Lecture 4 1/31/25 Flashcards
What are the characteristics of dysphagia?
-difficult prehension and swallowing
-repeated swallowing
-ptyalism/drooling
-localizes to oral cavity or pharynx
What are the characteristics of regurgitation?
-passive expulsion of non-digested food and fluid
-typically occurs soon after a meal
-localizes to esophagus
What are the characteristics of vomiting?
-forceful, active expulsion of material
-preceded by salivation, retching, and abdominal contractions
-localizes to stomach and/or small intestine
What is swallowing/deglutition?
complex reflex that moves food and fluids into the GI tract while avoiding the resp. tract
What are the 4 phases of swallowing?
-oral phase
-pharyngeal phase
-esophageal phase
-gastroesophageal phase
What are the characteristics of the oral phase of swallowing?
-voluntary
-food enters oral cavity
-chewing and bolus formation occur
-tongue elevates and propels bolus into pharynx
What are the characteristics of the pharyngeal phase of swallowing?
-involuntary
-bolus presence in caudal pharynx stimulates mechanoreceptors to send signals to the brainstem
-soft palate elevates to seal nasopharynx
-larynx and hyoid bone move forward and upwards
-epiglottis moves back and down to stop respiration
-cricopharyngeal stage occurs in this phase
What is the cricopharyngeal stage?
-contraction of the thyropharyngeal muscle
-relaxation of the cricopharyngeal muscle
-part of the pharyngeal phase
What are the characteristics of the esophageal and gastroesophageal phases of swallowing?
-involuntary
-bolus passes into esophagus
-esophagus contracts sequentially
-lower esophageal sphincter relaxes to allow bolus into stomach
What is odynophagia?
painful swallowing; commonly associated with severe esophagitis or foreign bodies
What are the causes of oral dysphagia?
-prehension deficits
-difficulty with bolus formation
-loss of tongue function
What are the causes of pharyngeal dysphagia?
-impaired initiation of involuntary passage of food through oropharynx
-structural obstruction
-acquired functional disorder
What causes esophageal dysphagia?
difficulty passing bolus through the esophageal body
What causes gastroesophageal dysphagia?
impaired passage of bolus through lower esophageal sphincter
What are the diagnostic signs of oropharyngeal dysphagia?
-undigested food
-food ejection is immediate
-multiple swallow attempts
-poor ability to drink
What are the diagnostic signs of esophageal dysphagia?
-undigested food
-delayed food ejection
-single swallow attempt
-variable ability to drink
How is dysphagia diagnosed?
-history, physical exam, and signalment
-watch patient ingest food and water
-videofluoroscopic swallow study
What are the treatment options for symptomatically treating dysphagia?
-feeding in an elevated position
-varying consistency of diet
-placing a gastrotomy tube
-treating reflux with acid suppressants and pro-kinetics that tighten the lower esophageal sphincter
What is achalasia?
congenital condition in which the cricopharyngeal muscle fails to open during swallowing
What is asynchrony?
acquired or congenital condition in which there is incoordination between pharyngeal contraction and pharyngeal sphincter relaxation
What is the signalment for cricopharyngeal dysphagia in dogs?
-young dogs
-toy breeds
-cocker/springer spaniels
-miniature dachshunds
-golden retrievers
What are the clinical signs of cricopharyngeal dysphagia?
-repeated swallow attempts
-coughing
-regurgitation immediately after or concurrent with swallowing
How is cricopharyngeal dysphagia diagnosed?
-fluoroscopic swallow study
-examination of pharynx
-thoracic radiographs
What are the characteristics of cricopharyngeal dysphagia treatment?
-permanent treatment is myectomy of cricopharyngeus muscle
-can inject botulism toxin into muscle to see if patient has response prior to surgery; not always indicative of surgical outcome
-bilateral myectomy can lead to severe aerophagia/air in stomach