Signs And Symptoms Of Dysphagia Flashcards

0
Q

What factors impact swallowing function and how?

A

Most dysphagic symptoms are related to sensori-motor dysfunction of the swallow mechanism
Also caused by problems in - motor planning, integration/execution of commands and faulty judgment

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1
Q

What are warning signs of dysphagia

A
Reports problem
Drooling
Poor  oral hygiene
Dysarthria +/- dysphonia 
Gurgly voice
Increased time with meals or refusal  to eat and drink
Coughing on  food/fluids
Recurrent  chest  infections/unexplained temperature spikes
Fluctuating level of consciousness
Primitive oral reflexes
Weight loss
Confused mental state
Diminished/absent cough
Certain medications
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2
Q

What are the four oral phases?

A

Reduced labial closure
Reduced range of tongue movement
Reduced buccal tension
Reduced oral sensitivity

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3
Q

Which disorders of the oral stage cause aspiration before the swallow?

A

Reduced range of tongue movement

Reduced oral sensitivity

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4
Q

What are the 6 disorders of the pharyngeal phase?

A
Delayed/absent swallow reflex
Inadequate pharyngeal closure
Reduced laryngeal closure
Reduced pharyngeal contraction
Reduced laryngeal elevation
Cricopharyngeal dysfunction
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5
Q

Which pharyngeal disorder causes aspiration before the swallow?

A

Delayed/absent swallow reflex

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6
Q

What pharyngeal disorder causes aspiration during the swallow reflex

A

Reduced laryngeal closure

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7
Q

Which 3 pharyngeal disorders cause aspiration after the swallow reflex

A

Reduced pharyngeal contraction
Reduced laryngeal elevation
Cricopharyngeal dysfunction

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8
Q

What disorder of the swallow occurs in the oesophageal phase?

A

Weak cricopharyngeus

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9
Q

When does a weak cricopharyngeus cause aspiration?

A

After the swallow

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10
Q

What four disorders of the swallow cause aspiration after the swallow reflex?

A

Reduced pharyngeal contraction
Reduced laryngeal elevation
Cricopharyngeal dysfunction
Weak cricopharyngeus

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11
Q

What other factors influence the swallow?

A
Age
Volume
Viscosity
Delivery of bolus
Impaired respiratory support
Saliva, taste, flavour perception
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12
Q

How does the swallow change when you get old?

A

Longer oral stage
Extra hyoid gestures
Small increase in oral and pharyngeal residue
Pharyngeal stage triggered later
Larynx elevated just enough to open UES
Slower and less efficient oesophageal transit and clearance
Reduction in smell and taste

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13
Q

The thicker the food…

A

Increased pharyngeal contraction
Increased transit time from oral to pharyngeal phases
Increased total swallow duration
No change to laryngeal closure time

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14
Q

What is the problem with straws?

A

If you don’t have a good swallow, they can deliver the bolus before you are ready for it - can be inhaling at the same time and then it will go straight down the larynx.

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15
Q

Key clinical populations in dysphagia…

A
Acute neurological - stroke, head injury
Degenerative neurological - Parkinson's, MND, dementia
Critical care and trauma
Mechanical/structural
Pulmonary
Iatrogenic
16
Q

What are some effects of left CVA

A
Unilateral weakness
Oral transit delays
Delays in triggering  pharyngeal swallow
Pharyngeal deficits
Impact of associated Aphasia on dysphagia  management
17
Q

What are signs of a right CVA.

A
Mild (but variable) oral transit delays
Delay in pharyngeal trigger/reflex
Unilateral weakness
Behavioural issues impacting as well as motor deficits
- verbose
- decreased attention, poor  new  learning
- impulsive
- left neglect
18
Q

What are some problems caused by multiple strokes

A

More significant problems
Slow oral transit
More severe delays in triggering pharyngeal swallow
Decreased laryngeal elevation and decreased ability to protect airway
Increased likelihood of residue in pharynx post swallow
Increased risk of aspiration

19
Q

Swallow patterns of a head injury

A

Oral disorders - lip closure, tongue functions, oral reflexes
Pharyngeal - triggering swallow, decreased laryngeal elevations and CP opening; decreased airway closure
Cognitive overlay - impulsiveness, too much food in, decreased new learning
Possible problem with compliance with food recommendations
Pulmonary complications may be present

20
Q

Dysphagia is an early feature of Parkinson’s - true/false

A

False

21
Q

Do all sufferers of Parkinson’s exhibit severe swallowing disorders?

A

No

22
Q

What are the effects of Parkinson’s on the oral stage

A
Repetitive tongue pumping
Lingual tremor
Inefficient mastication
Piecemeal deglutition, premature spill
Buccal retention
23
Q

What are some issues in the pharyngeal stage of sufferers of Parkinson’s?

A

Delayed swallow initiation
Pharyngeal residue secondary to poor BOT and PPW
Later stages - decreased pharyngeal excursion

24
Q

What affect does MND have on the oral stage of the swallow?

A

Poor lip and tongue function
Difficulty with viscous foods/fluids and mastication
Reduced Velopharyngeal function

25
Q

What affect does MND have on the pharyngeal stage of the swallow?

A

Pooling secondary to decreased BOT and PPW
Decreased laryngeal excursion and UES opening
Poor ability to protect airway and SOB

26
Q

What are the effects of dementia on swallowing?

A

Lack of recognition for food
Lack of understanding for feeding - how to use utensils. Inappropriate bolus size, affects independence
Don’t understand what to do with food once it is in mouth. May forget food is in mouth and add more

27
Q

What are some structural problems that affect swallowing?

A

Cervical osteophytes
Facial fractures
Pharyngeal pouch (Zenker’s diverticulum)
Oesophageal disorders

28
Q

What is an osteophyte?

A

Bony outgrowth from the cervical vertebrae

29
Q

What is the impact of osteophytes on the swallow?

A

Narrow pharynx - creating sensation of food getting stuck, discomfort on larger boluses and solids

30
Q

What is a pharyngeal pouch?

A

Side pocket formed when pharyngeal or oesophageal muscle herniates
Patient feels like something is in their throat

31
Q

Structural issues in the oesophagus lead to problems with…

A

Ability for patient to swallow larger amounts of food/fluid
Discomfort - tightness in chest
Back flow of materials back through the CP sphincter and may be aspirated

32
Q

What is gastro oesophageal reflux?

A

Failure of LES to keep food in stomach causes back flow that can extend to the pharynx and may cause aspiration if airway is unprotected

33
Q

What are some signs of gastro oesophageal reflux?

A

Burning sensation in pharynx or oesophagus
Frequent coughing/ gagging
Redness of arytenoids

34
Q

What issues are caused by COPD - Chronic Obstructive Pulmonary disease?

A
Swallowing  air
Anxiety
Hypoxia
Dyspnoea
Reduced appetite
Frequent expectoration of mucous
Fatigue
35
Q

How are the mechanisms altered for airway protection in COPD?

A
Delayed pharyngeal swallow
Delayed laryngeal closure
Premature laryngeal opening
Pharyngeal residue
Reduced pulmonary defence mechanisms
36
Q

How does COPD affect the swallow?

A

Slow and effortful bolus preparation
Xerostomia
Pharyngeal residue
Slow oesophageal clearance