Coughing or throat clearing before, during, or after swallowing food or liquid
• Hoarse, wet voice after swallows
• Complaints of food getting “stuck in throat”
• Nasal regurgitation of food
• Difficulty managing secretions

Question 17

What are the main focuses of dysphagia tx?

Answer 17

• Swallowing rehab
• Posture
• Food texture
• Feeding tools
• Oral strength
• Physical strength and coordination
• Behaviour modification
• Medication management

Question 18

What are some drug treatments for achalasia (disorder of lower esophageal sphincter)?

Answer 18

• Anticholinergics

- Calcium-channel blockers

Question 19

What are some drug treatments for diffuse esophageal spasm?

Answer 19

• Nitrates
• Calcium-channel blockers
• Sildenafil

Question 20

What are some drug treatments for eosophilic esophagitis?

Answer 20

• Proton pump inhibitors

- Topical steroids

Question 21

What are some drug treatments for infectious esophagitis?

Answer 21

• Antivirals

- Antifungals

Question 22

What are some drug treatments for peptic stricture?

Answer 22

PPI

Question 23

What are some drug treatments for scleroderma (systemic tissue sclerosis)?

Answer 23

• Antisecretory drugs

- Systemic medication management of scleroderma

Question 24

What are some drug treatments for hypersecretion?

Answer 24

Anticholinergics