Brainscape's Knowledge GenomeTM

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


See full index

Dysphagia > Unit 2 > Flashcards

Unit 2 Flashcards

1
Q

What is GERD?

A

excessive reflux of gastric contents into the esophagus

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

What patients is GERD most common in?

A

Middle aged people who are overweight or in pregnant women

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

If a patient has prolonged exposure to GERD, what can that lead to?

A

Mucosal inflammation and injury (esophagitis)

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

In severe cases of esophagitis, what can happen to the esophagus?

A

Mucosal inflammation –> narrowing of the esophagus –> bolus getting stuck in the esophagus

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

What is Barretts’ esophagus?

A

The epithelium changes and can become a pre-malignant condition

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

What do patients complain of with GERD?

A

Heartburn

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

What are 6 ways to treat GERD?

A
  1. Postural maneuvers
  2. chewing gum to
  3. medications
  4. dietary measures
  5. Dilation of stricture
  6. Surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Who do postural maneuvers help GERD

A

Gravity can help or aggravate GERD- do not eat a large meal before laying bed

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

How does chewing gum help GERD?

A

Increased saliva tends to neutralize the acidity in the stomach

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

What occurs in surgery for Barretts’ syndrome?

A

Remove a portion of the esophagus

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

What is achalasia?

A

A motility disorder of the esophagus, characterized by failure of the LES to relax and aperistalsis

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

What are signs/symptoms of achalasia?

A

Food stuck in the esophagus, regurgitation, chest pain, aspiration pneumonia, weight loss

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

How can aspiration pneumonia occur in patients with achalasia?

A

When they regurgitate, a portion of the regurgitated material can go into the airway and eventually result in pneumonia

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

What two ways in achalasia treated?

A
  1. disrupt LES surgically and by dilation

2. botox injection to LES

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

What is diffuse esophageal spasm?

A

intermittent chest pain and dysphagia for liquids and solids

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

What is diffuse esophageal spasm often confused with?

A

coronary artery disease (CAD)

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

What is a lax cricopharyngeus?

A

A UES that is not tight enough

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

What can a lax criopharyngeus result in?

A

May result in regurgitation back through the UES into the pharynx which can spill into the airway

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

If a lax cricopharyngeus results in aspiration, when does aspiration occur?

A

AFTER

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

What is reduced esophageal peristalsis?

A

The reduced ability to squeeze the bolus through the esophagus

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

What causes reduced esophageal peristalsis?

A

certain neurological disorders, surgery, or radiotherapy

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

What is a diverticulum?

A

a pocket in the esophageal or pharyngeal musculature which collects portions of the bolus

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

What happens when material does not empty from a diverticulum?

A

causes very bad breath

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

How is a diverticulum treated?

A

Surgery

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

What are two etiologies of a partial or total esophageal obstruction?

A

stenosis or tumor

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

What is a tracheoesophageal fistula?

A

an abnormal passage from the esophagus to the trachea

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

What is an esophageal cutaneous fistula?

A

An abnormal passage from the wall of the esophagus to the external skin of the neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

When/how does a fistula occur?

A

tends to occur after surgery due to part of the suture line not healing properly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is odynophagia?

A

pain with swallowing

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

What is another name for globus pharyngeus?

A

Globus hystericus

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

What is globus hystericus?

A

a transitory sensation of a lump in the throat that cannot be coughed up or swallowed

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

If a pt has a cortical stroke with left (dominant) hemisphere involvement, what 3 symptoms may be observed?

A
  1. Contralateral reductions in labial, lingual, and mandibular strength, rate, range of motion, and sensation
  2. Delayed pharyngeal swallow
  3. contralateral reductions in pharyngeal constriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

If a patient has a cortical stroke with right (nondominant) hemisphere involvement, what additional symptom may occur?

A

reduced orientation, perceptual deficits, attention deficits, impulsivity, errors in judgement, and loss of intellectual control over swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

If right hemisphere is damaged what additional stage would be in deficit?

A

The anticipatory stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Patients with a stroke w/ bilateral hemispheric are a higher risk for _______________.

A

silent aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

In addition to the symptoms of unilateral hemispheric stroke, what other symptoms would result from a bilateral stroke?

A
  1. bilateral incomplete laryngeal elevation and closure

2. UES involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

If the UES is insufficient, what could happen?

