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Y4 SA - Endocrine > Swallowing disorders > Flashcards

Swallowing disorders Flashcards

1
Q

Define swallowing

A

A series of sequential well-coordinated events that transport foods and liquids from the buccal cavity to the stomach

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2
Q

List the key anatomical structures involved in swallowing

A

Pharynx
Soft palate
Larynx
Oesophageal striated and smooth muscle
Gastro-oesophageal junction
Nerves:
- Sympathetic
- Parasympathetic (Vagus and recurrent Laryngeal)

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3
Q

Name the 3 major phases of swallowing

A

Oropharyngeal
Oesophageal
Gastro-oesophageal

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4
Q

List the main signs of swallowing disorders

A
  • Dysphagia = difficulty swallowing
  • Odynophagia = swallowing pain
  • Regurgitation (not vomiting)
  • Drooling saliva
  • Halitosis
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5
Q

What are the signs of dysphagia (how can it manifest?)

A

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

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6
Q

Dysphagia can be divided into which two categories?

A

Functional = abnormal neuromuscular activity
Morphological = structural abnormality

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7
Q

List the possible causes of a function dysphagia

A
  • Cricopharyngeal chalasia/achalasia
  • Myasthenia gravis
  • Brainstem disease
  • Peripheral neuropathy
  • Polymyopathy
  • Hypothyroidism
  • Botulism
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8
Q

List the possible causes of a morphological dysphagia

A
  • Oropharyngeal inflammation
  • Oropharyngeal trauma
  • Foreign bodies
  • Inflammation → ulceration, necrosis, secondary infection
  • Neoplasia
  • Congenital / developmental
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9
Q

List the possible congenital/developmental conditions which could lead to a morphological dysphagia

A

Hare-lip, lip-fold deformities
Cleft palate
Malocclusion
Craniomandibular osteopathy
Temporomandibular dysplasia

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10
Q

Give the term used to describe inflammation of the following anatomical locations:
- Oral mucosa
- Lips
- Tongue
- Gums
- Pharynx
- Tonsils

A
  • Oral mucosa = stomatitis
  • Lips = cheilitis
  • Tongue = glossitis
  • Gums = gingivitis
  • Pharynx = pharyngitis
  • Tonsils = tonsillitis
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11
Q

List some possible causes of halitosis

A
  • Oropharyngeal disease: Inflammation, Neoplasia, Foreign body
  • Oesophageal disease
  • Dietary associated
  • Malabsorption
  • Dental disease
  • Nasal cavity & sinus disease
  • Uraemia
  • Liver disease
  • Anal sac disease
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12
Q

How is regurgitation different to vomiting?

A

Regurgitation is a passive event
Undigested food
Covered by mucus/saliva
Immediate, or delayed
Neutral pH

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13
Q

Define Pseudoptyalism

A

Failure to swallow normal volume of saliva -> drooling saliva

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14
Q

Define ptyalism

A

Increased saliva production

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15
Q

What are some secondary signs of oesophageal and oropharyngeal disease?

A

Malnutrition / dehydration
Anorexia / polyphagia
Aspiration pneumonia / tracheal compression
- Cough
- Dyspnoea

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16
Q

List the methods of investigating and diagnosing swallowing problems

A

History & physical examination
Diagnostic imaging
Endoscopy
Laboratory investigations
FNA
Biopsy

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17
Q

What questions might you ask if presented with an animal with vomigurgitation?

A

What is brought up?
When is it brought up (timing wrt feeding)?
Signs of vomiting e.g. abdominal effort
Concurrent signs
Duration of illness

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18
Q

Describe the physical examination of a patient with swallowing disorders

A

Oral cavity examination
Examine head (jaw, skull, muscles)
Palpation of neck (oesophagus)
Systemic examination
Neurological examination

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19
Q

Describe the radiographic examination of a patient with swallowing disorders

A

Survey Radiographs: Head, neck, thorax
Barium oesophagram ± fluoroscopy
- Barium mixed with food
- Iodine contrast if perforation suspected

20
Q

What is the 2-M antibody lab test specific for?

A

Unique to the muscles of mastication

21
Q

When might you perform biopsy/FNA in swallowing disorder cases?

