Dysphagia

Question 1

Which muscles are involved in swollowing?

Answer 1

Çiğneme kasları superficial ve deep olmak üzere 2ye ayrılır.-
Superficial olanlar masseter ve temporalis.
Deepler medial ve lateral pterygoid muscles.
Dilin intrinsic kasları superior longitudinal,vertical,transverse,inferior longitudinal,ekstrinsik kasları palatoglossus,styloglossus,hyoglossus,genioglossus.
Farenksin constrictor kasları yutmada görev alır
Özofagus üst 1/3 ü iskelet kasından altı düz kastan oluşur. Serozası yoktur. Dışı longitudinal içi sirkular kastır. Myenteric plexus of Auerbach, parasympathetic ganglion cells, Submucosal myenteric plexus of Meissner (parasympathetic ganglion cells

Question 2

Which cranial nerves are involved in swollowing?

Answer 2

CN5 (trigeminal)-motor ve duyu.Çiğnemede önemli.
CN7 (facial)-motor ve duyu.Orofarenksin duyusu ve dil ön 2/3 tatta önemli.
CN9 (glossopharyngeal)-motor ve duyu.Farenksin motor ve duyusu,dil arka 1/3 tat.
CN10 (vagus)-motor ve duyu.important for taste to oropharynx, larynx and laryngopharynxin motor ve duyusu. Havayolu korunması için önemli.
CN12 (hypoglossal)-dil motor
5,7,9,10,12 medullada nucleuas. C1-C3 kas hareketleri.

Question 3

Which phases exist in swollowing?

Answer 3

Yutma 3 fazdan oluşur oral(tek volunter faz),pharyngeal(1 SANİYE),özofageaL(8 SANİYE)

Question 4

What are the most common causes of dysphagia?

Answer 4

The most common causes of dysphagia in young people include inflammatory muscle diseases, webs and rings.
In older persons, oropharyngeal dysphagia is usually caused by CNS including strokes, Parkinson’s and dementias. Esophageal dysphagia commonly results from reflux esophagitis, motility disorders and tumors.

Question 5

comp. of dysphagia

Answer 5

Dysphagia complications:Pneumonia from aspiration, Malnutrition, Dehydration, Reduced quality of life
Öyküde öğünlerinin süre olarak uzunluğunu, beslenmede katı sivı tercih değişikliği olup olmadığını, yemeğin nerde takılı kaldığını, konuşmada disartri olup olmadığı konuşma hızını, seste hipotonisite ya da spastisite olup olmadığına baktıktan sonra farenjial ve larenjial endoskopi.

Question 6

Tx modalities of dysphagia

Answer 6

1- FEES/FEESST Direct visualization of the oropharynx in action with and without swallowing, using a fiberoptic scope inserted nasal (Oropharyngeal dysphagia evaluation test) Flexible Endoscopic Evaluation of Swallowing. VFSSnin radyoaktif olmayan, ucuz, hızlı sonuç veren alternatifidir.Oral faza bakmaz farenjial faz da yarım. FEES is a two part test. The first part of the test assesses sensation in the larynx in order to illicit an airway protective reflex. The second part giving food (green food coloring mixed) and watching/ tracking where the food travels in the throat region. Compensatory strategies/postures are attempted to reduce risk aspiration.
2. Video Fluoroscopic Swallowing Study (VFSS)-gold standart for oropharenjial disfaji. Diğer adı modifiye barium swallow.Çeşitli formda gıdalar yutuluyor.Rezidüel materyal,aspirasyon.Dinamik bir testtir.Çene hareketleri vs.
3. Barium swallow studies:Initial recommended test if esophageal dysphagia is suspected.Suspected obstructive lesion (e.g., Schatzki’s ring, tumor) OR esophageal motility disorder
4. EGD/TNE(Esophagogastroduodenoscopi)(transnazal)
Suspected acute obstructive lesion (impacted food bolus).Evaluation of the esophageal mucosa
Confirmation of a positive barium study with biopsies or cytology
5. Manometry- Abnormality not identified on barium study or by endoscopy