Lecture 7: Dysphagia and Nutrition

Question 1

Difficulty swallowing only solid foods implies what type of dysphagia?

Answer 1

Mechanical

Question 2

If oropharyngeal dysphagia is suspected what type of imaging can aid in diagnosis?

Answer 2

Video fluoroscopy (esophagogram)

Question 3

3 major structural causes of oropharyngeal dysphagia?

Answer 3

1. Zenker diverticulum
2. Neoplasm
3. Cervical web

Question 4

Which imaging techniques can be used to evaluate mechanical dysphagia?

Answer 4

• Barium swallow

AND

• Esophagogastroscopy w/ endoscopic biopsy

Question 5

Intermittent dysphagia for solid foods may be caused by what 2 pathologies?

Answer 5

1. Schatzki ring
2. Esophageal web

Question 6

What is the most common cause of solid and liquid esophageal dysphagia?

Answer 6

GERD w/ weak peristalsis

Question 7

What are 2 major causes of odynophagia?

Answer 7

• Pill esophagitis
• Infectious esophagitis

Question 8

In a bedside swallow assessment the first step is to make sure the pt is what?

Answer 8

Cognitive (assessment): alert and coherent

Question 9

Posture of pt in bedside swallow assessment?

Answer 9

Upright

Question 10

During a bedside swallow assessment how is pts respiratory status checked?

Answer 10

Have them breath through nose

Question 11

What type of oral exam should be done during bedside swallow assessment?

Answer 11

Oral mechanism exam = CN’s

Question 12

Describe the oral trials of a bedside swallow assessment (i.e., start with what, observe what, palpate, and advancement)?

Answer 12

• Start with water (thin liquid) and observe the swallowing
• Palpate the thyroid notch for rise and fall
• Have the pt speak: voice quality, coughing? other signs of aspiration
• Advance to crackers or graham crackers, repeat
• Check for food retained in oropharynx

Question 13

Which CN is responsible for innervating the muscles of mastification?

Answer 13

CN V (Mandibular branch V3)

Question 14

Sx’s suggestive of aspiraton?

Answer 14

• Pts experiencing sudden cough

- Some people may wheeze, have trouble breathing, or have a hoarse voice after they eat, drink, vomit, or experience heartburn.

Question 15

Modified barium swallow is used to determine cause and evaluate severity of?

Answer 15

Tracheal aspiration

Question 16

Who performs a modified barium swallow?

Answer 16

Speech pathologist and radiologist

Question 17

What types of liquids are used during modified barium swallow?

Answer 17

• Barium suspensions of varying thickness
• Thin liquid, thick liquid, nectar, paste and solid –> mimic different food consistencies

Question 18

What are 3 indications for moving to a modified barium swallow (radiograph) instead of bedside swallow assessment?

Answer 18

• Patients conditions i.e., failed beside assessment
• Sx’s suggestive of dysphagia or aspiration
• Neuro findings suggestive of dysf. affecting swallowing mechanisms.

Question 19

What are some dysfunctions associated with neurological involvement impairing swallowing?

Answer 19

• Tongue paralysis
• Lack of saliva
• Lesions affecting sensory components of CN’s X and XI

Question 20

What are 3 mechanical appropriate dysphagia diets?

Answer 20

1. Pureed: all foods pureed to pudding-like consistency
2. Mechanically altered: moist, soft-textured and easily chewed (ground meat w/ gravy or sauce)
3. Dysphagia advanced: excludes hard, dry, sticky, or crunchy foods

Question 21

Is swallowing affected in Globus Pharyngeus?

Answer 21

No, pt just has sensation of lump lodged in throat

Question 22

Wet/gargly voice after swallowing during a bedside swallow assessment is associated with?

Answer 22

Silent aspiration