Swallowing disorders Flashcards
What are signs of oropharyngeal + oesophageal disease?
- 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
What’s the difference between functional + morphological diseases?
- Functional = abnormal neuromuscular activity
- Morphological = Structural abnormalities
What can cause functional neuromuscular dysphagia?
- Cricopharyngeal chalasia/achalasia
- myasthenia gravis
- brainstem disease
- peripheral neuropathy
- polymyopathy
- hypothyroidism
- botulism
What can cause morphological dysphagia?
- oropharyngeal inflammation
- oropharyngeal trauma
- foreign bodies
- neoplasia
- congenital / developmental
- Various e.g. =
-hare-lip, lip-fold deformities
-cleft palate
-malocclusion
-craniomandibular osteopathy
-temporomandibular dysplasia
What can cause halitosis?
- oropharyngeal disease = inflammation, neoplasia, foreign body
- oesophageal disease
- dietary associated
- malabsorption
- dental disease
- nasal cavity & sinus disease
- uraemia
- liver disease
- anal sac disease
What is regurgitation?
- PASSIVE EVENT (c.f. vomiting)
- undigested food
- covered by mucus/saliva (basic)
- immediate, or delayed
- neutral pH
What is Pseudoptyalism + Ptyalism?
- Pseudoptyalism = failure to swallow normal volume of saliva
- Ptyalism = increased saliva production
What are secondary signs of oesophageal + oropharyngeal disease?
- malnutrition / dehydration
- anorexia / polyphagia
- aspiration pneumonia / tracheal compression =
- cough
- dyspnoea
How would you investigate a swallowing problems?
- History & physical examination
- Diagnostic imaging
- Endoscopy
- Laboratory investigations
- FNA
- Biopsy
- Special tests
What history would be noted with vomigurgitation?
- What is brought up
- When is it brought up (timing wrt feeding)
- Signs of vomiting
- Concurrent signs
- Duration of illness
What radiographs should be taken?
- Survey Radiographs = head, neck, thorax
- Barium oesophagram ± fluoroscopy =
- barium mixed with food
- iodine contrast if perforation suspected (barium in abdomen = granulomatous inflammation)
What would you do with lab investigations?
- 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?
What are major diseases of the oesophagus?
- 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
What is megaoesophagus?
- “Oesophageal dilation with functional paralysis”
- Failure of progressive peristalsis
- Primary/idiopathic
- Secondary/Acquired
How is megaoesophagus diagnosed?
- Diagnosis by radiography ± contrast =
-uniformly dilated, gas and/or fluid filled
-ventral displacement of trachea
-secondary aspiration pneumonia - Fluoroscopy occasionally essential =
-oesophageal dysmotility
What are different causes of secondary megaoesophagus?
- CNS = Distemper, Cervical, vertebral, Brainstem, Neoplasia, Trauma
- Neuropathies = Polyneuritis, Poly-R-N, Ganglio-R, Dysautonomia, Axonal, Neuropathy, Spinal Muscular, Toxicity (lead/thallium/acrylamide), Vagus
- Neuromuscular = Myasthenia, Botulism, Tetanus, Acetylcholinesterase
- Oesophageal = Oesophagitis, SLE, Glycogen storage, Polymyositis, Dermatomyositis, Cachexia, Trypanosomiasis, HypoAC, HypoT
- Misc = Pyloric stenosis, GDV, Pituitary Dwarf, Thymoma, Mediastinitis
How is idiopathic megaoesophagus treated? What is the prognosis?
- Tx = Feeding from height, Slurry, textured food (meatballs), Metoclopramide
- Prognosis = guarded (danger of aspiration pneumonia)
What can cause oesophagitis?
- ingestion of caustics and irritants
- foreign bodies
- acute and persistent vomiting
- gastric reflux
What are clinical signs of oesophagitis?
- anorexia
- dysphagia
- odynophagia
- regurgitation
- hypersalivation
How is oesophagitis diagnosed?
- Clinical signs
- Endoscopy
- Response to empirical treatment
What is treatment of oesophagitis?
- Symptomatic (rest the oesophagus) =
- frequent small feeds
- antibiotics
- liquid antacids
- local anaesthetics
- gastrostomy tube feeding
- Sucralfate
- Metoclopramide
What can cause intraluminal, intramural + extramural oesophageal obstruction?
- Intraluminal = foreign body
- Intramural =
- neoplasm
- stricture
- granuloma
- Extramural =
- thyroid
- thymic /mediastinum
- vascular ring
What are causes of oesophageal stricture?
- fibrosis after ulceration of mucosa by =
- foreign body
- caustic material
- severe oesophagitis
- gastric reflux esp. pooled secretions during GA
- DRUG THERAPY e.g. doxycycline in cats
What are the 2 different stricture dilation techniques?
- Bougienage = downwards pressure (shoving a rod in, to try stretching ), Longitudinal shear, increased risk of perforation
- Balloon dilation = radial stretch, stationary force - less risk of perforation
How would you diagnose oesophageal foreign body?
- Radiography - NO Barium
- Oesophagoscopy
What is treatment of oesophageal foreign body?
- peroral approach =
- flexible or rigid endoscope
- preferably pull FB to mouth
- or push to stomach for gastrotomy
- check for oesophageal tear
- surgical removal = last resort, essential if large laceration
What should be done after removal of foreign body?
- Post removal oesophagitis
- Radiographs (pneumomediastinum)
- PEG Tube
- Omeprazole
- Sucralfate
