Flashcards in Dysphagia Deck (39)
What is dysphagia?
Essentially it is difficulty chewing or swallowing
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
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
In very brief terms, what does a speech language pathologist do with regards to dysphagia?
They will evaluate the swallow and determine the diagnosis
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
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
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
What are the three phases of swallowing?
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
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
Describe the esophageal phase of swallowing
Peristalsis drives the bolus through the lower esophageal sphincter into the stomach
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:
-physical/structural disease or injury
What are acquired neurological causes?
Defined as coming from or relating to a disease, condition or characteristic that develops after birth such as:
What are congenital neurological causes?
Defined as existing at or after birth, as a defect or medical condition, such as:
-musculoskeletal abnormalities at birth
-metabolic disturbances at birth
-internal organ deformities at birth
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:
What is physical/structural disease or injury (as a cause for dysphagia)?
Any condition causing injury to the anatomical structures. For example:
-poorly fitting dentures
-gum disease, mobile teeth or decayed teeth
-disease (cancer, surgical intervention)
What are psychogenic causes?
Any physical symptom, disease process or emotional state that is psychological rather than physical origin:
What are the different types of symptoms of dysphagia?
Oral stage symptoms
Pharyngeal stage symptoms
Other (reluctance or refusal to eat, unexplained weight loss)
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)
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
What are pharyngeal stage symptoms?
Coughing or throat clearing before, during or after swallowing food or liquid
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
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)
Xerostomia (dry mouth)
Dyskenesia (involuntary movement)
Dystonia (impaired muscle tone)
Nausea and vomiting
Dysgeusia (taste perversion)
What are some medications that cause dysphagia?
How do antibiotics contribute to dysphagia?
Nausea, vomiting, dyspepsia, thrush, dysgeusia, glossitis, pharyngitis, stomatitis
How do psychotropics contribute to dysphagia?
Xerostomia or hypersalivation, movement disorders (i.e., diskinesia, Parkinsonism), laryngospasm, nausea, vomiting, hiccups, glossitis
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
How do NSAIDs/analgesics contribute to dysphagia?
Nausea, vomiting, esophagitis, gastritis, dry cough, xerostomia, throat irritation, dysphagia, dysgeusia, laryngeal spasm, laryngeal oedema
How do cardiovascular drugs contribute to dysphagia?
Nausea, vomiting, weakness, dyspepsia, esophagitis, dizziness, dry cough, pharyngitis
How do gastrointestinal drugs contribute to dysphagia?
Nausea, vomiting, xerostomia, laryngitis, lassitude, dyspepsia
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
What are pharmacological treatments for achalasia (disorder of the lower esophageal sphincter)?
What are pharmacological treatments for diffuse esophageal spasm?
What are pharmacological treatments for eosophilic esophagitis?
What are pharmacological treatments for infectious esophagitis?
What are pharmacological treatments for peptic stricture?
What are pharmacological treatments for scleroderma (systemic tissue sclerosis)?
Systemic medication management of scleroderma
What are pharmacological treatments for xerostomia?
Moisturizers (i.e., MouthKote, Biotene)
What are pharmacological treatments for hypersecretion?
Anticholinergics (i.e., scopolamine)
What are pharmacological treatments for trush?