Swallowing Disorder- Joy Gaziano

Speech Language Pathology Spa6565 with Plowman at University of South Florida

About this deck

By: Diana Rosero
Created: 2010-10-23
Size: 26 flashcards
Views: 17

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Esophageal Anatomy
Describe it

Hollow collapsed muscular tube which transports food from pharynx to stomach
Lies posterior to trachea
Mucosa is squamous type; pink-gray color
Blood vessels are minimally visible

Esophageal Anatomy
Length, Thickness, Diameter

Length- 25 CM./ 10 IN.
Thickness- 3-4 MM./ 1/8 IN. The thickness of 3 pennies
Diameter- 2.5 CM./ 1 IN. The opening is the size of a quarter

Anatomical Landmarks
Location of UES AND LES

UES located at C5-6
LES located at T11

Esophageal Musculature
3 layers of Esophageal Wall

Mucosa
Submucosa
Muscularis

Proximal 1/3 is striated muscle
Distal 2/3 is smooth muscle
Transition zone of both covers 30-40%

Esophageal Motility

UES and LES are closed at rest
Bolus advances through the esophagus via gravity and peristalsis
Peristalsis occurs as a distally progressive band of circular muscle contractions
Contractions travel 3-4 cm per second. Normal bolus transit should be 6-8 seconds in a 25 cm esophagus

Esophageal Peristalsis

Primary Peristalsis initiated by the pharyngeal swallow
Secondary peristalsis "cleaning wave" elicited by esophageal distention
Tertiary contractions: simultaneous non propulsive contractions. "to and fro" movement. Commonly seen in non symptomatic patients. Can be indicative of disorder. It is not called peristalsis because contractions are continuous.

UES

High pressure zone between the pharynx and esophagus
Physiologic role is to protect against regurgitation into airway and excess air into digestive tract

UES Anatomy
Anterior Wall

Anterior wall of UES

Formed by the posterior surface of the cricoid cartilage
Upper part of arytenoids and interarytenoids

Innervated by branches of the VAGUS

UES Anatomy
Posterior Wall

Posterior and lateral wall of UES

Formed by the cricopharyngeus and thyropharyngeus muscles

Innervated by branches of the VAGUS

Unique characteristics of Cricopharyngeus muscle

Tonically active
High degree of elasticity
Comprised of slow and fast twitch fibers

Mechanics of UES opening

Muscles relaxation- manometric relaxation preceded opening of UES
Distraction- pulled open by upward and forward movement of hyo-laryngeal complex (suprahyoid muscles)
Distensibility- degree of compliance decreases with age, reflux, XRT
Hypo-pharygeal interbolus pressure-properties of oropharyngeal swallow

Assessment of UES
Radiologic findings

Radiologic-

decreased diameter of opening
post-swallow residue
post-swallow aspiration
reduced hyo-laryngeal anterior excursion

Assessment of UES
Manometric findings

Manometric-

Incomplete relaxation
High intrabolus pressure

History of dysphagia necessary when assessing

Associated odynophagia
Past history

Reflux symptoms
Medications used
Operations: N/G tube
History of infancy/childhood dysphagia
Hypermesis- constant vomiting
Chemo- XRT to head, neck and chest

Dysphagia localization

Level of sensation at the jugular notch/ base of neck has an obstruction usually at the jugular notch or below
Level of sensation below the jugular notch/base of neck has an obstruction at the same level as the sensation is noted

Radiographic Assessment

Timed Barium Emtying Study (TBES)

8 oz. barium rapidly ingested upright and xray taken at 0, 5 and 15 mins
Demonstrates esophageal clearing and retention

Esophageal Manometry

Evaluation of pressures generated and coordination of movement in the esophagus
Pressure catheter passed trans-nasally and water swallows provided
Indicated when suspecting motor abnormality, non-cardiac chest pain, or before anti-reflux surgery

24 PH Test

Assesses how often acid flows into the LES

Two causes of Esophageal Dysphagia

Mechanical/Obstructive
Motor abnormality

Extrinsic Structural Abnormalities

Cervical osteophytes from spine
External mass compressing esophagus
Mediastinal disease
Vascular compression

Intrinsic Structural Abnormalities

Mucosal rings, esophageal webs
Strictures
Malignant tumors
Diverticula (pouch or pocket)

Esophageal Stricture
Stenosis (umbrella term): general term for narrowing of a duct or canal
Stricture...

Stricture is a decrease in the caliber of a canal, duct or other passage as a result of cicatricial contraction or deposition of abnormal tissue

Etiology of simple esophageal stricture

Webs
Schatzki ring
GERD

Etiology of complex esophageal stricture

Radiation
NG tube/ Reflux
Pill induced
Ischemic
Anastomotic
Fundoplication
Bariatric
Eosinophilic Esophagitis

Total Pharyngoesophageal Lumen Obstruction

Complete stricture of the pharynx or esophagus

Increasingly more common occurrence due to chemo-radiation protocols, reduced mortality and PEG tubes

Esophageal stricture
TRENDS AND CONCERNS

Simple reflux strictures are decreasing in incidence due to improved acid suppression
Complex strictires are increasing due to new cancer tx modalisties, other medical procedures, and eosinophilic esophagitis

About this deck

By: Diana Rosero
Created: 2010-10-23
Size: 26 flashcards
Views: 17

About StudyBlue

“I have been getting MUCH better grades on all my tests for school. Flash cards, notes, and quizzes are great on here. Thanks!”
Kathy