Dysphagia And Nutrition

Question 1

Common hospital diets based on disease present

Answer 1

Clear liquid

Full liquid

Regular

Low residue

Low sodium

No added salt

Cardiac (low sodium, low cholesterol)

Question 2

Differentiate between barium swallow, modified barium swallow, and bedside swallowing assessment

Answer 2

Barium swallow = designed to evaluate pharyngeal and esophageal mucosa; video capture fluoroscopy to study functional dynamics of the pharynx and esophagus. Air contrast makes mucosal surface more distinct

Modified = to determine cause for and evaluate the severity of tracheal aspiration; performed by a speech pathologist and radiologist. Barium suspensions of varing thickenss during fluoroscopy. Thin liquid, thick liquid, nectar, paste and solid — mimic different food consistencies; videotaped

Bedside = consists of cognitive assessment, posture, respiratory status, speech and vocal status, oral mechanism exam, and oral trials (start with water and observe, palpate thyroid notch for rise/fall, have pt speak and eval voice quality, advance as tolerated)

Question 3

Common signs of abnormal swallowing

Answer 3

Oropharyngeal dysphagia: dysphagia localized to neck, nasal regurgitation, aspiration, associated ENT sxs (ex: zenkers, neoplasm, cervical web, CVA, parkinsons, ALS)

Esophageal dysphagia: dysphagia localized to chest or neck, food impaction (ex: GERD, schatzki ring, neoplasm, peptic stricture, eosinophilic esophagitis, pill esophagitis, infectious esophagitis)

Question 4

Common osteopathic findings associated with dysphagia and GERD

Answer 4

Viscerosomatic findings (T1-4, T5-9) and red reflex

Question 5

Muscles of mastication and their innervation

Answer 5

Temporal m.
Medial pterygoid m.
Lateral pterygoid m.
Masseter m.

Innervation via CN V3 (mandibular branches)

Question 6

Common hospital diets based on dysphagia (mechanical issues)

Answer 6

Pureed — all foods pureed and thickened to pudding-like consistency

Mechanically altered — moist, soft-textured and easily chewed. Ground meat with gravy or sauce

Dysphagia advanced — excludes hard, dry, sticky or crunchy foods

Question 7

Terminology for difficulty swallowing

Answer 7

Dysphagia

Question 8

Terminology for painful swallowing

Answer 8

Odynophagia

Question 9

Terminology for aperistalsis and incomplete LES relaxation

Answer 9

Achalasia

Question 10

Terminology for sensation of a lump lodged in the throat but swallowing is unaffected

Answer 10

Globus pharyngeus