Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

9633 Swallowing > L11: Eso Dysphagia, Other Med/Surgical Interventions > Flashcards

L11: Eso Dysphagia, Other Med/Surgical Interventions Flashcards

(67 cards)

Start Studying
1
Q

need to understand eso structure and phys as imp in the eso phase can…

A

masquerade as pharyngeal phase disorders

backflow (retrograde flow) of material from eso to pharynx

potential for asp

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

typically, can’t modify eso impairments/disorder through…

A

behavioural therapy

some postural adjustments may be helpful (ex. left side lying position to reduce reflux)

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

what needs to be assessed of the eso?

A

eso structure and function

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

how can eso structure be assessed?

A

barium swallow = highlight structural issues impeding bolus flow
endoscopy = visualize mucosal lining of eso

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

how can eso function be assessed?

A

motility - manometry, high resolution manometry

GE reflux (GER) - pH and impedance testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what does the barium swallow assess? (esophagram)

A

assess mucosa for pathology using air as contrast (use CO2 granules to provide distension)

assess esophageal clearance, emptying using barium as contrast
- clearance w gravity (upright)
- clearance w/o gravity (sidelying,supine)
- gastroesophageal reflux challenge
- eval for hiatus hernia

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

transnasal esophagoscopy (TNE) =

A

visualization of mucosal lining - signs of reflux, assessment of globus, eso transit (<15 sec)

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

eso motility =

A

adequate contractile forces propelling bolus transit and resultant anterograde movement of the bolus through the digestive tract

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

esophageal manometry (conventional) =

2 ways

A

esophageal catheter w pressure sensors

perfused catheter = water inside catheter (fluid dynamics produce pressure signals, compression of water filled catheter activates sensors)

direct intraluminal transducers = electronic pressure sensors, directly activated by pressure

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

high resolution manometry (HRM) =

A

36 circumferential pressure censors

high-fidelity measurement of pharyngeal, sphincteric, and eso body phys

high reso pharyngeal manometry (HRPM) to visualize movement of bolus from pharynx to eso

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

2 types of GER monitoring

A

pH monitoring
impedance monitoring

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

pH monitoring

A

detection of acidified material in eso

catheter w pH sensitive electronic sensors

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

impedance monitoring

A

detection of fluid movement w/i the eso

contents from pharynx or from stomach entering the eso lower impedance

reflux of non-acidified content can be identified

used w pH monitoring and/or HRPM

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

esophageal phase assessment looked at by…

barium esophagram =

orophrayngeal swallowing safety …

A

gastroenterology

barium swallow

to be investigated first by modified barium swallow

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

diverticulum =

pharyngoesophageal diverticulum or Zenker’s =

results from?

A

an abnormal sac-like herniation of the mucosal layer through the muscular wall of the eso

= triangle of Killian - area of weakness bw oblique fibres of thyropharyngeus m and transverfibres of cricopharyngeus
- posterior hypopharyngeal mucosa protrudes bw two components of inferior pharyngeal constrictor

from repetitive high hypopharyngeal pressures due to poor compliance of the UES

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

Clin symps of zenker’s D

A

dysphagia w both soluds and liquids

regurgitation of undigested foods

coughing/asp

halitosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

diagnosis of zenker’s D via

A

barium swallow

can use endoscopy but risk a perforation of the eso

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

treatment of zenker’s D is

A

surgical

diverticulectomy (removal) and/or cricopharyngeal myotomy (surgical dissection of muscle fibres of the CP m)

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

cricopharyngeal bar =

results froms=

diagnosed via =

treatment =

A

a prominence in the CP m

results from abnormalities in mag or timing or UES relaxation, paradoxical UES contraction, or abnormal UES distensibility

diagnosed via barium swallow (or MBS)

treatment is medical (ex. botox)

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

tracheoesophageal fistula =

symps =

location =

treatment =

A

fistual (hole) in the common soft tissue bw the trachea and eso; food can backflow directly into the trachea

symps =mimic asp after the swallow (i.e. coughing after swallow)

typical location at the 1st and 3rd thoracic vertebrae = on MBS shadow of shoulder will obstruct view, have pt turn shoulders diagonally but maintain head forward

treatment = edges cauterized, filer is injected in the tract

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

eso strictures=

symp =

diagnosis=

treatment =

A

occurs due to repeated irritation and inflammation of eso mucosa - scar tissue forms and narrows the lumen (ex. erosive esophagitis due to GERD)

symp = solid dysphagia - may slowly progress to liquid dysphagia

diagnosis via barium swallow +/- TNE

treatment is non surgical = balloon dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

a type of eso stricture called Schatzki’s ring =

symps+

treatment =

A

mucosal ring at the junction of the eso and gastric mucosa

may be congenital and worsened w reflux

symps = solid dysphagia (mostly meats); food impaction can occur

treatment = non surgical balloon dilation

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

barrett’s eso

clinical sig =

associated w symps of …
should be assessed w?

