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Dysphagia week 2 notes from professor
Terms in this set (22)
When does the oral transit stage start?
once the oral prep stage is over...
starts at mid tongue-the tongue pushes the bolus back to the posterior and anterior faucial pillars
Where does the oral stage of the swallow starts at?
How long does the oral stage of the swallow take?
What are things that could go wrong in the oral stage(prep & transit)?
1. weakness of the tongue (caused from stroke or cancer)-won't be able to lateralize the tongue properly to move the bolus.
2. improper lip closure/seal-won't be able to maintain nutrition
3. pocket food in cheeks
4. reduced saliva production-called xerostomia- can be caused by radiation due to cancer
5. mastication problems(lack of teeth/ill fitting dentures)
6. jaw protrusion
7. tongue thrust
8. excessive saliva-causing drooling
9. absence of taste-due to aging and medications
10. Oral hygiene-can aspirate bacteria from not cleaning-can prohibit function, movement, sensation, and taste of the oral structures
The most common retention sites in the oral cavity is pocketing in the...
left and right lateral sulci and the interior sulcus -which is the cheek and the gum area and the area under the tongue
When food gets stuck to portions in the oral cavity but fall off eventually
If we see these deficits interfering with swallowing(pocketing or the other 10 things that can go wrong in the oral stage), What type of dysphagia does the client have?
Where does the pharyngeal (laryngeal) stage start?
Starts at the anterior and posterior faucial pillars
-when the bolus touches the faucial pillars it is sensed and the swallow initiation begins
How long does the pharyngeal stage take?
What happens neurologically when the swallow initiation begins?
the sensation sends a signal to the reticular formation of the brainstem(the medulla oblongata) and the pathway kicks in for the swallow initiation to take place
Once the swallow is initiated what is going to happen?
1. the larynx lifts-when this happens the airway is protected
2. the true vocal folds close
3. the false vocal folds close
4. the epiglottis closes
** at same time the larynx is lifting, the velum is closing off the nasal cavity.
5. the pharyngeal wall moves/approximates to the anterior base of the tongue-moves bolus down to the vallecula
6. The bolus moves in and out of the vallecula-the bolus bifurcates and moves around the laryngeal wall and vestibule
7. the bolus then moves left and right into the pyriform sinuses
8. the bolus then moves to the UES and the UES relaxes
What happens if the larynx doesn't lift? (this is the key element to the swallow)
What happens if you don't have anterior movement the larynx?
-The epiglottis won't go down
-the UES won't relax
At the level of the vallecula the bolus _____ and moves around the _______ _______ and ______. It moves to the left and right ________ ______, and goes up into the ____.
bifurcates, laryngeal wall, Laryngeal vestibule , pyriform sinuses, UES
**Not 50/50, can move 75/25 in each sinus etc...
What are things that can go wrong in the pharyngeal stage?
1. aspiration-the bolus will enter the laryngeal vestibule/trachea below the vocal folds
2. penetration-the bolus will enter the laryngeal vestibule above the vocal folds
3. nasal regurgitation
4. The larynx may not lift properly due to something neurological( e.g. radiation from laryngeal cancer therapy) this will also cause the UES not to relax from lack of the anterior movement of the larynx
When does a pt. develop aspiration pneumonia?
if the bolus moves into the lungs
How can you tell whether the patient has aspirated or penetrated?
e.g. FEES or NBS
Patients we see don't really choke because they are on...
modified diets e.g purees, chopped foods
Patients who choke the bolus gets _______, a person who aspirates or penetrates the bolus enters the _______ ______.
stuck and blocks airway so can't breath, laryngeal vestibule/trachea(usually cough sometimes have silent aspiration though)
What is the most common retention site in the pharyngeal area?
The pyriform sinuses for residue or pooling-a space or cavity-if not getting enough phyrangeal movement of the bolus the bolus will remain in places -it can happen before or after swallow
What is the other retention site for the bolus in the pharyngeal area?
If retention after the swallow it is called ...
If retention happens before the swallow it is called...
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