A

may lead to residue in the pyriform sinuses (bilaterally)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the key symptom that is characteristic of a brain stem stroke?

A

absent or delayed iniitation of the pharyngeal swallow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Which two neurological etiologies have a high risk of silent aspiration?

A

Brainstem stroke and bilateral hemispheric stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

The symptoms of TBI are interaction between ________________, ________________, and ________________.

A

cognitive, behavioral, and linguistic impairments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Symptoms of TBI vary depending on what…?

A

location and extent of the head injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are other symptoms of a TBI?

A

reduced tongue control, prolonged oral transit, delayed or absent pharyngeal swallow, reduced pharyngeal contraction, laryngeal penetration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What could result from long term intubation of a pt w/ TBI?

A

tracheoesophageal fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is myasthenia gravis?

A

An autoimmune disorder characterized by fatigue and exhaustion of the muscular system caused by impaired conduction at the myoneural junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Explain chewing and swallowing characteristics of pts with myasthenia gravis

A

Chewing and swallowing deteriorate toward the end of the meal and toward the end of the day

Symptoms become more obvious on repeated swallowing attempts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is postpolio syndrome?

A

Refers to symptoms experienced by survivors of the poliomyelitis infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What a symptoms of postpolio syndrome?

A

Infection: symptoms usually begin several decades after recovery from the acute illness and may be progressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How can an acquired immune deficiency syndrome compromise swallowing function (AIDS)?

A
  1. local infection involving the mouth, pharynx, larynx, esophagus, and lungs
  2. candidiasis
  3. Odynophagia may be one of the first symptoms of an acute HIV infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is candidiasis?

A

(thrush)- a fungal infection that commonly causes odynophagia and dysphagia in patients w/ AIDS

50
Q

How does dementia compromise swallowing function?

A
  1. Cognitive deficits may compound the neruomuscular changes of normal aging and interfere with the spontaneous use of compensatory techniques
  2. protracted or nonpurposeful bolus processing
51
Q

What are possible symptoms related to dysphagia that are often present in patients with a spinal cord injury?

A
  1. absent or delayed pharyngeal swallow
  2. reduced pharyngeal contraction
  3. reduced base of tongue elevation
  4. reduced laryngeal elevation and/or closure
  5. upper esophageal sphincter dysfunction
52
Q

What are two types of MS?

A
  1. fluctuating pattern of remission and exacerbation

2. gradual progression

53
Q

What dysphagia symptoms are characteristic of patients with MS?

A
  1. impaired ability to hold the bolus anteriorly and laterally
  2. delayed initiation of the pharyngeal swallow
  3. reduced pharyngeal contraction
  4. reduced laryngeal adduction
54
Q

Symptoms associated with parkinsonism

A
  1. tongue tremor w/ reduced initiation of lingual movement
  2. repetitive tongue-pumping action
  3. lingual festination (posterior part of the tongue remains elevated, preventing passage of the bolus into the pharynx)
55
Q

What is one symptom associated with ALS?

A

nasal regurgitation

56
Q

In regards to oral, pharyngeal, and laryngeal cancer, what is usually the main etiology of dysphagia?

A

the TREATMENT of the cancer; not the actual cancer

57
Q

Swallowing deficits in patients with cancer will depend on…?

A
  1. the amount of ablative surgery
  2. the degree of reconstructive surgery
  3. the presence of scar tissue
  4. the integrity of the remaining oropharyngeal and laryngeal structures
  5. potential side effects of pre- and post- operative radiation
58
Q

What are 5 side effects of radiation?

A
  1. hardens tissue (muscle fibrosis)
  2. reduces muscle movement
  3. osteoradionecrosis (death of bone due to RT)
  4. xerostomia & reduced saliva production
  5. increases dental caries
  6. decreases blood flow resulting in poor tissue healing
59
Q

What are the two primary treatment modalities of head and neck cancer?

A
  1. surgical resection

2. radiotherapy

60
Q

What is the purpose of chemotherapy?

A

Chemotherapy is used as an adjunct therapy; used in combination w/ surgical resection and/or radiotherapy to control metastasis

61
Q

Small tumors are treated with…

A

radiotherapy or surgery alone

62
Q

Large tumors are treated with..

