Dysphagia and Regurgitation

What are some of the anatomical players for NORMAL swallowing? (5)

- Tongue

- hard and soft palate

- pharyngeal muscles

-esophagus

- gastroesophageal junction

What are the TWO reflexes that fall under the "protective reflex" category?

- gag reflex

- swallowing reflex

What are the THREE phases of swallowing?

oral preparatory phase, pharyngeal phase, Esophageal phase

Which one of the three phases is voluntary?

oral preparatory phase

What drives the pharyngeal phase?

swallowing center

T/F The esophageal/ gastroesophageal phase is voluntary

false, involuntary

With the esophageal phase, there are contributions of ____ control from the ____ nerve and ____ ____ of esophageal muscle

motor, vagus, myoenteric plexus

What occurs durning in the oral preparatory phase?

mastication and formation of a food bolus

How would you describe the movement of the tongue in the oral preparatory phase?

aboral movement to base of the tongue

What does the oral preparatory phase initiate?

coordinated series of reflexes in pharynx

T/F The reflexes in the oral preparatory phase is involuntary

True

What happens in the pharyngeal/cricopharyngeal phase?

bolus moves through the pharynx toward the upper esophageal sphincter

T/F In the pharyngeal/cricopharyngeal phase, the epiglottis is closed and breathing is inhibited

True

What are the TWO muscle groups that makes up the upper esophageal sphincter?

CRICOPHARYNGEAL AND

ESOPHAGEAL MUSCLE COMBO

What are the THREE sections that the esophagus is divided into?

cervical, thoracic, small abdominal portion

In the esophageal phase, what stimulates the first peristalisis wave which moves the bolus into the cervical esophagus?

food bolus moving through

T/F Continued dilation and pressure caused by the movement of the bolus stimulates the second peristalisis wave

True

Movement of the bolus through the thoracic esophagus and forces what to open?

lower esophageal sphincter abdominal portion

The lower esophageal tone prevents what?

gastroesophageal reflux

T/F There are species variability of

esophageal muscle

True

What portion of the dogs esophagus is skeletal muscles?

all of it

What portion of the cats esophagus is skeletal muscle?

cranial 2/3 (caudal 1/3 is smooth muscle)

What swallowing disorder has difficult, painful, swallowing and you localize the lesion based on phase of swallowing inhibited by disease or cause?

Dysphagia

What swallowing disorder is a passive expulsion of food/fluid and is localized based of the cause of esophageal abnormality?

Regurgitation

T/F Dysphagia is an Esophageal disease and Gastric disease

False, regurgitation

What are TWO unique clinical finding of the Oral preparatory phase?

Abnormal prehension, dropping food

What are SIX clinical findings that are unique to the criocopharyngeal-pharyngeal phase?

hard repetitive swallowing when eating and drinking, odynophagia, gagging, eructation, bloating, flatulence

What are some of the unique signs associated with the Esophageal/Gastroesophageal phase?

regurgitation, repetitive dry swallowing, ondynophagia, lip licking, gagging, neck extension during swallowing, restlessness, intermittent epigastric phase pain, aerodigestive disease

If an animal has difficulty prehending food, creating a food bolus, and forming food bolus that falls from the mouth, where would you localize the dysphagia?

OROPHARYNGEAL DYSPHAGIA

If an animal is able to prehend food, takes multiple attempts to swallow without success, and formed a food bolus that was regurgitated, where would you localize the dysphagia?

Cricopharyngeal dysphagia

If an animal is able to prehend food, has better success at swallowing food and has undigested and digested foo regurgitation, where would you localize the dysphagia?

ESOPHAGEAL DYSPHAGIA

What are 8 dysphagia differentials for gastrointestinal obstruction?

1. FOREIGN BODY

2. NEOPLASIA

3. GRANULOMA

4. SIALOCELE

5. SIALODENITIS

6. FOREIGN BODY

7. ESOPHAGEAL STRICTURE

8. CRICOPHARYNGEAL ACHALASIA

What are 11 differentials for gastrointestinal pain that is idiopathic neuromuscular?

1. STOMATITIS

2. GINGIVITIS

3. PERIODONTAL DISEASE

4. TONSILITIS

5. PHARYNGITIS

6. PHARYNGEAL DYSPLASIA

7. MEGAESOPHAGUS

8. GASTROESOPHAGEAL

9. REFLUX DISEASE

10. BRAIN NEOPLASIA

11. CRANIAL NERVE DISEASE

What are some extra gastrointestinal neuromuscular differentials for dysphagia?

