Diseases of the Oropharynx Flashcards
What is the main clinical sign of disease in the oropharynx?
dysphagia (commonly mistaken for regurg
What is the oropharynx bound by dorsally, ventrally and laterally?
Dorsal: soft palate
Ventral: root of tongue
Lateral: tonsillar fossae
What are functional causes of dysphagia?
Functional causes of dysphagia are usually secondary to a neurologic or muscular disturbance
If a patient is struggling to keep down solids, what is most likely the cause of the disease?
Structural disease
ex. neoplasia
If a patient cannot keep down liquids, what is most likely the cause of the disease?
functional disease
If a patient has difficulty seconds after eating, where should we suspect the problem to localize to?
oropharyngeal region
If a patient appears to struggle 10-15 sec - hours after attempting to eat where should we suspect the problem to be localized to?
proximal esophagus if its a matter of seconds
distal esophagus if its closer to hours
A patient with a history of what drugs may develop an esophageal stricture?
doxyxycline or clindamycin
(was the p recently intubated? can also lead to regurg then stricture)
Describe oropharyngeal dysphagia
difficulty with prehension and abnormal transport through the upper esophageal sphincter
What are some clinical signs of oropharyngeal dysphagia while eating?
retching
gagging
repeated swallowing
food coming out of nose - patients can’t swallow and move food into the esophagus
-exaggerated swallowing movements and food will usually drop from the mouth within seconds of prehension
What must relax in order for the patient to swallow?
cricopharyngeal muscle
What are clinical signs of neurogenic dysphagia?
What are clinical signs of Cricopharyngeal dysphagia?
Patients struggle more with liquid - remember functional problem
What functional disorder is caused by the failure of the UES to relax (achalasia) or a lack of coordination between the UES relaxation and pharyngeal contraction?
Cricopharyngeal dysphagia
What species are predisposed to the congenital or aquired neuromusclar disorder of the upper esophageal sphincter?
Dachshunds and golden retrievers
If I suspect cricopharyngeal dysphagia in my patient, what diagnostics should I perform?
I need to perform a swallow contrast videofluoroscopy
If cricipharyngeal dysphagia is on my differnetial lsist, what conditions do I need to R/o?
myopathy or polyneuropathies
myasthenia gravis
Autoimmune myositis and muscular dystrophy
muscle biopsy
hypothyroidism
Describe to your client the surgical treatment for cricopharyngeal dysphagia
we will conduct a surgical myotomy of the cricopharyngeal muscle i.e we will cut this muscle to allow for better passage of food
If my client declines surgical repair for cricopharyngeal dysphagia, what are their other options?
gastrostomy tube or injection of botulinum toxin into the muscle- however this is temporary
What is the only diagnostic test to evaluate functional dysphagias?
barium contrast videofluroscopy
