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GIR Test 3 > B5.056 Dysphagia (ENT) > Flashcards

B5.056 Dysphagia (ENT) Flashcards

1
Q

salivary glands

A

parotid
submandibular
sublingual
minor

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2
Q

functions of saliva

A 
antibacterial
antiviral
antifungal
buffering
mineralization
lubrication
digestion
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3
Q

parotid gland saliva properties and innervation

A

serous, water
parasympathetic - CN9
sympathetic- superior cervical ganglion via external carotid

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4
Q

submandibular gland saliva properties and innervation

A

mixed, semi-viscous
parasympathetic- CN 7 (chorda tympani)
sympathetic- superior cervical ganglion via lingual artery

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5
Q

sublingual gland saliva properties and innervation

A

mucous, viscous
parasympathetic- CN 7 chorda tympani
sympathetic- superior cervical ganglion via facial artery

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6
Q

minor gland saliva properties and innervation

A

mucous, viscous
parasympathetic- multiple CN
sympathetic- superior cervical ganglion via external carotid

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7
Q

parasympathetic stimulated saliva

A

large volume, watery

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8
Q

sympathetic stimulated saliva

A

low volume, proteinaceous

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9
Q

neuromuscular control of oral and oropharyngeal swallow

A 
5 cranial nerves
-pons = 5,7
-medulla = 9, 10, 12
spinal nerves = C1-C3
27 unique muscle
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10
Q

innervation of masticatory muscles

A

5

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11
Q

innervation of tongue muscles

A

12

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12
Q

innervation of suprahyoid muscles

A

5, 7, 12

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13
Q

innervation of palatal muscles

A

9, 10, few 5

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14
Q

innervation of pharyngeal muscles

A

9, 10

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15
Q

innervation of infrahyoid muscles

A

10

C1-3

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16
Q

function of trigeminal nerve (5)

A

sensation

anterior 2/3 tongue and palate

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17
Q

function of facial nerve (7)

A

taste

anterior 2/3 tongue

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18
Q

function of glossopharyngeal nerve (9)

A

taste and sensation

posterior tongue and oropharynx

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19
Q

function of vagus nerve (10)

A

taste and sensation

larynx (epiglottis)

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20
Q

function of larynx in swallowing

A

must move out of the way for safe swallowing

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21
Q

sensation above the vocal chords

A

superior laryngeal nerve (comes off of vagus)

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22
Q

sensation at and below the vocal chords

A

recurrent laryngeal nerves

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23
Q

most important function of the vocal chords in a swallow

A

thyroarytenoid muscle ADDucts to close chords and prevent aspiration
innervated by recurrent laryngeal nerve

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24
Q

describe the UES structure

A

2-4 cm high pressure zone between pharynx and upper esophagus
ventrally cartilaginous
dorsally muscular: inferior pharyngeal constrictor and cricopharyngeus
innervated by CN 9 and 10

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25
Q

what stimulates UES opening

A

cricopharyneal relaxation + passive opening

stimulated by swallowing, mastication, vomiting, belching

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26
Q

what stimulates UES contraction

A

esophageal distention
intraesophageal acid infusion
emotional stress

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27
Q

esophagus anatomy

A

18-22 cm
stratified squamous epithelium
internal circular muscle (upper 1/3 stratified, lower 2/3 smooth)
external longitudinal muscle fibers (skeletal)
NO SEROSA

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28
Q

physiological narrowings of esophagus

A

cricopharyngeus
aortic arch/ left mains tem bronchus
LES

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29
Q

sympathetic innervation of the esophagus

A

DRG TI-9
reduce peristalsis
increase LES pressure

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30
Q

parasympathetic innervation of the esophagus

A

CN 10
increased peristalsis
decreased LES pressure
increased secretion

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31
Q

phases of swallow

A 
preparatory
-salivation
oral
-preparation
-propulsion
pharyngeal 
-conduit for airflow to and from the respiratory
-conduit for passage of food liquid to the esophagus
esophageal
-propulsion/peristalsis
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32
Q

how much saliva do we make per day

A

1-1.5L

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33
Q

where is unstimulated saliva from

A

70% from submandibular gland

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34
Q

where is stimulated saliva from

A

70% from parotid gland

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35
Q

pharyngeal phase of swallowing

A

under reflexive control (nonvoluntary)
CN 9 in healthy patients
respiration function ceases
1 second

36
Q

process of laryngeal closure

A 
epiglottic inversion
false cord closure
true cord closure
UES relaxes
larynx moves anterior and superior out of path of bolus
37
Q

3 types of esophageal contractions

A

primary- in response to food entering esophagus, circular muscle contraction wave, longitudinal muscle contraction
secondary- occur with esophageal distention
tertiary- non peristaltic, pathogenic

38
Q

general prevalence of dysphagia

A

2-10%

39
Q

prevalence of dysphagia in the elderly

A

11-35%

40
Q

prevalence of dysphagia in elderly patients with significant co-morbidities

A

55%

41
Q

coughing with meals, recurrent pneumonia

A

aspiration

42
Q

odynophagia

A

foreign body
inflammation
tumor

43
Q

regurgitation of undigested food

A

diverticulum

stricture

44
Q

drooling

A

oral incompetence (neuro)

