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Dysphagia > Dysphagia Lecture 1 > Flashcards

Dysphagia Lecture 1 Flashcards

1
Q

What is dysphagia? (3)

A

1 Difficulty swallowing
2 Difficulty moving bolus from the mouth to the stomach
3 Not age-specific (newborn>elderly)

*Not just a one time event. More chronic than that.

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2
Q

Etiologies of dysphagia (4):

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

What are the possible Consequences of dysphagia? (4)

A

1 Dehydration (e.g. coughing on thin liquids so pt avoids them)

2 Malnutrition (avoiding food that they have a hard time swallowing so not getting a rounded diet)

3 Aspiration pneumonia (repeated bouts of aspiration, food/drink gets pushed down and sits in lungs and grows bacteria.)

4 Quality of life

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4
Q

What are the Types of dysphagia? (4)

A

1 Oral (tongue mvmt, lip closure, pocketing, transport)

2 Pharyngeal (airway closure, residues, motility, UES (upper esophageal sphincter))

3 Oropharyngeal* (both oral and pharyngeal dysphagia)

4 Esophageal (motility, LES (lower esophageal sphincter), fistula, diverticulum, HCl – reflux; ulcer)

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5
Q

What are the Stages of dysphagia? (3)

A

1 (Oral Prep) / Oral (time varies with bolus consistency)

2 Pharyngeal (~ 1 second)

3 Esophageal (~ 10 seconds)

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6
Q

Oral Prep / Oral Stage of dysphagia:

A

(time varies with bolus consistency)

Involves: mastication, bolus formation, and bolus transport from the oral cavity to the pharynx

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7
Q

Pharyngeal Stage of dysphagia:

A

Time: (~ 1 second)

Involves: epiglottis inverts over the laryngeal vestibule
larynx and hyoid bone are pulled anteriorly and superiorly to open the pharynx, relax the cricopharyngeus (UES) muscle, and assist the vocal folds in closing off the glottis
bolus is propelled through the pharynx toward the esophagus by action of pharyngeal constrictors

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8
Q

Esophageal Stage of dysphagia:

A

Time: (~ 10 seconds)

Involves: bolus flows through the esophagus via peristaltic contractions of striated and smooth muscle along the esophageal wall
relaxation of LES (lower esophageal sphincter) allows bolus to flow into the stomach

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9
Q

Signs and Symptoms of Oral or pharyngeal dysphagia: (14)

A

1 Coughing or choking with swallowing

2 Difficulty initiating swallowing

3 Food sticking in the throat

4 Sialorrhea (excessive siliava)/ xerostomia (dry mouth)

5 Drooling or spillage (e.g. premature spillage-over the tongue base and pharyngeal phase not triggering)

6 Unexplained weight loss (10% weight loss in a short time)

7 Change in dietary habits (avoiding certain things)

8 Penetration (bolus or part of bolus gets past epiglottis and into laryngeal vestibule area)

9 Aspiration (bolus gets past the vocal folds)

10 Recurrent pneumonia

11 Change in voice (wet, gurgly voice quality)

12 Nasal regurgitation

13 Tearing and/or nose running (typically signs of silent aspiration)

14 Sore throat (reflux involved?)

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10
Q

Signs and Symptoms of Esophageal dysphagia: (7)

A

1 Sensation of food sticking in the chest or throat (happens frequently with radiation patients, causes esophageal narrowing/esophageal strictures)

2 Chest pain

3 Oral or pharyngeal regurgitation

4 Change in dietary habits

5 Recurrent pneumonia

6 Reflux

7 Aspiration

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11
Q

Signs and Symptoms of SILENT ASPIRATION!!

A

NO s/s!
No cough reflex
Possible signs: tearing, runny nose

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12
Q

Feeding =

A

= placement of food in the mouth before initiation of swallow

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13
Q

Stages of Feeding: (1)

A

Oral prep stage (salivation, presentation)

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14
Q

Swallowing =

A

= transfer of food/drink from mouth to stomach

There are 3 stages:

  • Oral stage
  • Pharyngeal stage
  • Esophageal stage
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15
Q

What is all included in a Swallow Screening? (5)

A

1) 10-15 minute administration/ observation of a small bolus
2) Bedside clinical assessment
3) Assess Signs & symptoms
4) Cannot assess A & P
5) Pre-diagnostic

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16
Q

What is included/assessed during the bedside clinical assessment for a swallow screening: (6)

A 
1 Bedside clinical assessment
2 Medical history
3 Level of alertness
4 Pt interview
5 Oral motor exam
6 Assess swallow with small bolus
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17
Q

What Signs & symptoms to look for during the bedside clinical assessment (9):

A

1) Spillage?
2) Oral residue?
3) Long transit time?
4) Cough?
5) Throat clear?
6) Gurgly voice?
7) Tearing?
8) Runny nose?
9) Wrong sound (auscultation)?

