Swallowing disorders Flashcards
Define swallowing
A series of sequential well-coordinated events that transport foods and liquids from the buccal cavity to the stomach
List the key anatomical structures involved in swallowing
Pharynx
Soft palate
Larynx
Oesophageal striated and smooth muscle
Gastro-oesophageal junction
Nerves:
- Sympathetic
- Parasympathetic (Vagus and recurrent Laryngeal)
Name the 3 major phases of swallowing
Oropharyngeal
Oesophageal
Gastro-oesophageal
List the main signs of swallowing disorders
- Dysphagia = difficulty swallowing
- Odynophagia = swallowing pain
- Regurgitation (not vomiting)
- Drooling saliva
- Halitosis
What are the signs of dysphagia (how can it manifest?)
Difficulty lapping up food or forming bolus
Excessive jaw or head motion
Dropping food from mouth
Drooling saliva / foaming at mouth
Persistent, ineffective swallowing
Nasal discharge
Gagging
Coughing
Failure to thrive
Reluctance to eat or pain
Halitosis
Blood-tinged saliva
Dysphagia can be divided into which two categories?
Functional = abnormal neuromuscular activity
Morphological = structural abnormality
List the possible causes of a function dysphagia
- Cricopharyngeal chalasia/achalasia
- Myasthenia gravis
- Brainstem disease
- Peripheral neuropathy
- Polymyopathy
- Hypothyroidism
- Botulism
List the possible causes of a morphological dysphagia
- Oropharyngeal inflammation
- Oropharyngeal trauma
- Foreign bodies
- Inflammation → ulceration, necrosis, secondary infection
- Neoplasia
- Congenital / developmental
List the possible congenital/developmental conditions which could lead to a morphological dysphagia
Hare-lip, lip-fold deformities
Cleft palate
Malocclusion
Craniomandibular osteopathy
Temporomandibular dysplasia
Give the term used to describe inflammation of the following anatomical locations:
- Oral mucosa
- Lips
- Tongue
- Gums
- Pharynx
- Tonsils
- Oral mucosa = stomatitis
- Lips = cheilitis
- Tongue = glossitis
- Gums = gingivitis
- Pharynx = pharyngitis
- Tonsils = tonsillitis
List some possible causes of halitosis
- Oropharyngeal disease: Inflammation, Neoplasia, Foreign body
- Oesophageal disease
- Dietary associated
- Malabsorption
- Dental disease
- Nasal cavity & sinus disease
- Uraemia
- Liver disease
- Anal sac disease
How is regurgitation different to vomiting?
Regurgitation is a passive event
Undigested food
Covered by mucus/saliva
Immediate, or delayed
Neutral pH
Define Pseudoptyalism
Failure to swallow normal volume of saliva -> drooling saliva
Define ptyalism
Increased saliva production
What are some secondary signs of oesophageal and oropharyngeal disease?
Malnutrition / dehydration
Anorexia / polyphagia
Aspiration pneumonia / tracheal compression
- Cough
- Dyspnoea
List the methods of investigating and diagnosing swallowing problems
History & physical examination
Diagnostic imaging
Endoscopy
Laboratory investigations
FNA
Biopsy
What questions might you ask if presented with an animal with vomigurgitation?
What is brought up?
When is it brought up (timing wrt feeding)?
Signs of vomiting e.g. abdominal effort
Concurrent signs
Duration of illness
Describe the physical examination of a patient with swallowing disorders
Oral cavity examination
Examine head (jaw, skull, muscles)
Palpation of neck (oesophagus)
Systemic examination
Neurological examination
Describe the radiographic examination of a patient with swallowing disorders
Survey Radiographs: Head, neck, thorax
Barium oesophagram ± fluoroscopy
- Barium mixed with food
- Iodine contrast if perforation suspected
What is the 2-M antibody lab test specific for?
Unique to the muscles of mastication
When might you perform biopsy/FNA in swallowing disorder cases?
Oropharynx c.f. oesophagus
- Mass
- Draining lymph nodes
Direct sampling or US-guided
Usually requires GA
Define the term megaoesophagus
“Oesophageal dilation with functional paralysis’’
What are the causes of megaoesophagus?
Primary idiopathic megaoesophagus = Congenital or Acquired - great dane, irish setter, pyloric stenosis in siamese cats
Secondary acquired megaoesophagus
List the causes of a secondary megaoesophagus
CNS = distemper
Neuropathies
Neuromuscular = myasthenia gravis, botulism, tetanus
Oesophagitis
Pyloric stenosis
GDV
Thymoma