A

a combination of modalities

63
Q

What is the general rule of surgical removal of tumors?

A

the malignant tumor must be resected along with a margin of at least 1.5-2cm of normal tissue

64
Q

2 types of surgery

A
  1. simple resection

2. composite resection

65
Q

What is a simple resection?

A

one structure is involved in the surgery

66
Q

What is a composite resection?

A

More than one structure is involved

67
Q

What is the MAJOR rule of cancer surgery?

A

no ablative surgical procedure should be compromised because of the desire to maintain the patient’s function

68
Q

How are tumors staged?

A

SIZE and LOCATION

69
Q

What are the 3 components of tumor staging?

A

tumor size, nodal status, and presence of absence of metastisis

70
Q

What are reasons for tumor staging?

A

understanding the location and size, planning treatments, what combination of treatments is appropriate, prognosis and recovery

71
Q

How is tumor size measured?

A

T: 1-4
1= smallest lesion
4= largest lesion

72
Q

How is nodal status measured?

A

N followed by a number representing the # of nodes involved

73
Q

How is metastisis measured?

A

M is assigned 0-1 if there is or is not presence of metastisis

74
Q

What are the two main types of reconstruction in cancer surgery?

A
  1. Primary closure

2. Flaps

75
Q

What is primary closure?

A

The remaining soft tissues are pulled together and sutured

Sometimes, primary closure is not achievable if there is not enough soft tissue left

76
Q

What is a flap?

A

Surgeon takes tissue from another area and puts it in the defect area

77
Q

What are the two types of flaps?

A
  1. Local

2. Distant

78
Q

What is a local flap?

A

tissue is taken from an adjacent area

79
Q

What is a distant flap?

A

tissue is taken from another area to close the gap

80
Q

What are 6 general principles of swallowing therapy with treated ORAL cancer patients?

A
  1. couseling
  2. swallowing therapy including oral motor exercises when the surgeon indicates that there is no danger to suture lines
  3. aggressive program of tongue and jaw ROM exercises
  4. swallowing tx is begun when pt. is still in the hospital with ng tube
  5. therapy continues until the pt.’s swallowing has reached a point where the therapist and pt. agree that maximum goals have been attained.
  6. consistent support of nursing and physician involvement is important
81
Q

After the oral cancer surgery, what part of therapy must be stopped immediately?

A

ROM exercises for about 10-14 days in order for the sutures to heal

82
Q

For small tumors in the larynx, what is the frequent treatment of choice?

A

radiotherapy

83
Q

What are the 3 areas of the larynx?

A

Supraglottis
Glottis
Subglottis

84
Q

What is the most frequent area of the larynx for cancer?

A

glottis (65%)

85
Q

What is the rarest laryngeal cancer location?

A

subglottis (5%)

86
Q

What is the % of supraglottic tumor occurrence?

A

35% (2nd most common)

87
Q

What are the 2 types of laryngeal surgeries?

A
  1. Total laryngectomy

2. Partial laryngectomy

88
Q

What are the 4 types of partial laryngectomies?

A
  1. laryngofissue
  2. Hemilaryngectomy (vertical)
  3. Supraglottic laryngectomy (horizontal)
  4. Partial laryngopharyngectomy
89
Q

What is removed in a total laryngectomy?

A

hyoid, epiglottis, larynx, upper 2 tracheal rings, strap muscles

90
Q

What happens to the trachea in a total laryngectomy?

A

It has to be shunted out in order for the patient to breathe

91
Q

Where is the lower pharynx attached?

A

upper esophagus

92
Q

Are patients with a total laryngectomy at risk for aspiration?

A

NOPE

93
Q

What may be one swallowing related side effect of a total laryngectomy?

A

Stenosis of the pharynx

94
Q

What is a laryngofissure?

A

They surgeon opens the larynx from the front with cordectomy

95
Q

What is removed in a laryngogissue?

A

One of both true vocal folds and false folds

96
Q

What are advantages of a laryngofissue?

A
  1. can breathe through the mouth
  2. laryngeal elevation in tact
  3. epiglottis is not removed and will still invert
97
Q

What problems may be associated with laryngofissue?

A
  1. Could result in aspiration DURING the swallow due to reduced laryngeal closure
  2. breathy voice
98
Q

What is removed in a hemilaryngectomy?

