Swallowing Disorders and Cricopharyngeal Dysfunction

2021 ◽  
Author(s):  
Rebecca J. Howell ◽  
Briana Vamosi
Keyword(s):  
Aspiration Pneumonia ◽  
Oropharyngeal Dysphagia ◽  
Signs And Symptoms ◽  
Risk Groups ◽  
Swallowing Disorders ◽  
Barium Swallow ◽  
Mortality And Morbidity ◽  
Transnasal Esophagoscopy ◽  
Neurologic Disorders ◽  
Cricopharyngeal Dysfunction

A functional swallow involves the neuromuscular coordination of ingestion and digestion of food.  Dysphagia is the term for abnormal swallowing, a discoordination of respiration, phonation, and digestion. Swallowing disorders can describe a simple abnormal sensation of swallow or a complex disorder leading to aspiration pneumonia. The most common cause of mortality and morbidity in dysphagia patients is aspiration pneumonia. Additional complications include malnutrition and dehydration. The prevalence of oropharyngeal dysphagia is up to 40% in adults over 65 and increases to 60% in institutionalized elderly. Oropharyngeal dysphagia is common after stroke, Parkinson’s disease, and other neurologic disorders. Patients in high-risk groups and patients with signs and symptoms of dysphagia should be diagnosed appropriately to determine underlying cause and aspiration risk. This chapter will focus on dysphagia due to pharyngeal phase disorders and their diagnosis and treatments.  This review contains 6 figures, 4 videos, 5 tables and 49 references. Key Words: dysphagia, swallowing, Zenker diverticulum, modified barium swallow, videofluoroscopic swallowing study, FEES, transnasal esophagoscopy, esophagram 

scholarly journals Identification of risk groups for oropharyngeal dysphagia in hospitalized patients in a university hospital

CoDAS ◽  
2014 ◽  
Vol 26 (1) ◽  
pp. 17-27 ◽  
Author(s):  
Daiane Bassi ◽  
Ana Maria Furkim ◽  
Cristiane Alves Silva ◽  
Mara Sérgia Pacheco Honório Coelho ◽  
Maria Rita Pimenta Rolim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Oropharyngeal Dysphagia ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Risk Groups ◽  
Hospitalized Patients ◽  
University Hospital ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Purpose: To identify risk groups for oropharyngeal dysphagia in hospitalized patients in a university hospital. Methods: The study was design as an exploratory cross-sectional with quantitative data analysis. The researched population consisted of 32 patients admitted to the medical clinic at the university hospital. Patient history data were collected, followed by a universal swallowing screening which included functional feeding assessment, to observe clinical signs and symptoms of dysphagia, and assessment of nutritional status through anthropometric data and laboratory tests. Results: Of the total sample, the majority of patients was male over 60 years. The most common comorbidities related to patients with signs and symptoms of dysphagia were chronic obstructive pulmonary disease, systemic arterial hypertension, congestive heart failure, diabetes mellitus and acute myocardial infarction. The food consistency that showed higher presence of clinical signs of aspiration was pudding and the predominant sign was wet voice. Conclusion: There is a high incidence of risk for oropharyngeal dysphagia in hospitalized patients and an even higher rate of hospitalized patients with nutritional deficits or already malnourished. Hospitalized patients with respiratory diseases, chronic obstructive pulmonary disease, congestive heart failure and patients with xerostomia were indicated as risk group for oropharyngeal dysphagia.

Neurological Disorders

2017 ◽  
Author(s):  
Margit L. Bleecker
Keyword(s):  
Carbon Monoxide ◽  
Neurological Disorders ◽  
Occupational Exposures ◽  
Signs And Symptoms ◽  
Dose Effect ◽  
Temporal Association ◽  
Biological Plausibility ◽  
Cognitive Domains ◽  
The Past ◽  
Neurologic Disorders

This chapter describes neurologic disorders related primarily to occupational exposures along with presenting signs and symptoms. Acute or subacute occupational exposure to high levels of neurotoxic compounds, which occurred in the past and resulted in unique presentations of neurological disorders, occur infrequently today. Sections include the evaluation of toxic neuropathies and the approach to neurobehavioral impairment along with the cognitive domains commonly affected with exposure to neurointoxicants. A section describes the approach to a patient with exposure to neurointoxicants that includes the need for a temporal association between exposure and effect, a dose-effect relationship, biological plausibility, and other causes eliminated Effects of selected neurotoxins are described, including carbon monoxide, lead, organic solvents, and manganese.

scholarly journals Sickle Cell Anemia Presenting with Vaso-Occlusive Pain: Should We Screen for COVID-19?

