symptoms related to swallowing Flashcards
sense of taste diminishes; # of dippers increases; amount of oral-pharyngeal residue increases; small increase in transient penetration; greater delay triggering the swallow; decreased laryngeal elevation so decreased UES opening
age-related changes
cough reflex less sensitive; esophageal changes (contractions, loss of tone in UES, slower esophageal transit)
age-related changes
dysphagia populations (6)
CVA; dementia (neurogenerative diseases); head and neck and brain cancers; hospitalized patients; cardiac conditions; trauma
groups predisposed to aspiration pneumonia (PNA) (5)
altered mental status; prolonged mechanical ventilation; GERD; neuromuscular disorders; upper aerodigestive tract tumors
presence and degree of dysphagia depends on size and location of lesion; brainstem CVA : significant CVA :: RHD : longer pharyngeal transit and higher chance of aspiration (compared to LHD)
neurological disorder: CVA (2)
rigidity and slowness of initiating movement (bradykinesia) underlie the disordered volitional stage of swallowing; delayed pharyngeal swallow; reduced pharyngeal contraction; also: impaired lingual movement (delayed oral transit time with excessive tongue pumping), minimal jaw opening, abnormal head and neck posture, impulsive eating bx
neurological disorder: parkinsons (PD) (7)
spasticity and incoordination of oropharyngeal and respiratory muscles contribute to dysphagia; examine these areas: delay and incoordination of laryngeal movements and pharyngeal constrictor dismotility
neurological disorder: multiple sclerosis (MS) (2)
swallowing problems occur in patients with bulbar movement; dysphagia is secondary to weakness from UMN-LMN damage; prophylactic use of PEG shown to increase length of life
neurological disorder: amyotrophic lateral sclerosis (ALS) (3)
presents with LMN signs; oral and pharyngeal stage weakness progresses as patient continues to eat
neurological disorder: myasthenia gravis (MG) (2)
UMN signs are common; LMN damage may occur due to skull fractures; you will commonly see poor oral control of the bolus, delayed swallow trigger, and weak pharyngeal transit; affected by cognitive issues (impulsiveness and / or lack of good judgment)
neurological disorder: TBI (4)
common clinical findings in dysphagia include ___ (6)
increased time to complete meal; spiking a temperature; pulmonary infiltrate on CXR; resistance to eating / drinking; oral residue / pocketing; odynophagia
cortical dementias (like Alzheimer’s) typically affect the oral stage of swallowing; it is common for patients to stop eating or significantly reduce feeding (PO intake)
neurological disorder: dementia (2)
surgical causes of dysphagia (4)
anterior cervical spine surgeries; head and neck cancers (tumor removal); surgeries involving the tongue, hard and soft palate, or pharyngeal walls; skull base surgeries
total laryngectomy
there is absolutely no risk of aspiration because there is no larynx
radiation causes of dysphagia (3)
irradiated tissues become fibrotic and lose their ROM; irritation of mucosa (mucositis); damaged salivary glands (xerostomia)
