Dysphagia Flashcards
decribe the phases of eating
- cephalic phase:
-sight, smell, procedure
-oral prep - ingestive phase: pharynx back
describe dysphagia
difficulty swallowing
can be broken down to:
- oral
- pharyngeal
- esophageal
all can be associated with increased or decreased appetite
then need to figure out:
-acute or chronic
-mechanical versus functional
-painful versus not painful
-type of food (liquid vs solid)
describe the 4 phases of swallowing
- voluntary: oral
- involuntary:
-pharyngeal, esophageal
describe clinical signs of oral dysphagia
- hyporexic, anorexic, unaware, no interest
- can’t prehend food, trouble chewing, food falls out of mouth, can’t close mouth, can’t form bolus, pain
- cannot grab and cannot chew = oral dysphagia
- most common cause is dental disease!
describe clinical signs of pharyngeal dysphagia
- can’t move bolus
- repeated efforts
- throws head back
- gagging/retching
- dyspnea
- aspiration
describe clinical signs of esophageal dysphagia
- regurgitation: passive bringing back up of food
- coughing
- gagging/retching
describe history of dysphagia
- can you describe what is happening?/how they eat
- how do they do with food versus water?
-mix food with water; does it help? - how long happening? getting worse? comes and goes or persistent?
- any other issues?
- what diet? who feeds? how much? do you see them eat?
- on any medications? (including OTC and supplements!!!!)
describe physical exam for dysphagia
- really good general PE!
- oral
- palpate neck
- neuro! esp cranial nerves!!
- thoracic auscultation: listening for where the noise is loudest, for gurgling in esophagus (fluid + air), also dysphagic patients are very prone to aspiration pneumonia!
describe initial diagnostics for dysphagia
- min database: cause or consequence, esp if chronic
- radiographs
-cervical: FB, masses
-thoracic: FB, esophageal dilation, aspiration pneumonia, metastatic disease
describe advanced diagnostics for dysphagia
- lab testing:
-endocrine: thyroid, adrenal
-neuro: type 2M antibody (masticatory myositis), acetylcholine receptor antibody (myasthenia gravis) - non-sedation/anesthesia visualization: contrast videofluoroscopy
- sedation/anesthesia visualization:
-oropharyngeal exam
-endoscopy
-neuromuscular testing +/- muscle/nerve biopsy
describe ddx for anatomic/obstructive dysphagia
DONT memorize these lists! just be able to localize
oral:
1. dental disease/abscess!!!!!
2. ST swelling (trauma), FB (ALWAYS a possibility)
3. bone/tooth fracture
4. mucositis/pharyngitis
pharyngeal:
1. ST swelling (trauma), FB
2. neoplasia
3. nasopharyngeal polyp
4. nasopharyngeal stenosis
5. sialocele, sialodenitis
6. granuloma
7. TMJ disease
DONT memorize these lists!
describe ddx for functional/dysmotility dysphagia
DONT memorize, just be able to localize
- masticatory myositis
- pharyngeal dysphagia
- polyneuropathy: tick paralysis, tetanus, botulism, rabies
- myasethenia gravis
- cricopharyngeal achalasia
- CNS disease
describe masticatory muscle myositis
autoimmune disease against type 2M antibodies; rotties predisposed
-acute: swollen, painful, very uncomfortable
-chronic: muscle atrophy and scarring/fibrosis = cannot open mouth
diagnosis:
1. clinical signs
2. type 2M antibodies
treatment: immunosuppression
prognosis:
-good if catch in acute phase (low recurrence rates, yay!)
-if get to chronic phase and can no longer open mouth management is difficult (feeding tube, cutting the muscle, etc.)
describe nasopharyngeal stenosis
etiology:
-dogs: reflux under anesthesia
-cats: chronic URI
-hard time breathing = have to work harder to eat and swallow so often present with dysphagia (don’t have enough time to eat while holding breath bc can’t breathe through nose)
clinical signs:
-exaggerated swallow
-open mouth breathing
-stertor
diagnosis: CT, endoscopy
treatment: dilate
describe pharyngeal dysmotility
etiology:
-unknown, prior hx of trauma/inflam?
-usually idiopathic
diagnosis:
-of exclusion!
-esophagram
treatment:
-alter food consistency
-treat aspiration pneumonia when present
prognosis: variable depending on pneumonia
describe cricopharyngeal achalasia
- difficulty swallowing
- cannot move bolus into esophagus
- try different foods!
contrast vomiting versus regurgitation
vomitus: partially/completely digested food
regurgitation: most often undigested food, saliva
