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Clinical Nutrition 1 > Introduction to Swallowing and Dysphagia > Flashcards

Introduction to Swallowing and Dysphagia Flashcards

1
Q

When can human fetus swallow?

A

12 weeks before CNS has developed

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2
Q

2 functions of swallowing?

A
  • Nutrition

- Protection from aspiration

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3
Q

On average human swallow ___

A

500 x/day

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4
Q

What are the 5 cranial nerves involved in swallowing? (TFG-VH)

A 
Trigeminal
Facial
Glossopharyngeal
Vagus
Hypoglossal
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5
Q

Which nerves are involved in oral prep and transit phase?

A

Trigeminal and Facial

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6
Q

Motor and sensory function of trigeminal nerve?

A

Mastication, taste and touch

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7
Q

Sensory function of facial nerve?

A

Taste on anterior 2/3 of tongue

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8
Q

Which nerves are involved in the pharyngeal and esophageal phases?

A

Glossopharyngeal and Vagus

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9
Q

What motor and sensory functions is the glossopharyngeal nerve responsible for?

A

Swallowing, gag reflux and palatal/oral sensations

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10
Q

What motor and sensory functions is the vagus nerve responsible for?

A

GI, cough and taste on posterior 2/3 of tongue

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11
Q

Facial nerve responsible for taste on posterior/anterior of tongue

A

Anterior

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12
Q

Vagus nerve responsible for taste on posterior/anterior of tongue

A

posterior

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13
Q

What phase is the hypoglossal nerve responsible for? What does it do?

A

All phases

Tongue movement

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14
Q

4 phases of swallowing? (OOPE)

A
  • Oral preparatory
  • Oral transit
  • Pharyngeal
  • Esophageal
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15
Q

Explain the oral preparatory phase

A

Voluntary phase which involved the trigeminal, facial and hypoglossal nerves. Lips will seal, and soft palate drops down over base of tongue the prevent food spillage within the airway. Saliva is secreted, mastication and bolus is formed.

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16
Q

What does mastication do?

A

-Break down of food, mixing with saliva, stimulates taste

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17
Q

Largest muscle involved in mastication?

A

Tongue (controlled by hypoglossal nerved)

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18
Q

Explain the oral transit phase

A

Under voluntary control, using the trigeminal, facila and hypoglossal nerves. The soft palate will seal the nasal cavity, while the posterior tongue depresses, allowing for the propelling of the bolus to the oropharynx. Meanwhile, the anterior of the tongue will be elevated and pressed against the hard palate and will contract in a wave like motion to propel the bolus into the oropharynx.

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19
Q

What are some consideration in the oral transit phase?

A

Foods that don’t form cohesive bolus may get stuck

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20
Q

Which phase is the epiglottis open?

A

Oral transit phase

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21
Q

Explain the pharyngeal phase

A

Under autonomic control by the glossopharyngeal, vagus and hypoglossal nerves. The soft palate will continue to seal the nasocavity, while laryngeal muscles close off vocal cords and epiglottis covers the larynx. The bolus is then propelled towards the esophagus.

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22
Q

What propels the bolus towards the esophagus in the pharygneal phase? (2)

A

1) Suprahyoid muscles will elevate the hyoid bone, blocking the airways –> Pressure will help propel bolus
2) Cricoid cartilage contacts, and opens the upper esophageal sphincter

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23
Q

Summary of Pharyngeal phase? (NLE–>HC)

A
  • Nasal cavity sealed
  • Laryngeal muscles close vocal cords
  • Epiglottic blocks airways
  • Suprahyoid bones elevate hyoid, help block airwyas
  • Cricoid cartilege pulls backs, and opens the UES
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24
Q

What is gagging, choking, watery eyes and wet vocal quality associated with?

A

Issues in the pharyngeal phase

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25
Q

Chief function of esophagus?

A

Motility

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26
Q

What kind of muscle is in the UES?

A

Cricopharyngeal muscle

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27
Q

What is another name for the UES?

A

Pharyngeoesophageal junction

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28
Q

What is the main barrier in preventing laryngopharyngeal reflux?

A

UES

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29
Q

Describe the esophageal phase?

A

This autonomic phase is controlled by the glossopharyngeal, vagus and hypoglossal nerves. When the cricopharyngeal muscles relax, the bolus is passed through the UES into the esophagus, peristalsis carries the bolus down to the LES and finally into the stomach.

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30
Q

What does GERD stand for?

A

Gastroesophageal Reflux disease

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31
Q

What causes GERD?

A

When pressure in stomach>pressure in esophagus –> reflux of contents back through the LES

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32
Q

When ___ is lowered, gastric contents can flow backwards into the espohagus

A

LES pressure

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33
Q

When gastric acid and pepsin are found in the esophagus, what could this be indicative of?

A

Gastric acid and pepsin

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34
Q

Foods aggravating GERD?

A

-High fat, chocolate, spearmint, peppermint, alcohol and caffeine

35
Q

What are the 3 major treatment goals of GERD?

A
  • Increase LES competence
  • Decease gastric acidity, decease symptoms
  • Improve clearance of the esophagus
36
Q

What is the most common medication for GERD?

A

Proton pump inhibitors

37
Q

What do proton pump inhibitors do?

A

Block H+ in HCL production

38
Q

What should be avoided in GERD?

A
  • Eating 3–4 hours prior to going to sleep
  • Lying down after meals
  • Tight fitting clothing
  • Smoking
39
Q

What are the two types of surgical procedures?

A

Fundoplication

Stretta

40
Q

What is a fundi?

