Iatrogenic Disorders Lecture 2/17

Question 1

What does iatrogenic mean?

Answer 1

acquired by medical or surgical intervention

Question 2

What is dysphagia?

Answer 2

A SYMPTOM

Question 3

T/F: Every surgery or medical intervention results in dysphagia

Answer 3

False

Question 4

What are some side effects of dysphagia?

Answer 4

dehydration, malnutrition, deconditioning, weakness

Question 5

Name some “repeat offenders” when it comes to surgery/medical intervention that result in dysphagia

Answer 5

edema, thyroidectomy, carotid endarterectomy, cardiovascular surgery, cervical spine procedures, osteophytes, esophagectomy, trauma, certain medications

Question 6

What is edema?

Answer 6

temporary tissue swelling

Question 7

How can edema post-surgery cause dysphagia?

Answer 7

impacts nerve supply (edema in the brain), restricts swallowing structures like pharynx

Question 8

What is a thyroidectomy?

Answer 8

surgical removal of the thyroid gland (wraps around larynx below thyroid cartilage)

Question 9

How can a thyroidectomy cause dysphagia?

Answer 9

possible unilateral vocal fold paralysis

Question 10

What is carotid endarterectomy?

Answer 10

cleaning out blocked carotid arteries

Question 11

How can a carotid endarterectomy cause dysphagia?

Answer 11

if they accidentally clip vagus nerve or cause cerebrovascular damage during surgery

Question 12

How can cardiovascular surgery cause dysphagia?

Answer 12

intubation, sometimes tracheotomy, proximity to vagus nerve to the aorta may cause temporary or prolonged VF paralysis

Question 13

Why is it important to know about iatrogenic disorders?

Answer 13

when looking at a patient’s chart, you should be able to know which surgeries might cause dysphagia

Question 14

Which cervical nerve involvement may impact swallowing in cervical spine procedures?

Answer 14

C2-C5

Question 15

What is a halo used for?

Answer 15

to support the head and prevent movement of the spine

Question 16

How can having a halo affect a person’s swallowing?

Answer 16

due to hyperextension

Question 17

Injury to which cranial nerve in cervical spine procedures can cause dysphagia?

Answer 17

pharyngeal plexus

Question 18

What does ACF stand for?

Answer 18

anterior cervical fusion

Question 19

How can ACF affect swallowing?

Answer 19

the hardware that fuses the spine is in along the posterior pharyngeal wall

Question 20

What are osteophytes?

Answer 20

boney outcroppings along the cervical spine; usually asymptomatic

Question 21

How big does an osteophyte have to be to be a problem?

Answer 21

10mm

Question 22

At what level will an osteophyte cause epiglottis to not invert?

Answer 22

at C3

Question 23

What happens if there are large osteophytes at C6?

Answer 23

the PES is disrupted after the swallow

Question 24

What percentage of the time do osteophytes over 10mm cause swallowing problems?

Answer 24

75%

Question 25

Which cranial nerves can be affected by trauma?

Answer 25

V, VII, IX, X, XI, XII

Question 26

What kind of trauma might elicit a dysphagia referral?

Answer 26

mandibular fracture with wired jaw, blunt trauma, burn injury, dental trauma, inhalation of toxic gases, skin grafting

Question 27

How can blunt trauma cause swallowing problems?

Answer 27

edema and swelling

Question 28

How do inhalation burns cause dysphagia?

Answer 28

edema

Question 29

What can medications affect which, in tern, can cause swallowing difficulties?

Answer 29

cognition, level of alertness, xerostomia, GI function, tardive dyskinesia

Question 30

What is esophagectomy?

Answer 30

removal of part of the esophagus as a result of esophageal cancer

Question 31

With what do they replace the esophagus?

Answer 31

tissue from the stomach or jejunum

Question 32

What is called when doctors replace the esophagus with stomach tissues?

Answer 32

anastomosis

Question 33

What can happen with an anastomosis?

Answer 33

there is a leak that allow for the bolus to leave the GI system

Question 34

How does tardive dyskinesia affect swallowing?

Answer 34

oral motor issues, lingual thrusting/protruding (oral phase issues)