A

metaplastic change of the lining of the eso mucosa rom squamous epi to intestinalized columnar epi

occurs at the junction bw tubular eso and stomach (which is lined w columnar epi)

sig = associated w heightened risk of eso adenocarcinoma

associated w symps of chronic GERD (heartburn, regurgitation) –> pts w chronic GERD should receive surveillance endoscopies to assess progression of tissue growth (cancer dev)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

eosinophilic esophagitis =

symp =

treatment=

A

change in the epi lining the eso (eosinophilic cells infiltrate squamous tissue) - becomes cardboard like, rigid, w stenosis

emerging disorder, likely due to food allergy (milk, eggs)

symp = solid dysphagia

treatment = behavioural and medical (dilation and PPIs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
gastroesophageal reflux (GER) = symps = less typical symps relatedto acid damage=
spontaneous movement of gastric contents into the eso - GERD = chronic symps or mucosal damage due to the reflux of gastric contents GER is extremely common in western society - poor dietary habits, obesity symps = heartburn, regugitation, chest pain less typ symps = sore throat, globus sensation, chronic cough, vocal changes (hoarseness), poor dentition, persistent throat clearing, asthma, asp... laryngopharyngeal reflux (LPR)
26
GERD common mechanism = 2 other mechanisms... diagnose = treatment =
transient lower eso sphincter relaxation - LES relaxes inappro, creating backflow into eso Hypotensive LES = weak contractile state hiatla hernia = stomach herniates thru diaphragmatic hiatus; LES no longer receives structural support from the diaphragm diagnose = w barium swallow w reflux challeng, pH monitoring and impedance treatment = behavioural, medical (PPIs, H2 blockers) and/or surgical (fundoplication)
27
what are 5 behavioural recos for GERD
dont eat before bedtime (last meal 3-4 hours prior to supine) elevate head 4-6" (use blocks under headboard not pillows) take antiacid med bf bed (neutralize any residual gastric acid, diminish irritation) avoid at (evening) meals: coffee, tea, peppermint, chocolate, citrus fruits, alcohol, high fat foods avoid tobacco use
28
29
PPIs =
inactivates proton pumps that produce HCl side effect profile w longer use (2-3m): inc risk of osteoporosis, vit deficiency, alzheimer's disease, neuropathy ex. emoeprazole
30
achalasia = causes = diagnosis = treatment =
hypertensive LES - fails to relax to baseline abnormal peristalsis in the body of the eso - air filled eso results - widening of the structure above the muscular contraction of the LES - "bird beak" of the bolus at the LES causes = idiopathic, viral, tumour diagnosis w barium swallow treatment = medical (meds, botox), and non surgical (balloon dilation)
31
what do we need to consider about medical therapies for neuromuscular disease?
has medical management been optimized are prescribed drugs likely to have an effect on swallowing risk inc for eso imp - ex. achalasia, imp CP relaxation
32
xerostomia = treatments include = risk factors =
impedes bolus formation and flow impacts oral and dental health and eso GER defense treatments: - maximize hydration - minimize use of products that dry oral cavity (meds, mouthwash, toothpastes w alcohol) - use pilocarpine tablets (inc moisture) risk factors: - sjogren's syndrome and related auto immune conds, radiation effects, meds, iron or vit B12 deficiency
33
surgical therapy for persistent NP regurgitation/hypernasality =
pharyngeal flap
34
surgical therapy for tongue tethering affecting mobility =
frenulectomy
35
surgical therapy for VF paresis/paralysis =
VF medialization
36
surgical therapy for UES dysfunction (imp opening) =
CP myotomy, balloon dilation, botox
37
surgical therapy for Zenker's D =
diverticulectomy (+/- myotomy)
38
artificial airway purpose = 3 sub purposes
to provide adequate ventilation and oxygenation maintain patent airway bypass obstruction proivide pulmonary tolieting (suction) in pts w asp
39
endotracheal intubation = 2 options
insertion of a tube into the trachea for purposes of anesthesia, airway maintenance, suctioning, lung vent orotracheal or nasotracheal intubation
40
what are 6 LT effects of endotracheal intubation?