1.MYASTHENIA GRAVIS

2. AUTONOMIA

3. BOTULISM

4. TICK PARALYSIS

5. HYPOADRENOCORTICISM

6. HYPOTHYROIDISM

7. IMMUNE MEDIATED

8. CNS NEOPLASIA

9. LEAD POISONING

10. RABIES

What are some extra gastrointestinal pain that are differentials for dysphagia?

1. TRAUMA

2. RETROBULBAR ABSCESS

3. TEMPOROMANDIBULAR

JOINT DISEASE

4. MASTICATORY MYOSITIS

What are some gastrointestinal disorders that are differentials for regurgitation?

•MEGAESOPHAGUS

•ESOPHAGITIS

•ESOPHAGEAL GRANULOMA

•ESOPHAGESAL STRICTURE

•ESOPHAGEAL DIVERTICULA

•ESOPHAGEAL NEOPLASIA

•GASTROESOPHAGEAL REFLUX DISEASE

What are some EXTRA GASTROINTESTINAL

OBSTRUCTION that are differentials for regurgitation?

•VASCULAR RING ANOMALY

•ESOPHAGEAL FOREIGN BODY

•SPIROCERCA LUPI

•HIATAL HERNIA

What are some EXTRA GASTROINTESTINAL

NEUROMUSCULAR that are differentials for regurgitation?

•LEAD

•HYPOTHYROIDISM

•HYPOADRENOCORTICISM

•MYASTHENIA GRAVIS

•SYSTEMIC LUPUS

•DYSAUTONOMIA

When you are doing the initial evaluation, what should be apart of the minimum database?

CBC

SERUM CHEMISTRY

URINALYSIS

What are some rads that you should take for dysphagia/regurg?

- THREE VIEW SURVEY THORACIC RADIOGRAPHS

- CERVICAL SURVEY RADIOGRAPHS

- ABDOMINAL RADIOGRAPHS

For neuromuscular disease, what are some of the advance diagnostics that you can do?

- ACTH STIMULATION TEST

- THYROID PROFILE

- ACETYLCHOLINE RECEPTOR

ANTIBODY

- LEAD LEVELS

What are some advance imaging that you can do for dysphagia and regurg?

- VIDEOFLUOROSCOPIC SWALLOW

STUDY

- LARYNGEAL EXAMINATION

- ESOPHAGOSCOPY

What is the MAJOR complication that can come from dysphagia and regurgitation?

ASPIRATION PNEUMONIA

What are THREE indications for a VIDEOFLUOROSCOPIC SWALLOW STUDY?

- Esophageal dilation

- Evaluation of Esophageal motility

- Gastroesophageal reflux

What are the steps to doing VIDEOFLUOROSCOPIC SWALLOW STUDY?

take survey radiographs and then take a standing rad with a barium plus canned food slurry

What are some of the PROs to ESOPHAGRAM WITH FLUOROSCOPY? (3)

- Esophageal and oropharyngeal phases

- Normal sequence

- Measure timing

What are some of the CONS to ESOPHAGRAM WITH FLUOROSCOPY? (2)

- Mucosal surface not evaluated

- Aspiration pneumonia possible

What is the prep for an endoscopy?

- 12 hour fast

- General anesthesia

What are some indications for endoscopy?

- Good for morphological diagnosis

- Allows inspection of esophageal lumen for diagnostics or intervention

- Biopsy

- Stricture dilation

- Foreign body removal

- Regurgitation with normal

radiographic imaging or

esophagram

What are some examples of specific therapy based on diagnostic testing?

- TREATMENT FOR ESOPHAGEAL HYPOMOTILITY IN HYPOTHYROID DOG WITH WITH THYROID HORMONE SUPPLEMENTATION

- TREATMENT ESOPHAGEAL

STRICTURE WITH BALLOON

DILATION

- TREATMENT OF ESOPHAGEAL

FOREIGN BODY WITH REMOVAL

What are some ways that you can have supportive treatment and nutritional management of dysphagia and regurgitation?

- CHANGE CONSISTENCY OF FOOD AND WATER

- LET GRAVITY HELP

- PLACE FEEDING TUBE

What should something that helps to treat regurgitation do?

- PROTECT THE ESOPHAGEAL MUCOSA

- HELP THE SLUGGISH MOVEMENT OF ESOPHAGUS

- DECREASE INFLAMMATION

- PAIN MANAGEMENT