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Flashcards in Dysphagia Deck (39):
1

What is dysphagia?

Essentially it is difficulty chewing or swallowing

2

How common is dysphagia (in which particular populations)? What are risk factors?

About one third of residents in long term care facilities have difficulty in swelling solid oral dosage forms (SODF)
Dysphagia is remarkably common in the general population
GERD is a risk factor for dysphagia as well as odynophagia
Intermitten dysphagia was associated with anxiety, while progressive dysphagia was associated with depression

3

How is dysphagia diagnosed?

Dysphagia needs to be evaluated by a speech language pathologist (SLP)
Official diagnosis by a physician is based on evaluation by a SLP
In the community, not many individuals have dysphagia as an active diagnosis

4

In very brief terms, what does a speech language pathologist do with regards to dysphagia?

They will evaluate the swallow and determine the diagnosis

5

What does an occupation therapist do with regards to dysphagia?

Adapts mealtime environments; including visual presentation of the meal to encourage eating, and creation of a setting that encourages attention to the meal
Enhances feeding skills; including strategies to create feeding independence and provision of appropriate adapted utensils
Positions the body to facilitate optimal digestion and arm use for independent and safe eating

6

What does a registered dietician do with regards to dysphagia?

Consulted for unexplained weight loss, poor appetite, inadequate oral intake, difficulty chewing, mealtime management concerns, constipation, and urinary tract infections related to reduced fluid intakes
Routine screening for dysphagia during meal observation and nutritional assessments
Manages all aspects of achieving and maintaining optimal hydration and nutritional status through oral, enteral and parenteral routes of administration

7

What do pharmacists do with regards to dysphagia?

Evaluate drug-related causes of dysphagia
Suggest treatments for xerostomia (dry mouth)
Modify time of administration and dosage form and make medication recommendations to minimize, eliminate or adapt to dysphagia where appropriate
Communicate with the dysphagia team regarding drug causes of dysphagia and treatments for same

8

What are the three phases of swallowing?

Oral phase
Pharyngeal phase
Esophageal phase

9

Describe the oral phase of swallowing

Food is chewed and mixed with saliva to form a bolus
Voluntary swallowing is initiated and the tongue pushes the bolus posterior towards the pharynx, stimulating several receptors to start the swallowing response

10

Describe the pharyngeal phase of swallowing

The swallowing response stops the breathing and raises the larynx for the bolus to pass
The bolus is transported by peristalsis across the closed vocal folds and epiglottis into the esophagus through the cricopharyngeal sphincter

11

Describe the esophageal phase of swallowing

Peristalsis drives the bolus through the lower esophageal sphincter into the stomach

12

What are the causes of dysphagia?

Patients may have one or a combination of conditions that may predispose them to feeding and/or swallowing impairments
There are three main sources that may place a person at risk for dysphagia:
-neurological
-physical/structural disease or injury
-psychogenic conditions

13

What are acquired neurological causes?

Defined as coming from or relating to a disease, condition or characteristic that develops after birth such as:
-CVA (stroke)
-Head trauma
-Polio

14

What are congenital neurological causes?

Defined as existing at or after birth, as a defect or medical condition, such as:
-cerebral palsy
-ringed esophagus
-musculoskeletal abnormalities at birth
-metabolic disturbances at birth
-internal organ deformities at birth
-genetic disorders

15

What are degenerative neurological causes?

Defined as a progressive decline in the condition of one's organs, cells or overall health from cause such as:
-ALS
-Parkinson's disease
-Huntington's disease
-Multiple sclerosis
-Dementias

16

What is physical/structural disease or injury (as a cause for dysphagia)?

Any condition causing injury to the anatomical structures. For example:
-trauma
-poorly fitting dentures
-gum disease, mobile teeth or decayed teeth
-disease (cancer, surgical intervention)
-generalized weakness

17

What are psychogenic causes?

Any physical symptom, disease process or emotional state that is psychological rather than physical origin:
-emotional disturbances
-developmental delay
-medication induced
-psychiatric diagnosis

18

What are the different types of symptoms of dysphagia?

