Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Swallowing > L5 Abnormal Swallow Physiology & Etiology > Flashcards

L5 Abnormal Swallow Physiology & Etiology Flashcards

1
Q

T or F: The line between abnormal and normal is always clear

A

False

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why is knowing the incidence of dysphagia and your patient population important?

A
  • anticipation of clinical caseload will help plan and allocate resources
  • use figures to lobby for support from hospital admin
  • knowledge of risk factors can improve Ax and Tx of disease via modification of risk factors or earlier detection of disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the idea behind the surgical sieve technique?

A

a way to approach thinking about your patients symptoms to make sure you have considered all the contributing factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why is the surgical sieve technique useful for deglutition disorder clinicians?

A
  • forces you to consider all factors
  • consider why symptoms are presenting the way they are
  • helps consider potential prognosis for return to baseline diet
  • consider long, medium and short term prognosis
  • helps reason through Tx plan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When going through the sieve what types of factors do you include

A
  • neurological
  • neoplastic
  • traumatic
  • inflammatory
  • congenital
  • degenerative
  • autoimmune
  • idiopathic
  • environmental
  • metabolic
  • endocrinological
  • haematological
  • anatomical variations
  • feeding ability and feeding techniques
  • GI tract disorders
  • Respiratory disorders
  • Iatrogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Stroke and Parkinsons examples of _________ factors

A

neurological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Teeth loss due to aging, dementia and MS are examples of __________ factors

A

degenerative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pierre-Robin Sequence and cerebral palsy are examples of __________ factors

A

congenital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The shape of the epiglottis and pyriform sinuses are examples of __________ factors

A

anatomical variations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

COPD has a _______ course of dysphagia symptoms

A

chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pharyngitis has a _________ course of dysphagia symptoms

A

acute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Parkinsons, MS and ALS all have a ________ course

A

degenerative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

After a tongue resection, the dysphagia symptoms follow a ________ course

A

stabilizing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

T or F: delirium and confusion in patients can affect their swallowing

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Overall what are the 2 main etiology courses of dysphagia

A
  • recuperative

- degnerative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List some examples that fall under recuperative etiology course

A
  • stroke
  • head and neck cancer
  • cervical spine injury
  • head injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

List some examples that fall under degenerative ethology course

A
  • Parkinsons
  • Alzheimers
  • Multiple Sclerosis
  • Huntington’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When assessing dysphagia in stroke, using screening, clinical Ax and VFS, which method is most effective in identifying dysphagia in stroke

A

VFS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

After first ischemic stroke _____% of individuals have dysphagia alone

A

49%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the 2 symptoms that co-occur with dysphagia after a ischemic stroke?

A

dysarthria

and aphasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In an MRI study of brain lesions, which brain areas were associated with a high dysphagia

A
  • lateral medulla (57%)
  • medial medulla (40%)
  • poins (43%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Neurologic dysphasia may present in 3 ways. List them

A

1) Known neuro etiology & obvious symptoms
2) Known neuro etiology & no obvious symptoms (less common)
3) Unknown neuro etiology & obvious symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

List 4 common causes of neurologic related dysphagia

A
  • stroke
  • head injury
  • progressive neurological (AD, PD)
  • LMN disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the incidence of dysphagia in acute stroke?

A

> 55%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is meant by silent aspiration?

A

aspiration without any obvious signs of swallowing difficulty, such as coughing or difficulty breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

T or F: the first swallow during a VFS or FEES is a reliable representation of a person’s swallowing

A

False - strange things can happen on the first bolus so we don’t push too much weight on the first swallow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the common dysphagia impairments in stroke

A
  • Prolongation of oral and pharyngeal transit times (>2 sec)
  • Delay and/or absent pharyngeal swallow
  • Shorter laryngeal closure, UES opening & laryngeal elevation
  • Site or side of lesions don’t always correlate well with symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the common dysphagia impairments in head injury

A
  • delayed and/or absent pharyngeal swallow
  • reduced lingual control
  • reduced pharyngeal clearance
  • aspiration during and after swallow
  • cognitive deficits impact on safety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the prevalence of dysphagia in MS?

A

24-65%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the prevalence of dysphagia in ALS

A

83%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the prevalence of dysphagia in Parkinsons

A

82%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

T or F: In parkinsons patients, their report of swallowing difficulties is more sever than their actual dysphagia

A

FALSE - it Patient report tends to be less severe than their actual dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Describe the swallowing features in Parkinsons

A
  • Oral: lingual rocking, poor bolus containment, incomplete bolus transport
  • Pharyngeal: delay in pharyngeal swallow, increased aspiration
  • Esophageal: reduced UES opening & airway closure (due to rigidity of lingual movements)
34
Q

What is the difference between laryngeal penetration and aspiration?

