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Dysphagia > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What does GERD stand for?

A

Gastroesophageal reflux disease

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2
Q

What is GERD?

A

Excessive reflux of gastric contents into the esophagus

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3
Q

What is esophagitis?

A

Mucosal inflammation and injury caused by prolonged exposure of reflux

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4
Q

What is esophageal stricture?

A

Narrowing of hte esophagus

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5
Q

What is acalasia?

A

Motility disorder of the esophagus characterized by failure of the LES to relax

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6
Q

What are some common symptoms of achalasia?

A

Food stuck in the esophagus, regurgitation, chest pain, aspiration pneumonia, and weight loss

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7
Q

What are the symptoms of diffuse esophageal spasm?

A

Intermittent chest pain and dysphagia for liquids and solids

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8
Q

What stage is a lax cricopharyngeus in?

A

Esophageal stage

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9
Q

What might a lax cricopharyngeus result in?

A

Regurgitation back through UES into pharynx, which may spill into the airway

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10
Q

If an individual has a lax cricopharyngeus, when would the risk of aspiration be?

A

After

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11
Q

What is reduced esophageal peristalsis?

A

Reduced ability to squeeze the bolus through the esohpagus

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12
Q

What is a diverticulum?

A

A pocket in the esophagus or pharyngeal musculature which collects portions of the bolus

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13
Q

What is the difference between a tracheoesophageal fistula and an esophageal cutaneous fistula?

A

A tracheoesophageal fistula is the abnormal passage from the trachea to the esophagus, whereas an esophageal cutaneous fistula is an abnormal passage from the wall of the esophagus to the external skin of the neck

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14
Q

What is odynophagia?

A

Pain with swallowing in the absence of a swallowing disorder or any other disease process

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15
Q

What is globus hystericus? (aka?)

A

Aka globus pharyngeus; it’s a transitory sensation of a lump in the throat that cannot be coughed up or swallowed.

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16
Q

With a left (dominant) hemisphere cortical stroke, what are the 3 most common characteristics we might see?

A

1 - contralateral reductions in labial, lingual, and mandibular strength, rate, ROM, and sensation
2 - delayed pharyngeal swallow
3 - contralateral reductions in pharyngeal contraction

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17
Q

What is the difference in characteristics between a L and R hemisphere cortical stroke?

A

They’ll have the same 3 symptoms as a L hemisphere involvement, but it’s occurring on the opposite side of the body. Also, R hem. will result in reduced orientation, perceptual deficits, attention deficits, impulsivity, errors in judgment, and a loss of intellectual control over swallowing.

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18
Q

What stages of swallowing would a L-hem vs. a R-hem cortical stroke result in?

A

Both could have disorders of the oral prep, oral, and pharyngeal stages, but the R-hem is distinct in possibly having anticipatory stage disorders (cognitive impairment).

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19
Q

For which type of cortical stroke (which hemisphere) would the improvement of swallowing be more difficult?

A

R hemisphere, because they may not understand their deficits and might have difficulty remembering therapy/strategies

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20
Q

What is the difference between a single hemisphere stroke and a stroke with bilateral hemisphere involvement?

A

Same symptoms but they will be present on both sides of the body. Also have bilateral incomplete laryngeal elevation and closure, UES involvement, and at a high risk of silent aspiration.

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21
Q

Where we would expect to see residue in a patient who has bilateral hemisphere involvement?

A

In both pyriform sinuses, maybe bilateral coating of the pharyngeal walls, and maybe even reside in the valleculae.

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22
Q

What are some distinctive swallowing characteristics of a brain stem stroke?

A

Bilateral damage, absent or delayed initiation of the pharyngeal swallow, and a high risk of silent aspiration.

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23
Q

What are some things to note about swallowing disorders as a result of TBI? (the symptoms vary according to… what must be considered… etc.)

A

The symptoms vary according to the location and extent of the head injury

Interaction of cognitive, behavioral, and linguistic impairments with the dysphagia must be considered.

Tracheoesophageal fistula may occur often as a result of long-term intubation

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24
Q

How could a tumor affect swallowing?

A

It will depend on the location and the size of the tumor; cranial nerve tumors will affect swallowing if they involve any of the nerves that control oral-pharyngeal-laryngeal function. Usually the treatment for tumors causes the biggest problems for feeding and swallowing.