A

The thyroid is cut vertically: true VF, false VF, and arytenoid on the same side are removed

Thyroid is sutured back together

99
Q

What is a problem associated with a hemilaryngectomy?

A

A lack of VF closure, risk of aspiration during the swallow, abnormal voice

100
Q

What kind of compensatory strategy/therapy will often help patients after a hemilaryngectomy?

A

Postural adjustments: tilt head to one side so gravity keeps the food in the noncompromised channel

101
Q

What is removed in a supraglottic laryngectomy?

A

epiglottis, hyoid, pre-epiglottic space, false folds, upper half of the thyroid

102
Q

Which part of the larynx is spared in a supraglottic laryngectomy?

A

True VF

103
Q

How does a patient achieve closure of the true VF during swallow?

A

holds their breath before swallow

104
Q

What would be a major anatomical/physiological problem after a supraglottic laryngectomy?

A

Poor laryngeal elevation because attachments from the tongue to the hyoid are removed

105
Q

If there is poor laryngeal elevation post supraglottic laryngectomy, what problems may occur?

A

UES may not open –> residue in pyriform sinuses

106
Q

Are patients at risk for aspiration post supraglottic laryngectomy?

A

YES- the epiglottis is removed and cannot divert food into the lateral channels

107
Q

What is a partial laryngopharyngectomy?

A

The same as supraglottic laryngectomy except portions of the pharynx are also removed

108
Q

What are 6 general guidelines for swallowing therapy with treated LARYNGEAL cancer patients

A
  1. counsel the pt. preoperatively to inform them about changes to voice and swallowing.
  2. Therapy is behavioral; therefore, the patient needs to participate and be cooperative
  3. Exercise programs begins after the sutures have healed; the programs are necessary until there is no sign of aspiration
  4. patients should be seen daily as in-patients and weekly as out-patients
  5. ROM exercises for the tongue base and larynx should begin before radiotherapy starts and continue 5-10 times daily for 10 minutes each time and for a period of months afterward
  6. consistent support of all disciplines involved with the patient is important
109
Q

What is a tracheotomy?

A

The surgical procedure of creating a stoma to breathe through

110
Q

What is a tracheostomy?

A

a hole left behind in the trachea by the surgical procedure

111
Q

Where is the tracheostomy tube inserted?

A

Below the larynx into the trachea

112
Q

What are two indications for a tracheotomy?

A
  1. airway obstruction

2. Prolonged ventilatory support due to underlying pulmonary or CNS disease

113
Q

What are 3 categories of airway obstructions?

A
  1. acute
  2. Chronic
  3. Both (acute and chronic)
114
Q

What are 2 acute etiologies that necessitate a tracheotomy?

A
  1. Infectious process or allergic reaction

2. upper respiratory infection

115
Q

What chronic conditions lead to a tracheotomy?

A
  1. presence of a mass
  2. sleep apnea
  3. hypertrophy of tonsils
116
Q

What is a combination condition that lead to a tracheotomy?

A

vocal cord paralysis secondary to bilateral recurrent laryngeal nerve injury

117
Q

VF paralysis refers to what the VF…

A

CANNOT do

E.g., bilateral AB-duction- the VF will not open

118
Q

What are three conditions that result in prolonged ventilatory support?

A
  1. COPD
  2. Guillion Barre’ syndrome
  3. ALS
119
Q

What are advantages of tracheostomy?

A
  1. eliminates prolonged orotracheal intubation
  2. facilitates pulmonary toliet when pt. is unable to clear secretions
  3. Decreases possibility of subglottic stenosis that results from prolonged orotracheal intubation
  4. More permanent solution
120
Q

What is a disadvantage of a tracheostomy?

A

The trachea tends to stenos or narrow around the tube

121
Q

What are possible effects of tracheostomy tubes on swallowing?

A
  1. May inhibit laryngeal elevation –> reduced UES opening
  2. may desensitize the larynx due to the presence of the trach tube which could result in an inhibition of the cough reflex
  3. External compression of the esophagus by the trach tube cuff enables secretions to pool above the cuff level in the esophagus and then spill into the airway
  4. may result in discoordination and “disuse atrophy” of the swallowing musculature
  5. Creates a functional separation of degultition and respiration which may result in discoordination of glottic closure during swallowing

Dysphagia (4 decks)

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