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Semester 4 (NME) > Swallowing and Dysphagia > Flashcards

Swallowing and Dysphagia Flashcards

1
Q

What are the three stages of swallowing? Which are automatic?

A

1) Voluntary (initiation)
2) Pharyngeal
3) Oesophaygeal
2+3 are automatic

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2
Q

When epithelial swallowing receptor area’s are stimulated which nerves carry the information and to which centres?

A

CN V and CN IX

To nucleus of solitary tract and reticular substance neuronal area in pons/ medulla

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3
Q

Which muscles comprises the UES (upper oesophageal sphincter)?

A

Cricopharyngeus

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4
Q

What are tertiary contraction waves?

A

Not peristaltic, caused be events such as fluroscopy

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5
Q

ACh and Substance P are examples of what type of NT when acting in the nerves of the GI system?

A

Excitatory

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6
Q

VIP and nitric Oxide are examples of what type of NT when acting in the nerves of the GI system?

A

Inhibitory

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7
Q

What percentage of patients who suffer stroke experience dysphagia?

A

40%

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8
Q

What is the definition of dysphagia?

A

Abnormal food transfer from mouth to stomach

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9
Q

What is the difference between aspiration and penetration in relation to dysphagia?

A

Aspiration- Food decends below vocal cords

Penetration- Food enters larynx but stays above vocal cords

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10
Q

What proportion of stroke patients aspirate on swallow and what percentage go on to develop aspiration pneumonia?

A

1/3 aspirate on swallow

1/9 go on to develop AP

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11
Q

What are the general symptoms of dysphagia?

A

Difficulty or inability to swallow
Coughing/ choking when eat/drink
Persistant saliva drooling
Changes in voice/ resp status/ temp

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12
Q

Name two long term symptoms of patients with dysphagia?

A

Weight loss

Recurrent chest infections

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13
Q

What diagnostic tests could be used to observe for dysphagia?

A 
Water swallow (quick 150ml swallow)
Videofluroscopy (modified barium swallow)- X-ray P whilst drinking (barium is non-toxic)
FEES (Fiberoptic endoscopic examination of swallow)- Camera inserted into nose and swallow observed
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14
Q

What are the pro’s/cons of PEG vs NGT?

A

NGT- Swap nostrils each month (irritation/ infection risk)

PEG- Tube into stomach (infection/ hemorrhage/ displacement/ more difficult to resume normal feed)

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15
Q

What is the treatment for oropharyngeal (high) dysphagia?

A

SLT swallowing therapy (exercises)
Diet changes (Softer foods/ thicker fluids)
Feeding tubes (NGT/PEG)
Head postural adjeustments - SLT

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16
Q

What is a PEG tube?

A

Percutaneous endoscopic gastrostomy

Flexible feeding tube through abdomen into stomach/ intestine

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17
Q

What is the treatment options for oesophageal (low) dysphagia?

A

PPI’s to lower acid production
Botox (paralyse oesophageal muscles)
Surgery (stent/ ballon)

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18
Q

What is the most common site of aspiration pneumonia?

A

Lower lobe of R lung

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19
Q

How is aspiration pneumonia best prevented?

A

Bed bound patients with dysphagia best kept at >30degrees

Give NGT for at risk patients

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20
Q

What is the compostition of saliva? How much is secreted each day?

A

1L secreted each day

  1. 4% water
  2. 6% (Na/Cl/HCO3/ Glycoproteins/enzymes)
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21
Q

What gives salvia it’s lubricating action?

A

Glycoproteins called mucins

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22
Q

What antibiotic is present in saliva?

A

Lysozyme

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23
Q

What enzymes are present in saliva?

A

Salivary amylase (starch to sugar)

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24
Q

How does the pH/ osmolarity of saliva change if it is secreted at a low rate or a high rate?

A

Low rate: pH 6-7 (slightly acidic) + hypotonic

High rate: Closer to isotonic (More Na/ less K+ and HCO3-)

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25
Q

What are the three main salivary glands and what do each secrete?

A

Submandibular (70%)- Mucous + serous
Sublingual (5%)- Mucous (high in glycoprotein- sticky)
Parotid (25%)- Serous (Watery- protein/enzymes/ ptyalin)

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26
Q

What is ptyalin?

A

A major form of amylase

27
Q

By what intracellular pathways does PNS stimulation affect saliva production?

A

ACh binds to muscarinic receptors + Substance P binds to tachykinin NK-1 receptors
This increases saliva secretion by activating signalling pathways:
IP3 calcium 2qnd messenger / DAG 2nd messenger

28
Q

By what intracellular pathways does SNS stimulation affect saliva production?

A

SNS from T1-T3 sup cervical ganglion uses NA to activate Badrenergic receptors, increasing cAMP

29
Q

What determins the permiability of the tight junctions between the cells of the salivary duct acini?

A 
Claudin proteins 
(these are the most important components of TJ's)
30
Q

Which is the most important H2O channel in salivary ducts?

A

Aquaporin 5

31
Q

What type of flow happens through ion channels?

A

Passive, driven by conc gradient

32
Q

What type of flow happens through aquaporins?

A

Passive, driven by osmosis

33
Q

What type of flow happens through carriers?

A

Either facilitated diffusion (not ATP) or active transport (uses ATP)

34
Q

What type of flow happens through uniporters?

A 
Facilitated diffusion (Passive, down conc grad0
Undergo's conformational change
E.g GLUT1 or GLUT2 transporters
35
Q

What type of flow happens through symporters?

A

Secondary active transport (ATP used)
One substance brought in against gradient
Electrochemical gradient from other substance used for energy purposes

36
Q

What type of flow happens through anti-porters?

A

Secondary active transport (ATP used)
One substance brought in against gradient
Electrochemical gradient from other substance used for energy purposes

37
Q

What type of flow happens through pump channels?

A

Primary active transport

ATP binds to pump and it undergoes conformational change

38
Q

What are the actions of the TMJ?

A

Translation and rotation

39
Q

What is the most likely location for food or a fishbone to become wedged in the throat?

A

Piriform fossa

between aryepiglottic fold and thyrohyoid membrane

40
Q

What is the foreamen cecum?

A

Embryological remnant of thyroglossal duct

Tumour/ lump distinguishable as it’s the only one that moves when tongue protruded

41
Q

What is the first muscle to contract in the swallowing sequence?

A

Myelohyoid

42
Q

Which two neurotransmitters regulate peristalsis and how?

A

ACh and nitric oxide (smooth muscle relaxants)

43
Q

How long does an average swallow take? How many times do we swallow per day?

A

0.5-1sec

1000x per day

44
Q

When testing a patients swallows how many should they do?

A

At least 10 (to test fatigue)

45
Q

Guidelines suggest stroke patients should have a swallowing assesment within how long of arriving in hospital?

A

4hours

46
Q

Which area of the cortex organises the patterned response in swallowing?

A

Brain stem central programme generator (CPG)

47
Q

Why is the LES needed? What happens if it is not fully functional?

A

As pressure in stomach is slightly higher than in oesophagus

If pathology then = acid reflux

48
Q

Define achalasia

A

Failure of a ring of muscle fibres (such as those in oesophageal sphincter) to relax
Caused by degeneration of neurons (inflammation) in oesophageal wall/ myenteric plexus

49
Q

What is the best diagnostic test for achalasia?

A

Modified barium swallow

Look for dilated oesophagus above narrow slit

50
Q

What is manometry

A

Catheter with sensors is passed down nose into stomach, used to asses oesophageal function

51
Q

What is Barrett’s oesophagus?

A

What is Barrett’s oesophagus?
GORD cause’s glandular metaplasia and causes squamous epithelium to become columnar, it is precancerous, leading to adenocarcinoma

52
Q

How do you treat GORD?

A

Antacids (Gaviscon)
H2 receptor antagonists (cimetidine)
PPI’s (omeprazole)

53
Q

What is the most common cause of oesophageal dysphagia?

A

GORD

54
Q

The pH of saliva is found to increase with the flow rate of saliva along the salivary duct. Why?

A

As rate of metabolism in the salivary duct increases, secretion of bicarbonate also increases

55
Q

Problems with the oral phase of swallowing commonly result in:

A

Aspiration pneumonia

56
Q

What is the purpose of oromotor exercises?

A

Increase back of tongue function in holding material orally

57
Q

Swallowing difficulties in the oral phase relate to…?

A

Difficulty moving food to the back of the mouth

58
Q

What nerve innervates tensor veli palatini?

A

CN V3 (mandibular)

59
Q

PNS and SNS cause secretion of which types of saliva?

A

PNS: Thin, rich in enzymes
SNS: Thick, rich in mucus

60
Q

What is the function of kallikrein?

A

Enzyme activator of bradykinin (vasodilator)

61
Q

Speech and language therapy doing oromotor exercises aims to mainly strengthen which muscle?

A

Suprahyoid

62
Q

Where in the brain is the central program generator swallowing centre found?

A

Medulla oblongata

63
Q

In the population of patients who experience dysphagia post stroke, what % will retain problems swallowing over the long term?

A

90%

Semester 4 (NME) (24 decks)

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