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25
What is myasthenia gravis?
An autoimmune disorder characterized by fatigue and exhaustion of the muscular system caused by impaired conduction at the myoneural junction
26
Describe the feeding/swallow deficits in a patient with MG.
Symptoms become more obvious on repeated swallowing attempts; chewing and swallowing deteriorate toward the end of a meal and toward the end of the day.
27
What is post-polio syndrome?
It refers to symptoms experienced by survivors of the poliomyelitis infection. These symptoms usually begin several decades after recovery from the acute illness and may be progressive.
28
How could AIDS compromise swallowing function?
CNS complications * Local infection and neoplasms involving the swallowing system * Candidiasis (thrush) is a fungal infection that commonly causes odynophagia and dysphagia in patients with AIDS
29
What might be one of the first symptoms of acute HIV infection?
Odynophagia
30
What are some common swallowing symptoms associated with dementia?
Cognitive deficits that may interfere with the spontaneous use of compensatory techniques; protracted or nonpurposeful bolus processing.
31
Specific swallowing symptoms for spinal cord injury vary depending on what?
Level of the injury
32
What is the pattern of disease processing for multiple sclerosis?
MS presents a fluctuating pattern of remission and exacerbation or one of gradual progression
33
What are some common swallowing symptoms associated with Parkinson's disease?
Tongue tremor with reduced initiation of lingual movement; repetitive tongue-pumping action; lingual festination
34
What are some common side effects of radiotherapy?
Muscle fibrosis, reduction of muscle movement, osteoradionecrosis, reduction of saliva production
35
What is the medical term for dry mouth?
Xerostomia
36
What are the two primary treatment modalities for head and neck cancer?
Surgical resection and radiotherapy
37
What is the adjunct therapy for head and neck cancer?
Chemotherapy--used in combination with either surgical resection or radiotherapy designed to control metastasis
38
Contrast the treatment between small and large tumors?
Small tumors are treated with radiotherapy or surgery alone, large tumors are treated with a combination of modalities.
39
What is the general rule for surgical removal of tumors (about margins)?
The malignant tumor must be resected along with a margin of at least 1.5-2 cm of normal tissue
40
What are the 2 types of surgery?
Simple resection (one structure) and composite resection (more than one structure)
41
What the is biggest major rule of cancer surgery?
No ablative surgical procedure should be compromised of the desire to maintain the patient's function
42
What is tumor staging helpful for?
Helping surgeons/doctors decide the best course of treatment and the prognosis
43
What does each letter stand for in TNM staging?
``` T = tumor size N = nodal status M = metastasis ```
44
In regards to surgical reconstruction, what is primary closure?
Where remaining soft tissues are pulled together and sutured
45
Why should we counsel patients before their surgery?
To inform them of potential speech and swallowing problems
46
When can you begin swallowing exercises after surgery?
When the surgeon says there won't be any damage to suture lines
47
How long does swallowing therapy continue after surgery?
Until the patient's swallowing has reached a point where the therapist and patient agree that maximum goals have been attained
48
What is considered as severe trismus?
Less than 35 mm of jaw opening
49
What is the more frequent treatment choice for smaller tumors in the larynx?
Radiotherapy
50
For the purpose of staging, the larynx is divided into what three areas?
Supraglottis, glottis, and subglottis
51
Where in the areas of the larynx do tumors occurs most frequently?
65% occur at the glottic level, 35% in the supraglottic level, and 5% in the subglottic level
52
Is a patient who has undergone a total laryngectomy at risk for aspiration during feeding?
No because their esophagus is completely closed off from their airway
53
What all is removed in a total laryngectomy?
Hyoid bone, epiglottis, larynx, upper two tracheal rings, and the strap muscles
54
How would a laryngofissue with cordectomy affect voice?
Voice would be breathy because one VF has been removed so they cannot fully approximate
55
When would the risk of aspiration be in a laryngofissue with cordectomy?
Aspiration during because of reduced laryngeal closure
56
Describe a hemilaryngectomy and give another name for it.
AKA vertical laryngectomy. Thyroid is cut top to bottom so you are essentially removing either the R or L half of the larynx (the true, false, and arytenoid all on the same side are removed)
57
Describe a supraglottic laryngectomy and give another name for it.
AKA horizontal laryngectomy. Remove the epiglottis, hyoid bone, pre-epiglottic space, false folds, and upper half of the thyroid cartilage, but luckily the true VF are spared!
58
Why might a cricopharyngeal myotomy be performed in a patient who underwent a supraglottic laryngectomy?
Since there is reduced laryngeal elevation and therefore reduced UES opening, surgeons cut some of the cricopharyngeus muscle to loosen it/make it more relaxed
59
What's the difference between a tracheotomy and a tracheostomy?
A tracheotomy is the surgical procedure of creating a hole in the neck or a stoma through which the person can breathe; the tracheostomy is the hole left behind by the surgical procedure
60
Under what conditions might an individual need a tracheotomy?
Airway obstruction (acute, chronic, or both) or prolonged ventilatory support due to underlying pulmonary or CNS disease
61
Examples of acute airway obstruction?
Infection process or upper respiratory or pulmonary infection
62
Examples of chronic airway obstruction?
Presence of a mass, sleep apnea, hypertrophy of tonsils
63
What are some advantages of a tracheostomy?
1 - eliminates prolonged orotracheal intubation 2 - facilitates pulmonary toilet when pt is unable to clear secretions 3 - decreases possibility of subglottic stenosis that results from prolonged orotracheal intubation
64
What is an obturator of a tracheostomy tube?
The device simply used for insertion of the tube into the tracheostomy opening. makes the end smoother for easier insertion. must remove after insertion because it occludes the tube!
65
What is the outer cannula?
The outer housing of the tracheostomy tube
66
What is a fenestration?
The "window" that allows air to go through the tube and then vibrate the VF
67
What is the inner cannula?
You insert it into the outer cannula; makes it easier to clean the trach tube because if it gets clogged you can pull this out and rinse it
68
What is the cuff of a tracheostomy tube?
The part that inflates in order for the respirator to better inflate the lungs
69
What is the pilot balloon?
How we inflate the cuff (via the cuff inflation line)
70
What is the face plate?
Outer portion; how we tell the size of the tracheostomy tube
71
What is the minimal leak technique?
How we inflate the cuffs to avoid over-inflation; using a stethoscope to inflate until we no longer hear breathing around the cuff, and then deflate the tube until we just start to hear air leakage around the cuff.
72
What are some negative effects the tracheostomy tube could have on swallowing? (5)
1 - may inhibit laryngeal elevation 2 - may desensitize the larynx 3 - external compression of the esophagus by the trach tube cuff enables secretions to pool above the cuff level in the esophagus and then spill into the airway 4 - may result in discoordination and "disuse atrophy" of the swallowing musculature 5 - creates a functional separation of deglutition and respiration which may result in discoordination of glottic closure during swallowing

Dysphagia (4 decks)

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