Swallowing disorders Flashcards
1
Q
What are signs of oropharyngeal + oesophageal disease?
A
- dysphagia
- drooling saliva
- halitosis
- odynophagia (that’s painful swallowing)
- regurgitation (only oesophagus)
- difficulty lapping 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
2
Q
What’s the difference between functional + morphological diseases?
A
- Functional = abnormal neuromuscular activity
- Morphological = Structural abnormalities
3
Q
What can cause functional neuromuscular dysphagia?
A
- Cricopharyngeal chalasia/achalasia
- myasthenia gravis
- brainstem disease
- peripheral neuropathy
- polymyopathy
- hypothyroidism
- botulism
4
Q
What can cause morphological dysphagia?
A
- oropharyngeal inflammation
- oropharyngeal trauma
- foreign bodies
- neoplasia
- congenital / developmental
- Various e.g. =
-hare-lip, lip-fold deformities
-cleft palate
-malocclusion
-craniomandibular osteopathy
-temporomandibular dysplasia
5
Q
What can cause 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
6
Q
What is regurgitation?
A
- PASSIVE EVENT (c.f. vomiting)
- undigested food
- covered by mucus/saliva (basic)
- immediate, or delayed
- neutral pH
7
Q
What is Pseudoptyalism + Ptyalism?
A
- Pseudoptyalism = failure to swallow normal volume of saliva
- Ptyalism = increased saliva production
8
Q
What are secondary signs of oesophageal + oropharyngeal disease?
A
- malnutrition / dehydration
- anorexia / polyphagia
- aspiration pneumonia / tracheal compression =
- cough
- dyspnoea
9
Q
How would you investigate a swallowing problems?
A
- History & physical examination
- Diagnostic imaging
- Endoscopy
- Laboratory investigations
- FNA
- Biopsy
- Special tests
10
Q
What history would be noted with vomigurgitation?
A
- What is brought up
- When is it brought up (timing wrt feeding)
- Signs of vomiting
- Concurrent signs
- Duration of illness
11
Q
What radiographs should be taken?
A
- Survey Radiographs = head, neck, thorax
- Barium oesophagram ± fluoroscopy =
- barium mixed with food
- iodine contrast if perforation suspected (barium in abdomen = granulomatous inflammation)
12
Q
What would you do with lab investigations?
A
- Haematology
- Serum biochemistry & urinalysis
- Virology (cats especially)
- “Special” tests = Anti-ACh receptor antibody
- 2-M antibodies (muscles of mastication)
- ACTH stimulation test
- Thyroid testing?
- Toxicological tests?
13
Q
What are major diseases of the oesophagus?
A
- Motility = Megaoesophagus, Congenital, Acquired (Primary/Secondary), Dysautonomia, Hiatal Hernia
- Obstruction = Vascular Ring, Stricture, Foreign body, Neoplasia
- Inflammation = Oesophagitis, Reflux, Hiatal Hernia
- Misc = Diverticulum, Broncho-oesophageal fistula
14
Q
What is megaoesophagus?
A
- “Oesophageal dilation with functional paralysis”
- Failure of progressive peristalsis
- Primary/idiopathic
- Secondary/Acquired
15
Q
How is megaoesophagus diagnosed?
A
- Diagnosis by radiography ± contrast =
-uniformly dilated, gas and/or fluid filled
-ventral displacement of trachea
-secondary aspiration pneumonia - Fluoroscopy occasionally essential =
-oesophageal dysmotility
