HC 2 Pathophysiology Flashcards
What conditions are needed for a succesful swallow?
- normal structures
- higher neural control
- good central pattern generator
- peripheral input/output
What is …
- trismus?
- sulci?
- stasis?
- achalasia?
- xerostomia?
- odynophagia?
- not being able to open the mouth
- pockets
- blocking the transport of the bolus downwards
- sphincter is not opening
- dry mouth, not enough saliva to prepare the bolus
- painful swallow
Scientific name for….:
- dry mouth, not enough saliva to prepare the bolus
- painful swallow
- pockets
- blocking the transport of the bolus downwards
- not being able to open the mouth
- sphincter is not opening
What is …
- xerostomia?
- odynophagia?
- sulci?
- stasis?
- trismus?
- achalasia?
What pathophysiology can we see in the esophageal phase?
- regurgitation
- reflux
- motility disorders
- stasis
What might cause dysphagia after a hemispheric stroke?
− Reduced ability to initiate a saliva swallow
− Delayed triggering of pharyngeal swallow
− Incoordination of oral movements in swallow
− Increased pharyngeal transit time
− Reduced pharyngeal constriction
− Aspiration
− PES dysfunction
− Impaire LES relaxation
− Paresis of the facial nerve
What might cause dysphagia after a brainstem stroke?
− Absent or delayed pharyngeal response
− Reduced oropharyngeal, pharyngeal constriction
− Reduced laryngeal closure
− Reduced PES opening
− Generalized incoordination
What might cause dysphagia in people with dementia?
- Slow oral movement
- Slow or delayed pharyngeal reponse
- Overall slow swallowing duration
What might cause dysphagia in people with Parkinson’s disease?
− Oral stage:
• Lingual tremor, repetitive tongue pumping, buccal retention
− Pharyngeal stage:
• Vallecular & piriform sinus retention, impaired laryngeal elevation
What structural problems might cause dysphagia?
- Stasis in esophagus:
- Rings, webs, strictures, carcinoma, enlarged heart
- Diffuse esophageal spasms, reflux-induced dysmotility, achalasia
- Stasis in pharynx:
- Cervical osteophytes: longer bony elements on the spine presses on the esophagus
- cricopharyngeal bar: PES sphincter can not open fully or is too thick to open
- Zenker’s diverticulum: a part of the pharynx’ or esophagus’ wall is not strong enough and creates a pocket
Give some examples of dysphagia caused by structural problems due to therapy
- After radiation therapy:
−Mucositis
−Xerostomia
−Sensory changes in taste and smell
−Fibrosis à trismus
−Neuropathy
−Changed anatomy
−Odynophagia
−Edema
−Infection
- after surgery of head-neck cancer:
−Swelling of the mouth or throat
−Reduced mobility
−Numbness
−Changed anatomy
What may cause iatrogenic dysphagia?
•Postsurgical, depending on surgery:
−Cardiovascular surgery
−Cervical spine procedures
−Osteophytes
−Intubation
−Medication
Why would the normal ageing process cause dysphagia?
Changes in anatomy & physiology:
- Sarcopenie: loss of muscle mass & function
- Reduced strength of tissues and muscles
- Reduced elasticity and sensibility
- Reduced coordination
- Extended neural processing time
- Delayed response
- Joint disorders
- Delay in motor skills