A

Fundus of stomach is wrapped around the lower esophagus to help LES strength

41
Q

What is Stretta?

A

Ballon down esophagus, blast LES with radiofrequency which regenerates the muscles in becoming tighter

42
Q

What is baretts esophagus?

A

Persistent abnormal pH in esophagus despite medical management, and there is changes in the esophageal mucus epithelial cells

43
Q

How are the cells of the esophagus changed in BE?

A

Squamous cells –> Metaplastic columnar cells

44
Q

(T/F) There are major nutritional concerns in BE

A

False, UNLESS they are diagnoses with cancer

45
Q

What is the treatment for BE?

A

Relieving GERD symptoms

46
Q

Long term medication treating GERD may impair absorption of what? (3)

A

B12, Ca2+ and Fe

47
Q

Nutrition intervention in GERD?

A
  • Decrease exposure to gastric contents
  • Reduce gastric acidity
  • prevent aain and irritation
48
Q

(T/F) Dysphagia is a disease

A

F, a symptom caused by a variety of disorders

49
Q

How can dysphagia develop?

A

NOT dependent on age, can be stroke, neurological damage, head and neck cancer

50
Q

(T/F) More reported dysphagia in men than women

A

F

51
Q

When can transient dysphagia occur?

A
  • Esophageal webs
  • Bell’s palsy
  • GERD
  • Cancer
  • Intubation
52
Q

What are the two types of dysphagia?

A

1) Oropharyngeal dysphagia

2) Esophageal dysphagia

53
Q

Oral dysphagia symptoms?

A

-Weak tongue and lip muscles, difficulty initiating a swallow, difficulty propelling food to throat

54
Q

Oral dysphagia signs?

A
  • Reduced lip seals
  • Anterior loss
  • Lingual pumping
  • Reduced tongue motion, shape
55
Q

Pharyngeal dysphagia symptoms?

A
  • Delayed swallowing reflex
  • Swallow does not clear bolus from throat
  • Bolus penetrates into the larynx
56
Q

Pharyngeal dysphagia signs?

A
  • Repeated swallowing
  • Frequent throat clearing
  • Wet vocal
  • Globus sesnsation
  • Pneumonia, fever, chest and lung congestion
57
Q

esophageal dysphagia can be due to what?

A
  • Structural blockers
  • Stenosis
  • Strictures
58
Q

Signs/symptoms of esophageal dysphagia?

A
  • Pressure/discomfort in chest

- Chronic heart burn

59
Q

Complications of dysphagia?

A
  • Inadequate oral intake
  • Weight loss
  • Malnutrition
  • Choking
  • Aspiation pneumonia
60
Q

What is aspiration?

A

The accidental inhalation of food particles or food into the lungs

61
Q

What is silent aspiration

A

No signs of aspiration (choking) but food/liquids are entering the lungs

62
Q

What is aspiration pneumonia?

A

Aspirated contents are now causing inflammation within the lungs

63
Q

Techniques to prevent aspiration?

A

-Upright positioning, chin down, small quantities and dry swallow

64
Q

Who is at risk for dysphagia?

A
  • Stroke
  • Alzheimers
  • MS
  • Head and Neck Cancers
65
Q

Symptoms screening for dysphagia examples

A

-Drooling, pocketing of food, poor tongue control, slurred speech, weight loss

66
Q

What are the kinds of diagnostic tests for dysphagia?

A
  • Bedside Swallow
  • Modified barium swallow
  • FEES (endoscopy)
67
Q

How is the consistency of foods for the patient determined?

A

By bedside evaluation or barium swallow

68
Q

What needs to be assessed by the dietitian?

A
  • Cause of dysphagia
  • Consistency of food
  • Food intake
  • Food fatigue
  • Medications, lab results and biochemistry
69
Q

What is important for dysphagia patients?

A

Ensure they are not dehydrated

70
Q

How are diet description made?

A

Based on swallowing assessment and patient preference/tolerance

71
Q

What are 4 levels of foods with altered texture? (TSMO)

A

Tenders, soft, minced pureed

72
Q

What are the 4 levels of liquids with altered textures? (CNHP)

A

Clear, nectar, honey, pudding

73
Q

Tender diet?

A

Regular menu, where everything is allowed except hard or raw foods, most vegetable are cooked.

74
Q

Soft diet?

A

Foods should be easily separated by fork -> No pasta, rice, lettuce, grapes, fibrous fruits

75
Q

Minced diet?

A

Required minimal chewing and finely cut (5 mm or less)–> Cooked vegetables that are finely minced, meats, smooth puddings

76
Q

Pureed?

A

Foods are totally pureed with NO lumps, homogenous, no seeds, pulps, skins, no oatmeal.

77
Q

What is used fo quality assessment in dysphagia thickened liquid products?

A

Botwick consistometer –> measure distanced travelled by liquids in cm/30 secs

78
Q

Thin liquids?

A

24 cm/30 sec

79
Q

Nectar?

A

14cm/30 sec

80
Q

Honey?

A

8cm/30sec

81
Q

Pudding?

A

4 cm/30 sec

82
Q

Foods that ___ may be an issue for those with oral-pharyngeal dysphagia

A

Melt in mouth

83
Q

What is crucial for patients with oral-pharyngeal dysphagia?

A

Foods and fluids must have a stable consistency, no seperation or thawing into thin liquid is allowed as aspiration and complication risk increases

84
Q

(T/F) When patients are put on minced diet, they CANNOT have foods with textures

A

False, we need to consider the ethical implications 0 and priority is to feed according to patients wished.

Clinical Nutrition 1 (30 decks)

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