Oral stage symptoms
Pharyngeal stage symptoms
Other (reluctance or refusal to eat, unexplained weight loss)

19

What are some oral stage symptoms?

Poor lip closure
Drooling or excessive secretions
Seepage of food or liquid from the mouth
Reduced chewing ability
Pocketing of food on the weak side
Reduced tongue function (speech may be slurred)
Dry mouth
Food and liquid residue remains on the tongue and/or the roof of the mouth after swallowing
Increased time to complete a meal safely and enjoyably
Fatigue as the meal progresses (chewing ability may deteriorate)
Poor dentition or poorly fitting dentures

20

What are pharyngeal stage symptoms?

Coughing or throat clearing before, during or after swallowing food or liquid
Choking
Hoarse, wet voice after swallows (gurgly)
Complaints of food getting "stuck in the throat" or "going down the wrong way"
Nasal regurgitation of food
Difficulty managing secretions

21

What are some side effects from medications related to swallowing dysfunction?

Akathesia (motor restlessness)
Appetite changes (anorexia)
Ataxia (poor muscle coordination)
Changes in olfaction (ability to smell)
Confusion
Cough
Delirium
Xerostomia (dry mouth)
Dyskenesia (involuntary movement)
Dystonia (impaired muscle tone)
Esophageal ulceration
Extrapyramidal syndromes
Movement disorders
Nausea and vomiting
Reflux
Sedation
Dysgeusia (taste perversion)
Tremor

22

What are some medications that cause dysphagia?

Antibiotics
Psychotropics
Antiepileptics
NSAIDS/analgesics
Cardiovascular
Gastrointestinal

23

How do antibiotics contribute to dysphagia?

Nausea, vomiting, dyspepsia, thrush, dysgeusia, glossitis, pharyngitis, stomatitis

24

How do psychotropics contribute to dysphagia?

Xerostomia or hypersalivation, movement disorders (i.e., diskinesia, Parkinsonism), laryngospasm, nausea, vomiting, hiccups, glossitis

25

How do antiepileptics contribute to dysphagia?

Tremor, hypersecretion in upper respiratory passages, increase salivation, nausea, vomiting, xerostomia, hiccups, glossitis, dysgeusia, gingival hyperplasia enlarged lips, motor twitching, drowsiness, fatigue

26

How do NSAIDs/analgesics contribute to dysphagia?

Nausea, vomiting, esophagitis, gastritis, dry cough, xerostomia, throat irritation, dysphagia, dysgeusia, laryngeal spasm, laryngeal oedema

27

How do cardiovascular drugs contribute to dysphagia?

Nausea, vomiting, weakness, dyspepsia, esophagitis, dizziness, dry cough, pharyngitis

28

How do gastrointestinal drugs contribute to dysphagia?

Nausea, vomiting, xerostomia, laryngitis, lassitude, dyspepsia

29

How is dysphagia treated?

Treatment needs to involve health care team (SPL, RD, OT, PT, Pharmacist)
Treatments may focus on any combination of the following: swallowing rehabilitation, posture, food texture, feeding tools, oral strength, physical strength and coordination, behaviour modification, medication management

30

What are pharmacological treatments for achalasia (disorder of the lower esophageal sphincter)?

Anticholinergics
CCBs

31

What are pharmacological treatments for diffuse esophageal spasm?

Nitrates
CCBs
Sildenafil

32

What are pharmacological treatments for eosophilic esophagitis?

PPI
Topical steroids

33

What are pharmacological treatments for infectious esophagitis?

Antivirals
Antifungals

34

What are pharmacological treatments for peptic stricture?

PPI

35

What are pharmacological treatments for scleroderma (systemic tissue sclerosis)?

Antisecretory drgus
Systemic medication management of scleroderma

36

What are pharmacological treatments for xerostomia?

Moisturizers (i.e., MouthKote, Biotene)

37

What are pharmacological treatments for hypersecretion?

Anticholinergics (i.e., scopolamine)

38

What are pharmacological treatments for trush?

Nystatin

39

What are pharmacological treatments for parkinsonism or myasthenia?

Treat according to those guidelines (not covered here)