Dysphagia Flashcards
What is dysphagia?
A difficulty with swallowing.
Name the stages of swallowing.
- Oral Preparatory
- Oral Transit
- Pharyngeal
- Oesophageal
Name the steps to the oral preparatory phase.
See the bolus
Smell the bolus
Production of saliva
Vocal cords adduct (they close to protect the airway)
Lips Abduct
Jaw Abducts
Lips then close (adduct), holding the bolus in the mouth
Tension in labial and buccal musculature (closure of anterior/lateral sulci)- cheeks hold bolus
Rotary motion of jaw (chewing) -jaw openers activate
Lateral Rolling of the tongue, food on teeth (mastication)
Forward bulge of soft palate (seal oral cavity posteriorly.
Name the steps of the oral transit phase.
Tongue lifts, squeezes food bolus upward and backward along the hard palate.
Duration 1-1.5 secs.
Name why people may have problems with the oral transit phase.
-Cancer of the tongue= no tongue strength after chemo.
Name the steps of the pharyngeal phase.
Hyolaryngeal Excursion
Velopharyngeal Closure (nothing from the nose)
Base of tongue to posterior pharyngeal wall approximation
Shortening of the pharynx (contracts)
Airway Protection (eppiglotis tips up and over airway)
Opening of the Upper Oesophageal Sphincter.
What stage of swallowing does this describe?
- Base of tongue approximates palate to contain bolus orally.
- Lingual surface grooves with midline drop to collect bolus
- Midline of tongue elevates and moves bolus between teeth
- Bolus is moved around mouth to breakdown solids (mixes with saliva) and get bolus cohesion
- Tongue tip followed by blade to palate pushes bolus into oropharynx.
Oral Transit phase.
What nerve triggers the pharygeal phase?
Glossopharyngeal Nerve.
What is it important that the swallow center inhibits?
Respiration.
What is it called if food gets into lungs?
Aspiration pneumonia.
If somebody has a problem with protecting the airway, what are they most likely to have problems with?
The epiglottis.
People may have reduced ______ of the bolus going down.
Awareness.
What is the last stage of swallowing?
Oesophageal Stage.
How long does the oesophageal stage last?
8-10 seconds.
Food went down, but stuck, is a problem with what?
Oesophageal Stage.
There are various oesophageal _______.
constrictors.
What is an issue with the oesophageal stage?
It’s less easily examined in clinic. Needs special imaging.
What can be used to examine up to the oropharynx?
Flexiscope.
The flexiscope can only go down to just above the ______.
Larynx.
In order to look further down into the larynx etc. what is used?
A flexible endoscopy.
What is often used to asses the swallow?
Video-fluoroscopy.
As we get older, muscles become loose, what does this sometimes result in?
A pharyngeal pouch.
An endoscopy examines the…
lining of the throat and oropharynx.
Explain videofluoroscopy.
An x-ray video of a swallow
Give patient different textures to swallow
Identify aspiration
Also allows us to see effect of therapy sessions.
What is manometry used for?
To assess muscle coordination.
What is ultrasonography used for?
To assess tongue movement.
Dysphagia disrupts the _______ ______ and it interferes with a patient’s ability to ______.
Swallowing Process
Eat.
With dysphagia, patients often have a sensation of ______.
Delay.
What may having constant dysphagia be a sign off?
Cancer.
Name some problems dysphagia may cause.
Aspiration Pneumonia Malnutrition Dehydration Weight Loss Airway Obstruction
Name the oropharyngeal aetiology of dysphagia.
- difficulty initiating swallow
- problem in mobility of cricopharyngeus muscle
Name the oesophageal aetiology of dysphagia.
- difficulty with transport
- mobility disorders eg. achalasia
- diffuse spasm
- reduced contraction
Name some oral problems that may cause dysphagia.
- facial palsy
- dentures
- tumours
- salivary gland disease
- poor dentition/oral hygeine.
What can cause limited muscle strength/cartilage elevation that can cause dysphagia?
Atrophy (ageing, weakness, stroke).
What problems with the larynx cause dysphagia?
Palsy
Tumour
Fixation
Name problems with the hypopharynx that can result in dysphagia.
Tumours
Pouches
Strictures
Reflux
Strictures Tumours Reflux Achalasia Can all be problems with what?
Oesophagous- leading to dysphagia.
What is it called when people think they have a problem with dysphagia but nothing is actually wrong?
Psychogenic.
The _____ system affects how a muscle contracts.
Endocrine.
Problems with the CNS can also cause _______.
Dysohagia
Name the 3 medications given to patients with dysphagia.
Buscopan - muscle relaxant
Anxiolytics - Anti-inflammatories
Antireflux- stops reflux
Apart from medication, how else is dysphagia medically managed?
Modified Diet.
What texture is fork mashable?
Texture E.
What is texture D?
Pre-mashed.
What texture is thick puree?
Texture C
What is texture B?
Thin puree.
Name some surgical management of dysphagia.
Dental surgery
Palatal surgery
Tumour resection
Remove pouch
Dilation of oesophagus (if there’s a stricture)
NG/PEG/RIG feeding
Vocal Cord Augmentation if there’s a palsy
SLTs can give people with dysphagia exercises…
- exercises to strengthen swallowing muscles
- exercises to performed while swallowing
Name some compensatory techniques.
- Chin tuck position
- Turn head to weak side
- Tilt head to strong side
- Lying on side/ back whilst swallowing
- Supraglottic swallow
- Bolus-clearing manouvres.
