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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
what stimulates UES opening
cricopharyneal relaxation + passive opening | stimulated by swallowing, mastication, vomiting, belching
26
what stimulates UES contraction
esophageal distention intraesophageal acid infusion emotional stress
27
esophagus anatomy
18-22 cm stratified squamous epithelium internal circular muscle (upper 1/3 stratified, lower 2/3 smooth) external longitudinal muscle fibers (skeletal) NO SEROSA
28
physiological narrowings of esophagus
cricopharyngeus aortic arch/ left mains tem bronchus LES
29
sympathetic innervation of the esophagus
DRG TI-9 reduce peristalsis increase LES pressure
30
parasympathetic innervation of the esophagus
CN 10 increased peristalsis decreased LES pressure increased secretion
31
phases of swallow
``` 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 ```
32
how much saliva do we make per day
1-1.5L
33
where is unstimulated saliva from
70% from submandibular gland
34
where is stimulated saliva from
70% from parotid gland
35
pharyngeal phase of swallowing
under reflexive control (nonvoluntary) CN 9 in healthy patients respiration function ceases 1 second
36
process of laryngeal closure
``` epiglottic inversion false cord closure true cord closure UES relaxes larynx moves anterior and superior out of path of bolus ```
37
3 types of esophageal contractions
primary- in response to food entering esophagus, circular muscle contraction wave, longitudinal muscle contraction secondary- occur with esophageal distention tertiary- non peristaltic, pathogenic
38
general prevalence of dysphagia
2-10%
39
prevalence of dysphagia in the elderly
11-35%
40
prevalence of dysphagia in elderly patients with significant co-morbidities
55%
41
coughing with meals, recurrent pneumonia
aspiration
42
odynophagia
foreign body inflammation tumor
43
regurgitation of undigested food
diverticulum | stricture
44
drooling
oral incompetence (neuro)
45
fatigue, hair loss, weight gain
hypothyroidism
46
voice changes
vocal chord paralysis
47
contributing co morbidities to dysphagia
``` recurrent pulmonary infections reflux/GERD foreign body or caustic ingestion malignancy risk factors (smoking, alcohol) neuro disorders autoimmune diseases H&N surgery ```
48
pathologies associated with CN 7
decreased labial closure | associated w drooling
49
pathologies associated with CN 5/9/10 (palate)
decreased gag reflex | decreased palate elevation (uvula points to functional side)
50
pathologies associated with CN 12
tongue protrudes toward weak side | atrophy of weak side with prolonged denervation
51
what is a clinical swallow exam
performed by SLP clinical exam of facial, lip, tongue, pharyngeal, laryngeal and resp control may include trials of liquids or purees
52
advantages of swallow eval
can identify some pathologies | can identify who need further work up
53
disadvantages of swallow eval
absence of cough during trial does not = safe swallow | some silently aspirate
54
what is a functional endoscopic evaluation of swallow (FEES)
``` 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
advantages of FEES
done at bedside direct visualization no body habitus limitations can test laryngeal adductor reflex
56
disadvantages of FEES
cannot assess oral or esophageal phase | loss of image during initiation of swallow
57
what is a modified barium swallow (MBS)
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
what is an esophagram
assess esophageal phase esophagus must be distended patient lays supine to eliminate effects of gravity most images in AP plane
59
what is aspiration
inhalation of oropharygeal or gastric contents below level of vocal chords occurs more commonly with liquids
60
zenkers diverticulum
posterior | between inferior constrictor and cricopharyngeus
61
killian-jamieson diverticulum
lateral between cricopharyngeus and circular esophageal fibers RLN and inferior thyroid artery
62
cricopharyngeal bar
present in 5-19% of patients undergoing fluoroscopy | obstruction of UES that blocks => 50% of lumen throughout swallow
63
esophageal stricture
etiologies: radiation, caustic ingestion, anastomotic stricture, peptic injury
64
gold standard to image dysmotility and outlet obstructions
manometry
65
when would you suspect dysmotility
solid > liquid dysphagia
66
types of obstruction
achalasia | EGJ outlet obstruction
67
motility disorders
jackhammer esophagus distal esophageal spasm ineffective esophageal motility fragmented motility
68
advantages of videofluoroscopy
can identify pathophysiology of dysphagia can assess all phases of swallow can assess CP function
69
limitations of videofluoroscopy
use of radiation patient must be able to sit upright barium tastes gross limited mucosal assessment
70
types of endoscopy
laryngoscopy | esophagoscopy
71
advantages of endoscopy
visualization of mucosa | ability to biopsy and intervene
72
disadvantages of endoscopy
invasive procedure | limited assessment of function
73
what does high resolution manometry (HRM) show
UES (coordination, strength, pressure, timing) esophagus (peristaltic coordination) LES (basal and relaxation pressures) pharynx coming soon
74
how are esophageal motility disorders classified
Chicago classification | algorithm that helps diagnose
75
reasons to get an H&N CT/MRI
suspect stroke cranial neuropathies without clear etiology obvious H&N mass that needs to be evaluated
76
what are some rehab/therapy options for dysphagia
directed by SLP change consistencies of food strengthening exercises compensatory strategies and posture
77
medical management of dysphagia
treat reversible conditions (infection, autoimmune disorders, hypothyroid) optimize nutrition directed pharma interventions (GERD, CCBs or nitrates for esophageal spasm, botox)
78
how does botox work
prevents exocytosis of ACh into nerve terminals | results in flaccid paralysis
79
surgical treatment for strictures
dilation
80
3 treatment options for cricopharyngeal bar
dilation botox CP myotomy
81
adv and disadv of dilation
adv: low did disadv: may not provide much relief
82
adv and disadv of botox
adv: low risk, temporary effects? disadv: temporary effects (3 months), can effect swallowing muscles and make dysphagia worse
83
adv and disadv of CP myotomy
adv: affects only the UES musculature, causes 50% reduction in UES tone disadv: higher morbidity, permanent
84
when do you do an open resection of a diverticula
killian-jamieson | endoscopic felt to be risky due to possibility of RLN injury
85
surgical options for treatment of aspiration
tracheotomy feeding tube laryngeal durgery
86
endoscopic Zenkers procedure
staple diverticulum shut to provide a smooth passage for food

GIR Test 3 (19 decks)

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