A
  • Laryngeal penetration = within laryngeal vestibule, on or above VFs
  • Aspiration = below VFs
35
Q

What clinical considerations are important when treating Parkinson’s patients?

A
  • dosing of sinemet levodopa/cabidopa
  • timing of medication
  • deep brain stimulation
  • severity of PD
  • symptoms
  • voicing, coarticulation, respiratory aspects
36
Q

PD patients report swallowing is easier in the _____ phase, and difficult in the _____ phase

A

on

off

37
Q

For deep brain stimulation, if an individual has dystonia, rigidity, bradykinesia and tremor, where in the brain is the stimulation?

A

globus pallidus internal or sub thalamic nucleus

38
Q

Describe how Alzheimers can affect swallowing

A

agnosia & apraxia for food, resulting in prolonged holding of food in oral cavity

39
Q

Describe how ALS can affect swallowing

A
  • Lingual atrophy, reduction in oral and/or pharyngeal motor strength.
  • Respond to aspiration with cough or throat clearing
40
Q

Describe how myasthenia graves can affect swallowing

A
  • swallow hesitancy & rapid fatiguability of all muscles
  • masseter weakness, bifacial weakness, poor palate elevation
  • also dysarthria, dysphonia & ptosis (eyelids droop)
  • liquids > solids, better at start of meal
41
Q

List the common mechanical diseases related to dysphagia

A
  • head and neck cancer
  • cervical spine osteophytes
  • diverticulum
  • CP bars, scars and fibroids
  • loss of dentition
42
Q

How do cervical spine osteophytes affect swallowing

A
  • lead to interruption of bolus transport through the pharynx, especially at C3-C6
  • will likely have residue and might need multiple swallows for one bolus
43
Q

How does a cricopharyngeal (CP) bar affect swallowing

A
  • interruption of bolus transport through the level of the UES
  • high upper esophageal pressure may lead to development of senders diverticulum
44
Q

What is a CP bar?

A

an overactive cricopharyngeus muscle

45
Q

A CP bar is seen in up to _____% of patients with GERD

A

50%

46
Q

How does a zenker’s diverticulum affect swallowing?

A

pocketing of food in the out-ouch at posterior intersection between the transverse fibres of the CP muscle and oblique muscles of inferior pharynx
-due to incomplete opening of UES

47
Q

How head and neck cancer affects swallowing depends on what factors

A
  • tumor size
  • staging
  • location
  • location and type of surgical resection/reconstruction
48
Q

Overall, how does head and neck cancer affect swallowing

A
  • obstruction due to bulk or extraluminal compression
  • decreased pliability of soft tissue due to neoplastic infiltrate
  • direct invasion of nerves leading to paralysis of pharyngeal/laryngeal muscles
  • pain
49
Q

If someone had had a partial laryngectomy how can this affect swallowing

A

delayed resumption of air way protection

50
Q

If someone had a total laryngectomy, how can this affect swallowing

A
  • scar tissue at base of tongue, leading to reduced motion
  • stricture or narrowing of esophagus
  • poor bolus clearance through pharynx
51
Q

If someone had a mandibulotomy how can this affect swallowing

A

lip closure problems

52
Q

If someone had a tongue resection how can this affect swallowing?

A

depending on amount, impaired lingual range of motion, control and strength

53
Q

How can radiation or chemo affect the oral structures?

A
  • xerostomia
  • radionecrosis: breakdown of tissue or bone
  • fibrosis
  • mucositis (thickening of saliva and mucous)
54
Q

What clinical considerations are needed in head and neck cancer

A
  • often times patient is able to communicate
  • consent may be easier
  • often times mobility is still intact
  • aspiration is tolerated to a higher degree than with other patient populations
55
Q

List common causes of iatrogenic dysphagia

A
  • head & neck surgeries
  • radiation or chemo
  • nasogastric feeding tube
  • tracheotomy tube
  • medications
56
Q

How can a nasogastric feeding tube affect swallowing

A
  • may interfere with deflection of epiglottis
  • hinder UES closure allowing gastric regurgitation into pharyngeal/laryngeal cavities
  • in the long term - traumatic friction and pressure along CA joints and cricoid lamina
57
Q

List some possible complications of nasogastric tube

A
  • tube may enter lungs
  • may cause trauma as it is passed
  • reflux of stomach contents
  • can enter the brain or perforate esophagus (Rare)
58
Q

Clinical considerations in NG tube patients

A
  • Consent for placement of the NG tube is taken by the MD (who will rely on SLP & RD recommendations)
  • Weighing benefits vs risks of NG tube placement is important for recommendations.
  • your recommendations should be in line with patient’s goals of care.
  • Knowing when NG tube is contra-indicated especially for end- of-life scenarios is important otherwise a potentially harmful/ futile treatment could be given.
59
Q

How long should NG tubes stay in?