18
Q

Diagnostic Procedure: (5)

A

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

2) Examines Physiology
Timing, tongue base motion, epiglottic dysfunction, laryngeal excursion, UES dysfunction, peristalsis, paralysis, sensitivity

3) Examines immediate effects of tx’s

4) Imaging:
FEES/FEESST (Fiberoptic endoscopic evaluation of swallowing), videofluoroscopy*, ultrasound, videoendoscopy, scintigraphy

5) Nonimaging:
EMG, EGG, acoustic (accelerometer or stethoscope), pharyngeal manometry

19
Q

What’s the leading cause of Death for PD pts?

A

Aspiration pneumonia

20
Q

When should the pharyngeal swallow should be triggered?

A

As soon as the bolus gets transported to the back of the tongue and the head of the bolus gets to the anterior+posterior faucial pillars, what should happen?

Many things happen:
upper esophageal sphincter opens.
Epiglottis closes.
VF close.
etc.
21
Q

Which stage dysphagia is the most common?

A

pharyngeal dysphagia

22
Q

If the bolus gets into the laryngeal vestibule it is:

A

penetration

23
Q

If the bolus gets past the vf it is:

A

aspiration

24
Q

T?F

If the bolus gets past the vf but the person coughs it out we don’t call it aspiration.

A

FALSE.

We still say they have aspiration with a cough.

25
Q

Flash penetration =

A

bolus penetrates but doesn’t stay

26
Q

How would someone get a wet/gurgly voice?

A

If they penetrate and the bolus lays on the vf

27
Q

What stage does silent aspiration occur during?

A

Pharyngeal

28
Q

If the vagus nerve is effected, then what reflex might be effected?

A

the cough reflex

29
Q

Examining Physiology during diagnostic: (8)

A

Look at:

1) Timing
2) tongue base motion
3) epiglottic dysfunction
4) laryngeal excursion
5) UES dysfunction
6) peristalsis
7) paralysis
8) sensitivity

30
Q

Types of Imaging for Swallowing: (5)

A

1) FEES/FEESST (Fiberoptic endoscopic evaluation of swallowing)
2) videofluoroscopy*
3) ultrasound
4) videoendoscopy
5) scintigraphy

31
Q

Types of Non-Imaging for Swallowing: (4)

A

1) EMG
2) EGG
3) acoustic (accelerometer or stethoscope)
4) pharyngeal manometry

32
Q

Types of Treatment for Swallowing: (8)

A

1) Diet modification
2) Compensatory
3) Maneuver
4) Exercise
5) Stimulation
6) Experimental

Done by other professionals:

7) Prosthetic
8) Surgery

33
Q

Who is a part of the multidisciplinary swallowing team? (10)

A

1) SLP
2) Physician / Neurologist / ENT
3) Nursing
4) Dietician
5) OT
6) PT
7) Radiologist (especially for MBS)
8) Pharmacist (lots of meds can cause dysphagia)
9) Social worker
10) Psychologist

34
Q

Treatment: Diet Modification can include (5)

A
  • volume
  • viscosity
  • texture
  • temperature
  • NPO (no food through the mouth)- NG tube, G tube, PEG, J tube, TPN)
35
Q

Treatment: Types of Compensatory Treatment Methods:

A

Positional: posture, chin tuck, head rotation

Multiple swallows

36
Q

Treatment: Types of Maneuvers (4):

A

1) Supraglottic Swallow
2) Super-supraglottic Swallow
3) Mendelsohn Maneuver
4) Effortful Swallow

37
Q

Treatment: Types of Exercises for Swallowing: (3)

A

1) Shaker
2) Masako
3) Oral muscle strengthening

38
Q

Treatment: Types of Stimulation:

A

Thermal/Tactile Stim

39
Q

Treatment: Types of Experimental Treatments: (4)

A

1) Neuromuscular electrical stimulation [NMES: “VitalStim”]
2) Deep Pharyngeal Neuromuscular Stimulation [DPNS]
3) Myofascial release [MFR]
4) Botox

40
Q

Treatment done by other professionals: Prosthetic (2)

A

1) Palatal lift

2) Obturator

41
Q

Treatment done by other professionals: Surgery (3)

A

1) CP myotomy
2) Diverticulectomy
3) Dilation

Dysphagia (5 decks)

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