HC 2 Pathophysiology

Question 1

What conditions are needed for a succesful swallow?

Answer 1

• normal structures
• higher neural control
• good central pattern generator
• peripheral input/output

Question 2

What is …

1. trismus?
2. sulci?
3. stasis?
4. achalasia?
5. xerostomia?
6. odynophagia?

Answer 2

1. not being able to open the mouth
2. pockets
3. blocking the transport of the bolus downwards
4. sphincter is not opening
5. dry mouth, not enough saliva to prepare the bolus
6. painful swallow

Question 3

Scientific name for….:

1. dry mouth, not enough saliva to prepare the bolus
2. painful swallow
3. pockets
4. blocking the transport of the bolus downwards
5. not being able to open the mouth
6. sphincter is not opening

Answer 3

What is …

1. xerostomia?
2. odynophagia?
3. sulci?
4. stasis?
5. trismus?
6. achalasia?

Question 4

What pathophysiology can we see in the esophageal phase?

Answer 4

• regurgitation
• reflux
• motility disorders
• stasis

Question 5

What might cause dysphagia after a hemispheric stroke?

Answer 5

− Reduced ability to initiate a saliva swallow

− Delayed triggering of pharyngeal swallow

− Incoordination of oral movements in swallow

− Increased pharyngeal transit time

− Reduced pharyngeal constriction

− Aspiration

− PES dysfunction

− Impaire LES relaxation

− Paresis of the facial nerve

Question 6

What might cause dysphagia after a brainstem stroke?

Answer 6

− Absent or delayed pharyngeal response

− Reduced oropharyngeal, pharyngeal constriction

− Reduced laryngeal closure

− Reduced PES opening

− Generalized incoordination

Question 7

What might cause dysphagia in people with dementia?

Answer 7

• Slow oral movement
• Slow or delayed pharyngeal reponse
• Overall slow swallowing duration

Question 8

What might cause dysphagia in people with Parkinson’s disease?

Answer 8

− Oral stage:

• Lingual tremor, repetitive tongue pumping, buccal retention

− Pharyngeal stage:

• Vallecular & piriform sinus retention, impaired laryngeal elevation

Question 9

What structural problems might cause dysphagia?

Answer 9

- Stasis in esophagus:

• Rings, webs, strictures, carcinoma, enlarged heart
• Diffuse esophageal spasms, reflux-induced dysmotility, achalasia

- Stasis in pharynx:

• Cervical osteophytes: longer bony elements on the spine presses on the esophagus
• cricopharyngeal bar: PES sphincter can not open fully or is too thick to open
• Zenker’s diverticulum: a part of the pharynx’ or esophagus’ wall is not strong enough and creates a pocket

Question 10

Give some examples of dysphagia caused by structural problems due to therapy

Answer 10

• After radiation therapy:

−Mucositis

−Xerostomia

−Sensory changes in taste and smell

−Fibrosis à trismus

−Neuropathy

−Changed anatomy

−Odynophagia

−Edema

−Infection

• after surgery of head-neck cancer:

−Swelling of the mouth or throat

−Reduced mobility

−Numbness

−Changed anatomy

Question 11

What may cause iatrogenic dysphagia?

Answer 11

•Postsurgical, depending on surgery:

−Cardiovascular surgery

−Cervical spine procedures

−Osteophytes

−Intubation

−Medication

Question 12

Why would the normal ageing process cause dysphagia?

Answer 12

Changes in anatomy & physiology:

• Sarcopenie: loss of muscle mass & function
• Reduced strength of tissues and muscles
• Reduced elasticity and sensibility
• Reduced coordination
• Extended neural processing time
• Delayed response
• Joint disorders
• Delay in motor skills