A

should ideally not stay in longer than 4-6 weeks after which other complications may arise (eg ulceration along the GI tract, infection, sepsis).

60
Q

Why is it common for someone who had endotracheal intubation to have dysphagia afterwards?

A

because the epiglottis and VFs were held open for a long period of time

61
Q

What are some post-intubation dysphagia clinical considerations

A
  • diagnosis of patient and comorbidities
  • reason for intubation
  • respiratory status
  • alterness and motivation
  • ability to manage secretions
  • demonstrated ability to tolerate being off ventilator (within 24 hours)
  • OPE results
  • goals of care
62
Q

What is a tracheotomy?

A

the surgical creation of an opening in the trachea, performed to create a patent airway and provide a means of pulmonary toilet

63
Q

What happens if a patient has been on a ventilator for a week, an they still need support what is the course of action?

A

will transfer them from a ventilator to a trach

64
Q

What is the difference between surgical and percutaneous tracheostomy?

A
  • Surgical: cutting a large hole incision layer by later

- Percutaneous: puncture a small hole through trachea and use dilators to slowly make hole bigger

65
Q

What are the parts of a tracheostomy tube?

A
  • outer cannula
  • inner cannula
  • flange
  • obturator
  • cuff
  • cork
66
Q

Why is the inner cannula of a tracheotomy tube changed around every 3 hours

A

There is a risk that it can get blocked with secretions

67
Q

Why is the cuff of a tracheostomy tube important?

A

used to create an airtight seal in the trachea

68
Q

What is the difference between tracheostomy and tracheotomy

A
  • tracheostomy - an artificial airway, trachea diverted into a stoma
  • tracheotomy - the surgical creation of an opening in the trachea
69
Q

What are the 2 types of tracheostomy tubes?

A

non-fenestrated

fenestrated (little holes)

70
Q

What are possible complications of tracheostomy?

A
  • tube obstruction
  • tube misplacement
  • hemorrhage
  • infection
  • tracheal granuloma
  • tracheomalacia
  • trachial stenosis
  • obstruction of esophagus or feeding tube
  • tethering of larynx?
71
Q

Describe the ideal tracheostomy patient

A
  • downsized to size 6 or 4
  • has an uncuffed tube
  • commenced corking trials or tolerating a speaking valve
  • Uses less than 51 O2
  • saturating well 90+
  • Resp rate not higher than 40 BPM
  • Able to stay alert and focused
  • Reason for trach is not one that preclude patient fro eating/drinking
72
Q

What goal in corking trials indicates that the patient is ready for decannulation?

A

they last 2 days with the cork in the trachea (breathing through mouth)

73
Q

What types of medications can affect swallowing?

A
  • neuroleptics
  • sedatives
  • antihistamines
  • diuretics
  • anticholinergics
74
Q

What are common side effects of medications?

A
  • drying of mucosa/ dry mouth
  • drowsiness
  • thirst
  • reduced appetite
75
Q

-How can medications be part of the swallowing problem?

A
  • shape of medication can affect how easily they are swallowed
  • size
  • liquid vs. solid
76
Q

-What considerations must be taken in regards to medication format?

A
  • Our guidance is very useful to reduce medication format alteration to a minimum and ensure all considerations have gone through pharmacy
  • Establish a good relationship with pharmacist on the unit
  • Nurses may not be sure whether or not a drink has been thickened to the appropriate consistency- suggest an item that is readily given at the correct texture
  • Explicitly state medication format suggestions in a way that is helpful to pharmacy and team
77
Q

What systemic disease affect swallowing

A
  • diabetes
  • AIDS
  • rheumatologic & connective tissue disease
  • malnutrition and dehydration
  • prolonged illness/ post op
  • iron and B12 deficiency
  • Sjorgen’s syndrome
78
Q

What are some psychogenic disease that can affect swallowing

A
  • Phagophobia - fear of swallowing
  • Globus sensation NYD
  • Insufficient and prolonged manipulation of foods - may aspirate
79
Q

What are some clinical considerations for psychogenic related dysphagia

A
  • Don’t say: “don’t worry it’s not real”
  • Reassurance may be of little value
  • Affirmation may be more effective
  • Mindfullness techniques
80
Q

Describe the clinical ‘to do list’

A
  • Take a careful history
  • Mention which factors you think are contributing to main symptoms of dysphagia
  • Mention how this relates to prognosis for return to baseline diet
  • Refer on to appropriate team members for areas of concern
  • Always consider whole GI tract
81
Q

The goal of intervention at end of life is not __________ but rather __________

A

rehabilitative

facilitative

Swallowing (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions