Swallowing and Regurgitation Flashcards
Dysphagia indicates ________ disease
oropharyngeal
Regurgitation indicates ________ disease
esophageal
The presence of dysphagia + regurgitation indicates what differentials?
- diffuse neuromuscular disease
- painful esophageal disease (esophagitis, FB)
Vocal changes indicate a problem with _______ function
laryngeal
If you have dysphagia with what sign, the prognosis is decreased
poor drinking ability
Oropharyngeal structural disease differentials
Oral, pharyngeal, and retropharyngeal disease
- inflammatory/infectious (periodontal dz, stomatitis, oral ulcers)
- foreign body
- mass lesions
- trauma
Salivary gland disease
Painful esophageal disease (esophagitis, FB)
Test for myasthenia gravis
anti-AchR antibodies
Achalasia
failure to relax
Chalasia
failure to contract
Dyssynchrony
incoordination between pharyngeal and cricopharyngeal phase of swallowing
Diagnostic approach to ruling out structural disease
Radiographs of thorax and neck
Esophagoscopy( > barium swallow for detection of FB or esophagitis)
Laryngeal function exam at induction
Causes of esophagitis
Gastroesophageal reflux
- frequent vomiting, recent anesthesia, hiatal hernia
Caustic substance ingestion
- alendronate, doxycycline, clindamycin
Physical injury
- foreign body
Esophagitis treatment
Remove insult (FB, doxycycline, fix hernia, etc.)
Inhibit gastric acid secretion–Proton pump inhibitor
Sucralfate slurry
Prokinetic drug–cisapride or metaclopramide
Gastrostomy tube if esophagus that damaged, not eating
What is the most common cause of esophageal stricture?
post-anesthesia reflux
Treatment of esophageal stricture
- dilation with bougies or balloon catheter
- gastric acid inhibition & prokinetic drugs
- intralesional or oral steroids
- possibly temporary gastrostomy tube
