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Dysphagia > Dysphagia > Flashcards

Dysphagia Flashcards

1
Q

What is dysphagia?

A
  • difficulty swallowing
  • difficulty moving bolus from mouth to stomach
  • not age specific
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2
Q

what are the etiologies of Dysphagia?

A
  • infection
  • structural malformations
  • surgery (thyroid, RLN, cervical)
  • conditions that weaken or damage muscles/nerves (CVA, PD, TBI)
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3
Q

Consequences of Dysphagia:

A
  1. Dehydration
  2. Malnutrition
  3. Aspiration Pneumonia
  4. Quality of Life
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4
Q

Types of Dysphagia:

A
  1. Oral
  2. Pharyngeal
  3. Oropharyngeal
  4. Esophageal
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5
Q

Oral Dysphagia includes?

A

tongue movement, lip closure, pocketing, transport

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6
Q

Pharyngeal Dysphagia includes?

A

airway closure, residues, motility, UES

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7
Q

Esophageal Dysphagia includes?

A

motility, LES, fistula, diverticulum, HCI–reflux; ulcer

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8
Q

Feeding vs. swallowing?

A

feeding is the placement of food in the mouth before initiation of a swallow
vs.
swallowing is the transfer of food/drink from mouth to stomach.

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9
Q

What stage does feeding include?

A

oral prep (salivation, presentation)

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10
Q

what stages does swallowing include?

A
  1. oral stage
  2. pharyngeal stage
  3. esophageal stage
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11
Q

What is included in the oral stage of dysphagia?

A

(time varies with bolus consistency)

  • mastication
  • bolus formation
  • bolus transport from oral cavity to pharynx
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12
Q

What is involved with the pharyngeal stage of dysphagia?

A

( about 1 second)

  1. epiglottis inverts over laryngeal vestibule
  2. larynx and hyoid are pulled anteriorly and superiorly to open the pharynx, relax the cricopharyngeus muscle (UES) and assist the vocal folds in closing off the glottis.
  3. Bolus is propelled through the pharynx towards the esophagus by action of pharyngeal constrictors
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13
Q

What is involved with the esophageal stage of dysphagia?

A

(about 10 seconds)

  1. Bolus flows through esophagus via peristalic contractions of striated and smooth muscle along the esophageal wall.
  2. Relaxation of LES allows bolus to flow into stomach.
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14
Q

Signs and Symptoms of Oral or Pharyngeal Dysphagia:

A
  1. Coughing or choking with swallowing
  2. difficulty initiating swallow
  3. food sticking in throat
  4. Sialorrhea/ xerostomia
  5. drooling or spillage
  6. unexplained weight loss
  7. change in dietary habits
  8. penetration
  9. aspiration
  10. recurrent pneumonia
  11. change in voice (wet, gurgly)
  12. nasal regurgitation
  13. tearing/ nose running
  14. sore throat
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15
Q

S/S of Esophageal Dysphagia:

A
  • Sensation of food sticking in the chest or throat
  • chest pain
  • oral or pharyngeal regurgitation
  • change in dietary habits
  • recurrent pneumonia
  • reflux
  • aspiration
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16
Q

S/S of silent aspiration:

A

No s/s

  • no cough reflex
  • possible signs: tearing, runny nose
17
Q

What takes place in a swallow screening?

A

(10-15 minute administration of a small bolus)

Bedside clinical assessment

  • medical hx
  • level of alertness
  • pt. interview
  • oral motor examination
  • assess swallow with small bolus

Signs and Symptoms:

  • spillage?
  • oral residue?
  • long transit time?
  • cough?
  • throat clear?
  • gurgly voice?
  • tearing?
  • runny nose?
  • wrong sound?

Cannot assess A &P
Pre-dx

18
Q

What is involved in a diagnostic procedure?

A

1.) ID symptoms or explain abnormalities in anatomy and physiology causing dysphagia (etiology)

  1. ) Examines Physiology
    - timing,
    - tongue base motion,
    - epiglottic dysfunction,
    - laryngeal excursion,
    - UES dysfunction,
    - peristalsis,
    - paralysis,
    - sensitivity
  2. Examines immediate effects of treatments
  3. Imaging:
    - FEES/FEEST,
    - Videofluoroscopy
    - ultrasound
    - videoendoscopy
    - scintigraphy
  4. Non-imaging
    - EMG
    - EGG
    - Acoustic (Accelerometer or stethoscope)
    - Pharyngeal Manometry
19
Q

Treatments for Dysphagia:

A
  1. Diet modification
  2. Compensatory
  3. Maneuvers
  4. Exercises
  5. Stimulation
  6. Experiential
  7. Prosthetic
  8. Surgery
20
Q

What is involved in diet modification?

A

-modify volume, viscosity, texture, temperature,

NPO: NG- Tube, G-Tube, PEG, J-Tube, water protocols,

21
Q

What’s involved with compensatory strategies?

A
  • positional
  • postural
  • chin tuck
  • head rotation
  • multiple swallows
22
Q

What’s involved in Maneuvers?

A
  • supraglottic
  • super-supraglottic
  • mendelsohn
  • effortful
23
Q

What’s involved with exercises?

A

shaker, masako, oral muscle strengthening

24
Q

what’s involved with stimulation?

A

thermal/tactile stimulation

25
Q

whats involved with Experimental?

A

Neuromuscular electrical stimulation (NMES):
-includes vitalstim, guardian way, ampcare ESP, eSWALLOW), deep pharyngeal neuromuscular stimulation, Myofascial release, botox

26
Q

what’s involved with prosthetic?

A

palatal lift or obturator ( SLP’s typically refer out)

27
Q

what involved with surgery?

A

CP Myotome, diverticulectomy, dilation

28
Q

Who’s included in the multidisciplinary team?

A
  • slp
  • physician/neurologist
  • nursing
  • dietician
  • OT
  • PT
  • Radiologist
  • Pharmacist
  • Social Worker
  • Psychologist

Dysphagia (7 decks)

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