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Dysphagia > Intro to Dysphagia PPT 1 > Flashcards

Intro to Dysphagia PPT 1 Flashcards

1
Q

What is dysphagia?

A

Difficulty swallowing and/or difficulty moving bolus from the mouth to the stomach

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2
Q

T/F Dysphagia only affects adults

A

False; Not age-specific (newborn-elderly)

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3
Q

What are the etiologies for dysphagia?

A

Infection
Structural malformations
Surgery (thyroid/RLN/cervical)
Conditions that weaken/damage muscles/nerves (CVA, PD, TBI)

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4
Q

T/F Dysphagia is always secondary to something else

A

True!

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5
Q

Name 4 consequences of dysphagia

A

Dehydration
Malnutrition
Aspiration pneumonia
Quality of life

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6
Q

Name the types of dysphagia

A

Oral
Pharyngeal
Oropharyngeal
Esophageal

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7
Q

Oral dysphagia can result in difficulties with (4 things)

A

Tongue movement
Lip closure
Pocketing
Transport

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8
Q

Pharyngeal dysphagia can result in difficulties with (4 things)

A

Airway closure
Residues (stasis)
Motility
UES

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9
Q

Esophageal dysphagia can result in difficulties with (5 things)

A 
Motility
LES
Fistula
Diverticulum
HCI-reflux; ulcer
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10
Q

What are the stages of swallowing?

A

Oral Prep/Oral Stage
Pharyngeal Stage
Esophageal Stage

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11
Q

How long is the oral stage of swallowing?

A

Time varies with bolus consistency

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12
Q

Describe the oral stage of swallowing.

A

Involves labial movement, lingual movement, sensory receptors, buccal muscle, and nose breathing.

Mastication of food occurs with rotary lateral movement of jaw and tongue.

Bolus is formed when tongue mixes food/drink with saliva.

The bolus is then transported from the oral cavity to the pharynx through the tongue’s posterior movement of the bolus.

When the bolus head reaches the faucial pillars is when the pharyngeal stage is ready.

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13
Q

With INCREASED viscosity= ? volume, ? pressure, and ? muscle activity.

A

DECREASED volume, INCREASED pressure, and INCREASED muscle activity.

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14
Q

How long is the pharyngeal stage of swallowing?

A

~ 1 second

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15
Q

Describe the pharyngeal stage of swallowing

A

Velum elevates & retracts for VP closure

Bolus transport occurs with tongue base retraction and pharyngeal wall constriction

Epiglottis inverts over the laryngeal vestibule

Larynx and hyoid bone are pulled anteriorly and superiorly to open the pharynx, relax (open) the cricopharyngeus (UES) muscle, and assist the vocal folds in closing off the glottis

Bolus is propelled through the pharynx toward the esophagus by action of pharyngeal constrictors

CP closes, larynx rests.

When the UES closes, the esophageal stage begins.

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16
Q

What is a delayed pharyngeal swallow?

A

If pharyngeal stage not triggered when bolus head passes between faucial arches and tongue base

17
Q

Describe the esophageal stage of swallowing

A

Bolus flow through the esophagus via peristaltic contractions of striated and smooth muscle along the esophageal wall

Relaxation of LES allows bolus to flow into the stomach

18
Q

How long does the esophageal stage last and how is it measured?

A

8-20 seconds
~ 10 seconds

Transit time is measured from UES through LES

19
Q

What are the signs and symptoms of oral or pharyngeal dysphagia?

A 
Coughing or choking with swallowing
Difficulty initiating swallowing
Food sticking in the throat
Sialorrhea/xerostomia
Drooling or spillage
Unexplained weight loss
Change in dietary habits
Penetration
Aspiration
Recurrent pneumonia
Change in voice or speech (wet voice)
Nasal regurgitation
Wet, gurgly voice quality
20
Q

What are the signs and symptoms of esophageal dysphagia?

A 
Sensation of food sticking in the chest or throat
Oral or pharyngeal regurgitation
Change in dietary habits
Recurrent pneumonia
Reflux
Aspiration
21
Q

What is an esophageal stricture?

A

Narrowing of the esophagus

22
Q

What are the signs and symptoms of silent aspiration?

A

NO SIGNS OR SYMPTOMS

Possible signs may include: tearing and/or runny nose

23
Q

What is the difference between feeding and swallowing?

A

Feeding: placement of food in the mouth before initiation of swallow (oral prep stage; salivation, presentation)

Swallowing: transfer of food/drink from mouth to stomach (oral, pharyngeal, and esophageal stage)

24
Q

What is a swallow screening?

A

A 10-15 minute administration/observation of a small bolus

25
Q

What does the swallow screening consist of?

A

Bedside clinical assessment
Signs and symptoms
Pre-diagnostic

26
Q

T/F The A&P can be assessed in a swallow screening

A

FALSE; A&P cannot be assessed

27
Q

What are the components of the bedside clinical assessment?

A 
Medical history
Level of alertness
Pt Interview
Oral motor exam
Assess swallow with small bolus
28
Q

What signs and symptoms do you look for in the swallow screening?

A 
Spillage?
Oral residue?
Long transit time? 
Cough? 
Throat clear? 
Gurgly voice?
Tearing?
Runny nose? 
Wrong sound (stethoscope)?
29
Q

T/F the swallow screening is a pre-diagnostic.

A

TRUE; the swallow screen is a pre-diagnostic.

30
Q

What does the diagnostic procedure do? (3 things)

A
  1. ID symptoms to explain abnormalities in anatomy or physiology causing dysphagia (etiology)
  2. Examines Physiology (timing, tongue base motion, epiglottic dysfunction, laryngeal excursion, UES dysfunction, peristalsis, paralysis, sensitivity
  3. Examines immediate effects of tx’s
31
Q

Name the 5 diagnostic procedures involving imaging.

A
  1. FEES/FEESST
  2. Videofluroscopy
  3. Ultrasound
  4. Videoendoscopy
  5. Scintography
32
Q

Name the 4 diagnostic procedures that do not involve imaging (non-imaging).

A
  1. EMG
  2. EGG
  3. Acoustic (accelerometer or stethoscope)
  4. Pharyngeal manometry
33
Q

What are the 8 treatments for dysphagia listed in the first PPT?

A
  1. Diet modification (volume, viscosity, texture, temperature, NPO diet-NG tube, G tube, PEG, J tube, TPN)
  2. Compensatory (Positional: posture, chin tuck, head rotation; Multiple swallows)
  3. Maneuver (Supraglottic, Super-supraglottic, Mendelsohn, Effortful)
  4. Exercise (Shaker, Masako, oral muscle strengthening)
  5. Stimulation (Thermal/Tactile Stim)
  6. Experimental (Neuromuscular electrical stimulation [NMES: VitalStim], Deep Pharyngeal Neuromuscular Stimulation [DPNS], Myofascial release [MFR], Botox)
  7. Prosthetic (Palatal lift or obturator)
  8. Surgery (CP myotomy, diverticulectomy, dilation)
34
Q

Who is part of the multidisciplinary team?

A 
SLP
Physician/Neurologist/ENT
Nursing
Dietician
OT
PT
Radiologist
Pharmacist
Social worker
Psychologist

Dysphagia (3 decks)

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