Dysphagia and Its Causes

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Questions and Answers

What is the duration of the swallowing process?

  • 10-12 seconds
  • 5-7 seconds
  • 15-20 seconds
  • 8-10 seconds (correct)

Which of the following conditions is NOT a cause of dysphagia?

  • Alzheimer disease
  • Cricopharyngeal dysfunction
  • Scleroderma
  • Asthma (correct)

Which phase of swallowing involves the preparation of the bolus?

  • Oral phase (correct)
  • Pharyngeal phase
  • Esophageal phase
  • Gastric phase

Which of the following is NOT included in the history review when evaluating dysphagia?

<p>Family history of asthma (C)</p> Signup and view all the answers

What imaging study is excellent for evaluating dynamic swallowing?

<p>Barium Swallow (B)</p> Signup and view all the answers

Which of the following is considered a structural disorder that can lead to dysphagia?

<p>Zenker's diverticulum (B)</p> Signup and view all the answers

Which cranial nerve is NOT typically evaluated during a physical exam for dysphagia?

<p>Cranial Nerve V (Trigeminal) (C)</p> Signup and view all the answers

Which medication category is linked to causing dysphagia?

<p>Antidepressants (C), Antihistamines (D)</p> Signup and view all the answers

Flashcards

Phases of Swallowing

The swallowing process is divided into three stages: oral, pharyngeal, and esophageal. The entire process typically takes about 8-10 seconds.

Oral Preparation of Bolus

Before swallowing begins, the food or liquid is prepared in the mouth by chewing and mixing with saliva to form a bolus.

What is Dysphagia?

Dysphagia refers to difficulty swallowing. It can be caused by a variety of factors, including structural abnormalities, neurological disorders, and motility problems.

Foreign Bodies in Dysphagia

Foreign objects lodged in the throat or esophagus can obstruct the passage for food and cause difficulty swallowing.

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Surgical Causes of Dysphagia

Surgical procedures involving the head and neck can affect the muscles and nerves involved in swallowing, leading to dysphagia.

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Oesophagitis and Dysphagia

Inflammation of the esophagus, often caused by GERD, infections, radiation, or medications, can cause pain and difficulty swallowing.

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Tumors and Dysphagia

Tumors in the oropharynx, hypopharynx, larynx, or esophagus can obstruct the passage for food, leading to dysphagia.

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CNS Disorders and Dysphagia

Central nervous system disorders like Alzheimer's disease, brain tumors, Guillain-Barré syndrome, and ALS can affect swallowing mechanisms.

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Study Notes

Dysphagia

  • Dysphagia is difficulty swallowing
  • Swallowing involves three phases: Oral, Pharyngeal, and Esophageal
  • Swallowing typically takes 8-10 seconds
  • Oral preparation of the bolus must occur before swallowing begins

Physiology of Swallowing

  • The act of swallowing involves three phases: Oral, Pharyngeal, and Esophageal
  • Swallowing takes about 8-10 seconds
  • Before swallowing begins, Oral Preparation of the bolus must occur.

Causes of Dysphagia

  • Foreign bodies
  • Surgical causes: Head and neck surgery
  • Oesophagitis (GERD, infectious, radiation-induced, drug-induced)
  • Tumors: oropharynx, hypopharynx, larynx, esophagus
  • CNS disorders: Alzheimer's disease, Brain tumors, Guillain-Barré syndrome, Amyotrophic lateral sclerosis (ALS)
  • Motility disorders: Diffuse esophageal spasms (DES), Achalasia, Scleroderma, Presbyesophagus, Cricopharyngeal dysfunction.
  • Structural disorders: Zenker's diverticulum, Plummer-Vinson or Paterson-Kelly syndromes

Evaluation of Dysphagia

  • History: Duration of dietary changes, weight loss, odynophagia (painful swallowing), solids or liquids, level of sensation, past surgery/trauma/caustic ingestion, associated symptoms (GERD, voice changes, nasal leakage, otalgia)
  • Review of Systems: Tobacco/alcohol use, medications (antihistamines, anticholinergics, antidepressants, antihypertensives), osteoarthritis, systemic neuromuscular disorders, auto-immune disorders, psychiatric state
  • Physical Exam (General mental status, drooling, wheezing, dyspnea, voice quality, Cranial nerves, Inspection of the tongue and palate for strength/symmetry, Laryngeal Examination for pooled secretions, vocal cord movement)
  • Imaging Studies: Plain X-ray, Barium Swallow (Excellent for dynamic swallow disorders), Manometry (for disorders where intraluminal pressures need measuring), Fiberoptic Endoscopic Evaluation of Swallowing (FEES), Esophageal Ultrasound, Endoscopic assessment of esophageal tumors, CT Scan & MRI

Treatment of Dysphagia

  • Identify and treat the cause.
  • The goals of treatment are to maintain adequate nutritional intake and maximize airway protection.

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