DSA Dysphagia Flashcards
What is Odynophagia?
Painful swallowing
What is globus pharyngeus?
Sensation of a lump lodged in the throat
Swallowing unaffected
Differentiate between oropharyngeal dysphagia and esophageal dysphagia
Oropharyngeal:
Structural- zenker diverticulum, neoplasm, cervical web
Neurogenic- CVA, Parkinson’s
Esophageal dysphagea:
Propulsive- GERD w/ weak peristalsis
Structural- Schatzki ring, neoplasm, peptic stricture, eosinophilic esophagitis
Structural/ Odynophagia- pill esophagitis, infectious esophagitis
What is included in a bedside evaluation for dysphagia?
Pt condition
Symptoms suggestive of dysphagia or aspiration
Neurologic findings suggestive of dysfunction affecting the swallowing mechanisms
When do you do a modified barium swallow?
To determine cause for and evaluate the severity of tracheal aspiration.
Performed by a speech pathologist and radiologist.
Barium suspensions of varying thickness during fluoroscopy to mimic different food consistencies. Videotaped.
What is included in the bedside swallow assessment?
Cognitive assessment: alert, coherent Posture: upright Respiratory status: breath through nose Speech and Vocal Status: clear vs slurred speech, normal voice vs dysphonia. Cough to clear and retest. Oral mechanism exam
What do you do in the oral trials for a bedside swallow assessment?
Start with water (thin liquid)
Observe the swallowing
Palpate the thyroid notch for rise and fall
Have the pt speak: voice quality? Coughing? Other signs of aspiration
Advance to crackers or graham crackers, repeat
Check for food retained in the oropharynx
What is a Barium Swallow or esophagogram?
Designed to evaluate pharyngeal and esophageal mucosa
Video capture fluoroscopy to study functional dynamics of the pharynx and esophagus
Air contrast (double contrast) makes mucosal surface more distinct
Describe the neuromuscular involvement in swallowing
Sensiromotor control of swallowing involves:
Afferent sensory fibers in CNs
Cerebral and midbrain fibers synapse with brainstem swallowing centers
Paired swallowing centers in the brain stem
Efferent motor fibers in CNs
Muscle and end organs
What innervates the muscles of mastication?
The lips, buccal musculature, orbicularis, and buccinators?
CN V
CN VII
What are some examples of Disease appropriate Hospital Diets?
Clear liquid Full liquid Regular Low residue Low sodium No added salt Cardiac (low sodium and low cholesterol)
What are some mechanical appropriate examples of hospital diets?
Dysphagia diets:
Pureed
Mechanically altered: moist, soft-textured and easily chewed.
Dysphagia advanced: excludes hard, dry, sticky, or crunchy foods