A

Oropharynx c.f. oesophagus
- Mass
- Draining lymph nodes
Direct sampling or US-guided
Usually requires GA

22
Q

Define the term megaoesophagus

A

“Oesophageal dilation with functional paralysis’’

23
Q

What are the causes of megaoesophagus?

A

Primary idiopathic megaoesophagus = Congenital or Acquired - great dane, irish setter, pyloric stenosis in siamese cats
Secondary acquired megaoesophagus

24
Q

List the causes of a secondary megaoesophagus

A

CNS = distemper
Neuropathies
Neuromuscular = myasthenia gravis, botulism, tetanus
Oesophagitis
Pyloric stenosis
GDV
Thymoma

25
Q

How is a megaoesophagus diagnosed?

A

Radiography ± contrast
- Uniformly dilated, gas and/or fluid filled
- Ventral displacement of trachea
- Secondary aspiration pneumonia

26
Q

How can you treat an idiopathic megaoesophagus?

A
  • Feeding from a height: Bailey chair – utilises gravity
  • Slurry, textured food, meatballs?
  • Bethanecol ?
  • Metoclopramide, cisapride ??
  • Raise water bowl
27
Q

Describe the prognosis for an idiopathic megaoesophagus

A

Guarded
Danger of aspiration pneumonia

28
Q

List the potential causes of oesophagitis

A

Ingestion of caustics and irritants
Foreign bodies
Acute and persistent vomiting
Gastric reflux

29
Q

List the clinical signs of Oesophagitis

A

Anorexia
Dysphagia
Odynophagia – pain in the oesophagus when eating
Regurgitation
Hypersalivation

30
Q

How is oesophagitis diagnosed?

A

Clinical signs
Endoscopy
Response to empirical treatment?

31
Q

Describe the symptomatic treatment of oesophagitis

A

(rest the oesophagus)
- Frequent small feeds
- Antibiotics
- Liquid antacids
- Local anaesthetic
- Gastrostomy tube feeding – if severe

32
Q

Describe the specific treatment of oesophagitis

A

Sucralfate
Antacids
Metoclopramide

33
Q

How is oesophageal obstruction categorised?

A

Intraluminal = FB
Intramural
Extramural

34
Q

What are the 3 causes of an intramural oesophageal obstruction?

A

Neoplasm
Stricture
Granuloma

35
Q

What are the 3 causes of an extramural oesophageal obstruction?

A

Thyroid
Thymic/mediastinum
Vascular ring

36
Q

Describe the aetiology of an oesophageal stricture

A

Fibrosis after ulceration of mucosa by:
- Foreign body
- Caustic material
- Severe oesophagitis
- Gastric reflux: especially pooled secretions during GA
- Drug therapy e.g. doxycycline in cats

37
Q

Name the 2 methods of oesophageal stricture dilation

A

Bougienage
Balloon dilatation

38
Q

Describe the bougienage method of oesophageal stricture dilation

A

Forcible passage of tubes of increasing diameter; some people use endotracheal tubes.
This produces a longitudinal shear effect and has an increased risk of perforation.

39
Q

Describe the balloon method of oesophageal stricture dilation

A
  • Best method
  • Radial stretch
  • Stationary force
  • Less risk of perforation
  • Inflatable balloon
  • Radial stretching less traumatic
  • Use pressure gauge
40
Q

Where do oesophageal foreign bodies most commonly lodge?

A

Lower oesophageal sphincter > heart base > thoracic inlet

41
Q

Which dogs usually present with oesophageal foreign bodies?

A

Usually young animals
Common in greedy dogs eating chop bones Esp terriers – 40% WHWT

42
Q

What should NOT be done if an oesophageal FB is suspected?

A

Dont give barium

43
Q

How is an oesophageal FB diagnosed?

A

Radiography
Oesophagoscopy

44
Q

How are oesophageal FBs treated?

A
  1. Peroral approach
    - Flexible or rigid endoscope
    - Preferably pull FB to mouth
    - Or push to stomach for gastrotomy
    - Check for oesophageal tear
  2. Surgical removal
    - Last resort
    - Essential if large laceration
45
Q

How should patients be managed post oesophageal FB removal?

A

Post removal oesophagitis
Radiographs (pneumomediastinum)
PEG Tube
Omeprazole
Sucralfate

Y4 SA - Endocrine (6 decks)

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