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SA DX & TX II > Exam 1 - Regurgitation > Flashcards

Exam 1 - Regurgitation Flashcards

1
Q

what is deglutition?

A

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

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2
Q

what structures are involved in deglutition?

A

tongue, hard palate, soft palate, oral muscles, pharyngeal muscles, esophagus, lower esophageal sphincter, & cranial nerves

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3
Q

what is phase 1 of the oropharyngeal phases of deglutition?

A

oral phase

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4
Q

what 3 components make up the oral phase?

A
  1. prehension & uptake of water
  2. mastication (preparation of food for swallowing)
  3. formation of food bolus at the base of the tongue
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5
Q

what structures contribute to phase 1 of deglutition?

A

oral cavity - tongue, teeth, hard palate, mandible, salivary glands, CN I, II, V, XII, & cerebral cortex)

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6
Q

what does anisognathic mean?

A

jaws are different sizes - maxilla is wider than mandible

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7
Q

what is phase 2 of the oropharyngeal phases of deglutition?

A

pharyngeal phase

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8
Q

what 2 components make up the pharyngeal phase?

A
  1. bolus is propelled from the oropharynx to the upper esophageal sphincter
  2. pharyngeal openings (nasopharynx, larynx) are closed to prevent aspiration
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9
Q

what structures control phase 2 of deglutition?

A

CN V, VII, IX, X, XII, & the medulla oblongata

pharynx, nasopharynx, oropharynx, & laryngopharynx

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10
Q

what is phase 3 of the oropharyngeal phases of deglutition?

A

pharyngoesophageal phase

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11
Q

what structures are involved in phase 3 of deglutition?

A

nasopharynx, soft palate, larynx, upper esophageal sphincter, dorsal pharyngeal wall, & tongue base

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12
Q

what is dysphagia?

A

difficulty in swallowing - disruption in transport of liquid or food from the oral cavity to the stomach

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13
Q

what causes dysphagia?

A

abnormalities in:

tongue, hard palate, soft palate, oral & pharyngeal muscles, upper esophageal sphincter, CN V, VII, IX, X, XII, & esophagus/GE junction

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14
Q

what is oropharyngeal dysphagia?

A

disruption of transport of liquid/food from the oral cavity through the upper esophageal sphincter - MUST BE DIFFERENTIATED FROM REGURGITATION

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15
Q

what causes oropharyngeal dysphagia?

A

abnormalities in:

tongue, dentition, mandible, maxilla, hard or soft palate, pharyngeal muscles, larynx, UES, & CN V, VII, IX, X, XII

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16
Q

what is the most common clinical sign associated with esophageal disorders?

A

regurgitation

normal drinking ability & no dropping food

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17
Q

where are you localizing to in oropharyngeal disorders?

A

oral cavity, pharynx, salivary glands

18
Q

what is the hallmark clinical sign of oropharyngeal disorders?

A

dysphagia

ptyalism, gagging, reluctance to eat, & dysphonia

19
Q

what are the 2 components that make up the esophageal phase of deglutition?

A
  1. uninterrupted & unidirectional transport of food/liquid to the stomach
  2. prevent of reflux of gastric contents
20
Q

what are the 3 segments of the esophagus?

A
  1. cervical (extra-thoracic)
  2. thoracic (body)
  3. abdominal
21
Q

what is the difference in make up of the esophagus between dogs & cats?

A

dogs have all striated muscle

cats - upper 2/3 is striated & lower 1/3 is smooth muscle

22
Q

what is the innervation of the esophagus?

A

somatic motor to striated & autonomic motor to smooth

visceral afferent sensory & vagus nerve

23
Q

why may cisapride be a better drug choice for cats?

A

works on 5HT3 receptors (smooth muscle)

24
Q

what 3 anatomic structures contribute to the lower esophageal sphincter?

A
  1. gastric smooth muscle (intrinsic)
  2. diaphragm (extrinsic)
  3. gastric oblique (sling fibers)
25
Q

what is the innervation of the LES?

A

autonomic

parasympathetic - contracts

sympathetic - relaxes

26
Q

what is the final deglutition phase?

A

esophageal - rapid relaxation wave that prepares for the oncoming bolus followed by a slower contraction wave that transports the bolus

27
Q

what are the 2 actions of the final deglutition phase?

A
  1. primary peristalsis - initiated by passage of food through the UES, continuation of the pharyngoesophageal phase but under distinct neuronal control
  2. secondary peristalsis - initiated by the presence of a persistent bolus
28
Q

what is the common history of patient with regurgitation?

A

no nausea, no abdominal effort, no retching, immediate to delayed, & often undigested food/bile free

29
Q

what is the common history of a patient with vomiting?

A

nausea (anxiety, lip smacking, drooling), abdominal effort, retching, delayed, & partially digested/acidic/bile present

30
Q

when should you suspect an oropharyngeal component in a patient with regurgitation?

A

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

31
Q

what should you palpate on a patient with regurgitation?

A

hard & soft palate, masticatory muscles, TMJ, mandible, maxillary bones, cervical neck, & salivary glands

32
Q

what are the general causes of secondary acquired generalized megaesophagus?

A

immune-mediated - SLE & polymyositis

endocrine - addison’s & hypothyroid

neuromuscular - MG & dysautonomia

33
Q

T/F: you should be able to see the esophagus on survey rads

A

false - shouldn’t see

34
Q

why do a CBC/chem on a patient with regurgitation?

A

CBC can give clues for aspiration/perforation - neutrophilia/left shift

chem can give clues of addison’s, hypothyroidism

increased CK & AST - polymyositis

35
Q

why do thoracic rads on a regurgitating patient?

A

look for structural disease (FB, hiatal hernia, perforation), megaesophagus, & aspiration pneumonia

36
Q

why would you use a barium swallow/videofluoroscopy?

A

better than rads - used to detect functional & structural disease (hypomotility, hiatal hernia, GERD, diverticula)

37
Q

when is a barium swallow contraindicated?

A

if there is perforation & risky with a megaesophagus patient

38
Q

what is the purpose of using esophagoscopy in a patient with regurgitation?

A

used to detect structural disease & inflammation - more sensitive than the barium swallow (strictures & esophagitis)

diagnostic & therapeutic purposes - stricture balloon dilation, FB removal, biopsy masses

39
Q

______ _______ is key in managing a regurgitating patient with megaesophagus

A

nutritional support - elevated feedings, reduced fat, alter moisture of diet, gastric feeding tubes

40
Q

how do you treat esophagitis?

A

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

SA DX & TX II (62 decks)

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