Exam 1 - Regurgitation Flashcards
what is deglutition?
transport of food/liquids from the oral cavity to the stomach - has 3 oropharyngeal phases & esophageal components
requires coordinated effort of oral cavity, pharynx, & esophagus
what structures are involved in deglutition?
tongue, hard palate, soft palate, oral muscles, pharyngeal muscles, esophagus, lower esophageal sphincter, & cranial nerves
what is phase 1 of the oropharyngeal phases of deglutition?
oral phase
what 3 components make up the oral phase?
- prehension & uptake of water
- mastication (preparation of food for swallowing)
- formation of food bolus at the base of the tongue
what structures contribute to phase 1 of deglutition?
oral cavity - tongue, teeth, hard palate, mandible, salivary glands, CN I, II, V, XII, & cerebral cortex)
what does anisognathic mean?
jaws are different sizes - maxilla is wider than mandible
what is phase 2 of the oropharyngeal phases of deglutition?
pharyngeal phase
what 2 components make up the pharyngeal phase?
- bolus is propelled from the oropharynx to the upper esophageal sphincter
- pharyngeal openings (nasopharynx, larynx) are closed to prevent aspiration
what structures control phase 2 of deglutition?
CN V, VII, IX, X, XII, & the medulla oblongata
pharynx, nasopharynx, oropharynx, & laryngopharynx
what is phase 3 of the oropharyngeal phases of deglutition?
pharyngoesophageal phase
what structures are involved in phase 3 of deglutition?
nasopharynx, soft palate, larynx, upper esophageal sphincter, dorsal pharyngeal wall, & tongue base
what is dysphagia?
difficulty in swallowing - disruption in transport of liquid or food from the oral cavity to the stomach
what causes dysphagia?
abnormalities in:
tongue, hard palate, soft palate, oral & pharyngeal muscles, upper esophageal sphincter, CN V, VII, IX, X, XII, & esophagus/GE junction
what is oropharyngeal dysphagia?
disruption of transport of liquid/food from the oral cavity through the upper esophageal sphincter - MUST BE DIFFERENTIATED FROM REGURGITATION
what causes oropharyngeal dysphagia?
abnormalities in:
tongue, dentition, mandible, maxilla, hard or soft palate, pharyngeal muscles, larynx, UES, & CN V, VII, IX, X, XII
what is the most common clinical sign associated with esophageal disorders?
regurgitation
normal drinking ability & no dropping food
where are you localizing to in oropharyngeal disorders?
oral cavity, pharynx, salivary glands
what is the hallmark clinical sign of oropharyngeal disorders?
dysphagia
ptyalism, gagging, reluctance to eat, & dysphonia
what are the 2 components that make up the esophageal phase of deglutition?
- uninterrupted & unidirectional transport of food/liquid to the stomach
- prevent of reflux of gastric contents
what are the 3 segments of the esophagus?
- cervical (extra-thoracic)
- thoracic (body)
- abdominal
what is the difference in make up of the esophagus between dogs & cats?
dogs have all striated muscle
cats - upper 2/3 is striated & lower 1/3 is smooth muscle
what is the innervation of the esophagus?
somatic motor to striated & autonomic motor to smooth
visceral afferent sensory & vagus nerve
why may cisapride be a better drug choice for cats?
works on 5HT3 receptors (smooth muscle)
what 3 anatomic structures contribute to the lower esophageal sphincter?
- gastric smooth muscle (intrinsic)
- diaphragm (extrinsic)
- gastric oblique (sling fibers)
what is the innervation of the LES?
autonomic
parasympathetic - contracts
sympathetic - relaxes
what is the final deglutition phase?
esophageal - rapid relaxation wave that prepares for the oncoming bolus followed by a slower contraction wave that transports the bolus
what are the 2 actions of the final deglutition phase?
- primary peristalsis - initiated by passage of food through the UES, continuation of the pharyngoesophageal phase but under distinct neuronal control
- secondary peristalsis - initiated by the presence of a persistent bolus
what is the common history of patient with regurgitation?
no nausea, no abdominal effort, no retching, immediate to delayed, & often undigested food/bile free
what is the common history of a patient with vomiting?
nausea (anxiety, lip smacking, drooling), abdominal effort, retching, delayed, & partially digested/acidic/bile present
when should you suspect an oropharyngeal component in a patient with regurgitation?
the patient is dropping food, chewing food on one side, prolonged/repated swallow, pawing at face, grinding teeth, facial asymmetry, pain on opening mouth, & oral lesions/mass/foreign body
what should you palpate on a patient with regurgitation?
hard & soft palate, masticatory muscles, TMJ, mandible, maxillary bones, cervical neck, & salivary glands
what are the general causes of secondary acquired generalized megaesophagus?
immune-mediated - SLE & polymyositis
endocrine - addison’s & hypothyroid
neuromuscular - MG & dysautonomia
T/F: you should be able to see the esophagus on survey rads
false - shouldn’t see
why do a CBC/chem on a patient with regurgitation?
CBC can give clues for aspiration/perforation - neutrophilia/left shift
chem can give clues of addison’s, hypothyroidism
increased CK & AST - polymyositis
why do thoracic rads on a regurgitating patient?
look for structural disease (FB, hiatal hernia, perforation), megaesophagus, & aspiration pneumonia
why would you use a barium swallow/videofluoroscopy?
better than rads - used to detect functional & structural disease (hypomotility, hiatal hernia, GERD, diverticula)
when is a barium swallow contraindicated?
if there is perforation & risky with a megaesophagus patient
what is the purpose of using esophagoscopy in a patient with regurgitation?
used to detect structural disease & inflammation - more sensitive than the barium swallow (strictures & esophagitis)
diagnostic & therapeutic purposes - stricture balloon dilation, FB removal, biopsy masses
______ _______ is key in managing a regurgitating patient with megaesophagus
nutritional support - elevated feedings, reduced fat, alter moisture of diet, gastric feeding tubes
how do you treat esophagitis?
remove the insult
gastric acid inhibition - proton pump inhibitor & cytoprotectant (sucralfate), decreases acid injury to denuded mucosa & promote mucosal healing
prokinetic drug - cisapride, to decrease reflux by improving tone of LES & promotes gastric emptying
analgesia
rest