45
Q

fatigue, hair loss, weight gain

A

hypothyroidism

46
Q

voice changes

A

vocal chord paralysis

47
Q

contributing co morbidities to dysphagia

A 
recurrent pulmonary infections
reflux/GERD
foreign body or caustic ingestion
malignancy risk factors (smoking, alcohol)
neuro disorders
autoimmune diseases
H&N surgery
48
Q

pathologies associated with CN 7

A

decreased labial closure

associated w drooling

49
Q

pathologies associated with CN 5/9/10 (palate)

A

decreased gag reflex

decreased palate elevation (uvula points to functional side)

50
Q

pathologies associated with CN 12

A

tongue protrudes toward weak side

atrophy of weak side with prolonged denervation

51
Q

what is a clinical swallow exam

A

performed by SLP
clinical exam of facial, lip, tongue, pharyngeal, laryngeal and resp control
may include trials of liquids or purees

52
Q

advantages of swallow eval

A

can identify some pathologies

can identify who need further work up

53
Q

disadvantages of swallow eval

A

absence of cough during trial does not = safe swallow

some silently aspirate

54
Q

what is a functional endoscopic evaluation of swallow (FEES)

A 
performed by SLP
assess pharyngeal phase
transnasal placement of scope
patient swallows colored/dyed foods
assessment based on presence of residual food in pharynx or evidence of aspiration
55
Q

advantages of FEES

A

done at bedside
direct visualization
no body habitus limitations
can test laryngeal adductor reflex

56
Q

disadvantages of FEES

A

cannot assess oral or esophageal phase

loss of image during initiation of swallow

57
Q

what is a modified barium swallow (MBS)

A

performed by SLP and radiologist
only study that allows for assessment of all phased of swallow
pt seated and attempts serial swallowing trials with measured amounts of liquid/food of different consistencies
treatment/compensatory techniques can be tried to assess outcomes

58
Q

what is an esophagram

A

assess esophageal phase
esophagus must be distended
patient lays supine to eliminate effects of gravity
most images in AP plane

59
Q

what is aspiration

A

inhalation of oropharygeal or gastric contents below level of vocal chords
occurs more commonly with liquids

60
Q

zenkers diverticulum

A

posterior

between inferior constrictor and cricopharyngeus

61
Q

killian-jamieson diverticulum

A

lateral
between cricopharyngeus and circular esophageal fibers
RLN and inferior thyroid artery

62
Q

cricopharyngeal bar

A

present in 5-19% of patients undergoing fluoroscopy

obstruction of UES that blocks => 50% of lumen throughout swallow

63
Q

esophageal stricture

A

etiologies: radiation, caustic ingestion, anastomotic stricture, peptic injury

64
Q

gold standard to image dysmotility and outlet obstructions

A

manometry

65
Q

when would you suspect dysmotility

A

solid > liquid dysphagia

66
Q

types of obstruction

A

achalasia

EGJ outlet obstruction

67
Q

motility disorders

A

jackhammer esophagus
distal esophageal spasm
ineffective esophageal motility
fragmented motility

68
Q

advantages of videofluoroscopy

A

can identify pathophysiology of dysphagia
can assess all phases of swallow
can assess CP function

69
Q

limitations of videofluoroscopy

A

use of radiation
patient must be able to sit upright
barium tastes gross
limited mucosal assessment

70
Q

types of endoscopy

A

laryngoscopy

esophagoscopy

71
Q

advantages of endoscopy

A

visualization of mucosa

ability to biopsy and intervene

72
Q

disadvantages of endoscopy

A

invasive procedure

limited assessment of function

73
Q

what does high resolution manometry (HRM) show

A

UES (coordination, strength, pressure, timing)
esophagus (peristaltic coordination)
LES (basal and relaxation pressures)
pharynx coming soon

74
Q

how are esophageal motility disorders classified

A

Chicago classification

algorithm that helps diagnose

75
Q

reasons to get an H&N CT/MRI

A

suspect stroke
cranial neuropathies without clear etiology
obvious H&N mass that needs to be evaluated

76
Q

what are some rehab/therapy options for dysphagia

A

directed by SLP
change consistencies of food
strengthening exercises
compensatory strategies and posture

77
Q

medical management of dysphagia

A

treat reversible conditions (infection, autoimmune disorders, hypothyroid)
optimize nutrition
directed pharma interventions (GERD, CCBs or nitrates for esophageal spasm, botox)

78
Q

how does botox work

A

prevents exocytosis of ACh into nerve terminals

results in flaccid paralysis

79
Q

surgical treatment for strictures

A

dilation

80
Q

3 treatment options for cricopharyngeal bar

A

dilation
botox
CP myotomy

81
Q

adv and disadv of dilation

A

adv: low did
disadv: may not provide much relief

82
Q

adv and disadv of botox

A

adv: low risk, temporary effects?
disadv: temporary effects (3 months), can effect swallowing muscles and make dysphagia worse

83
Q

adv and disadv of CP myotomy

A

adv: affects only the UES musculature, causes 50% reduction in UES tone
disadv: higher morbidity, permanent

84
Q

when do you do an open resection of a diverticula

A

killian-jamieson

endoscopic felt to be risky due to possibility of RLN injury

85
Q

surgical options for treatment of aspiration

A

tracheotomy
feeding tube
laryngeal durgery

86
Q

endoscopic Zenkers procedure

A

staple diverticulum shut to provide a smooth passage for food

GIR Test 3 (19 decks)

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