risk of laryngeal trauma tracheal injury, pressure necrosis granulomas stenosis laryngeal web (forms over VFs) glottic incompetence
41
tracheal injury/pressure necrosis degree of irritation varies proportionately w
size of the endotracheal tube balance bw vent needs to pt and risk of complications
42
granulomas =
form as injured laryngeal mucosa attempts to heal
43
stenosis=
narrowing of airway (treated using dilation or laryngeal stent)
44
glottic incompetence=
lack of airflow disrupts normal reflexes poor airway closure in response to stimulus
45
tracheotomy =
incision in ant trachea; below cricoid; thru 2nd and 4th tracheal rings
46
tracheostomy =
opening/stoma created by incision
47
tracheostomy tube=
artificial airway inserted into trachea
48
2 indications for tracheostomy tube
to bypass acute airway obstruction or chronic upper airway obstruction for prevention/treatment of tracheobronchial secretions
49
5 advantages of tracheostomy tube
pt comfort oral comm/feeding dec risk of decannulation (removal) reduced risk of laryngeal complications supports weaning from mech vent by dev anatomical dead space
50
10 components of tracheostomy tubes
outer tube/cannula inner tube flange outer diameter termination cuff air inlet valve air inlet line pilot cuff fenestration speaking valve/trach button
51
speaking valve =
one way valve on tracheostomy tube that is used to occlude the trach tube during exp to facilitate speaking/swallowing aka they can insp but not exp
52
trach button =
occlude trach tube during insp/exp prior to decannulation
53
fenestrated =
hole located on the curve of the outer tube used to enhance airflow in/out of trachea
54
cuffed =
inflatable air reservoir helps anchor TT in place provide max airway sealing w least amount of compression
55
how does a tracheostomy effect the redirection of airflow?
airflow bypasses upper airway deflated cuff and/or fenestration can facilitate some upper airway flow
56
how does a tracheostomy effect the vocal fold function?
disrupted dysphonia/aphonia
57
how does a tracheostomy effect sensitivity?
desensitization 2 degree to redirected airflow - aka less aware of secretions pooling
58
how does a tracheostomy effect subglottic air pressure?
no/dec subglottic air pressure diff coughing to clear oro and naso pharynx; transoral/transnasal suctioning to eliminate bacterial build up needed reduced secretion control
59
what happens w long term cuff inflation from a tracheostomy?
tracheal edema/stenosis (narrowing)
60
ventilar circuitry from tracheostomy can place torque on...
trache tube... tracheal injury
61
tracheostomy tube disrupts... reduces...
speed, coordination, penetration/asp (digiital occlusion can improve swallow biomechanis, dec asp) reduced saliva/secretion management possibly reduced laryngeal elevation while in situ
62
what do we need to do on CSA in regard to tracheostomy?
OME cuff deflation --> test swallows, Modified Evan's blue dye test
63
6 step protocol for Tracheostomy tube during CSA (Parts can only be done by resp therapist 1-2, 6)
1- pt suctioned both orally and endotracheally prior to beginning of eval 2- if the pt had cuff inflated, deflate cuff w physician approval, if trache is fenestrated remove inner cannula 3 - occlude tracheostomy - eval ability to breath thru upper airway, vocalize, cough vol 4- proceed w eval of swallowing using ice chips, liq, food tinged w blue dye 5- suction endotracheally after swallowing attempts - examine suction bottle for blue tinged secretions 6- reinsert inner cannula and re-inflate cuff as req
64
during CSA w tracheostomy tube, if high probability pt will asp during procedure...
leave cuff inflated until the end of the study then deflate the cuff imme to suction any material that has pooled on the cuff and is now in the airway
65
MEBDT (Mod Evans blue dye test) sensitivity and specificity....
MEDBT showed a false neg rate of 50% compared to MBS identified 100% of true asp who aspirted more than trace, but didnt identify asp of trace amounts 50% false neg rate compared to FEES identified asp in 67% of pts who asp more than trace, but failed to identify trace asp
66
endotracheal intubation =
high o2 needs over short term or in altered consciousness
67
trachostomy tube =
bypass upper airway obstruction; pt comfort and fx

9633 Swallowing (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions