Dysphagia Flashcards
Define dysphagia
Difficulty swallowing d/t problems with transit of food/liquid from mouth to hypopharynx or esophagus
Define Aphasia
Inability to swallow likely d/t an esophageal obstruction
Define Odynophagia
Painful swallowing typically d/t mucosal lacerations
Define Globus Pharyngeus
Foreign body sensation localized in the neck but does not interfere with swallowing. Typically relieved by swallowing
Define Transfer dysphagia
Nasal regurgitation or pulmonary aspiration
Define phagophobia
Fear of swallowing
Describe the physiology of dysphagia
Musculature of the oral cavity, pharynx, upper esophageal sphincter, and cervical esophagus are striated and directly innervated by lower motor neurons. Typically a neuronal innervation issue.
Which two cranial nerves innervate the oral cavity muscles?
CN 5 and 7
Which CN innervates the tongue
CN 12
Which two CN innervate the pharyngeal muscles
9 and 10
UES musculature innervation that facilitates opening during swallowing is due to which 3 CN?
5,7,and 12
What are the two causes of dysphagia and the subtypes?
Structural: Oversized bolus, narrow lumen
Propulsive or motor issues: Abnormalities of peristalsis, impaired sphincter relaxation
Multiple mechanisms: Scleroderma, peptic strictures
What are causes of oropharyngeal phase dysphagia (4)
Iatrogenic, Neurologic, structural lesions, poor food bolus formation and control
What are examples of iatrogenic causes of dysphagia
Surgery
Radiation
What are Neurologic causes of dysphagia
CVA, Parkinson’s, ALS
What are examples of structural lesions that cause dysphagia
Zenker’s diverticulum, cricopharyngeal bar, and neoplasia
What are causes of dysphagia in the pharyngeal phase
Retention in pharynx, poor tongue propulsion, UES obstruction
What is the average esophageal lumen size in a healthy adult and in a constricted adult?
Healthy: ~ 2
Unhealthy: <13mm
What is the most common cause of esophageal dysphagia
Schatzki’s rings
Define Schatzki’s rings
Circular band of mucosal tissue that forms at the distal end of the esophagus narrowing.
Define eosinophilic esophagitis
Chronic immune system disease
Eosinophils build up in the esophagus lining.
What are different diagnostic tests for dysphagia
Upper endoscopy w/ biopsy and histology is the most useful
Esophageal mammography (can confirm dysmotility if inconclusive upper endo)
Barium radiography
Treatment plan for therapeutic, cancers/achalasia, infectious, and eosinophilic dysphagias
Therapeutic: esophageal dilation
Cancers/Achalasia: surgery vs endoscopic techniques
Infectious: Antimicrobials, tx underlying immunosuppressive state
Eosinophilic: Eliminate dietary allergens, swallow topically acting glucocorticoids