2021 ◽  
pp. 1-4
Author(s):  
Mohammad Ali ◽  
Lina Okar ◽  
Nabil E. Omar ◽  
Jabeed Parengal ◽  
Ashraf Soliman ◽  
...  
Keyword(s):  
High Risk ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Signs And Symptoms ◽  
Risk Groups ◽  
Position Statement ◽  
Interesting Case ◽  
International Federation ◽  
Cell Disease ◽  
The World

Despite the widespread of coronavirus disease-19 (CO­VID-19) infection around the world, there are very scarce reported literature about the care of patients with a known diagnosis of hemoglobin disorders such as sickle cell disease (SCD) or thalassemia and confirmed COVID-19 infection. Thalassemia International Federation issued a position statement to include patients with thalassemia and SCD among the high-risk groups of patients. Here, we present an interesting case of a 42-year-old patient know to have SCD presenting with Vaso-occlusive (VOC) pain episode in the absence of COVID-19 signs and symptoms, who tested positive for COVID-19 infection and had a smooth recovery. This case highlights the importance of screening SCD patients presenting with VOC-related events even in the absence of COVID-19 signs and symptoms.

Assessment Framework for Recognizing Clinical Deterioration in Patients With ACS Undergoing PCI

2021 ◽  
Vol 41 (4) ◽  
pp. 18-28
Author(s):  
Kevin White ◽  
Judy Currey ◽  
Julie Considine
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Signs And Symptoms ◽  
Coronary Artery Occlusion ◽  
Coronary Intervention ◽  
Clinical Deterioration ◽  
Access Site ◽  
Mortality And Morbidity ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Topic Patients with acute coronary syndrome undergoing primary percutaneous coronary intervention are at risk of clinical deterioration that results in similar general signs and symptoms regardless of its cause. However, specific causes and forms of clinical deterioration are associated with key differences in assessment findings. Focused clinical assessments using a modified primary survey enable nurses to rapidly identify the cause and form of clinical deterioration, facilitating targeted treatment. Clinical Relevance Clinical deterioration during percutaneous coronary intervention is associated with increased mortality and morbidity. Previous studies identified nursing inconsistencies when recognizing clinical deterioration, with inconsistent collection of cues and prioritization of cues related to cardiac performance over more sensitive indicators of clinical deterioration. Purpose of Paper To describe a framework to help nurses optimize physiological cue collection to improve recognition of clinical deterioration during periprocedural care of patients undergoing percutaneous coronary intervention for unstable acute coronary syndrome. Content Covered Literature analysis revealed 7 forms of clinical deterioration in patients undergoing percutaneous coronary intervention: coronary artery occlusion, stroke, ventricular rupture, valvular insufficiency, lethal cardiac arrhythmias, access-site and non–access-site bleeding, and anaphylaxis. Evidence for the pathophysiology, incidence, severity, and clinical features of each form of clinical deterioration is identified. A framework is proposed to help nurses conduct highly focused patient assessments, enabling prompt recognition of and response to the specific forms of clinical deterioration that occur in patients undergoing percutaneous coronary intervention.

scholarly journals Evaluation of the fluorescent gonococcal test-heated

1976 ◽  
Vol 4 (5) ◽  
pp. 423-428
Author(s):  
H A Gaafar
Keyword(s):  
Indirect Fluorescent Antibody Test ◽  
Fluorescent Antibody ◽  
Clinical Signs ◽  
Antibody Test ◽  
Signs And Symptoms ◽  
Risk Groups ◽  
Indirect Fluorescent Antibody ◽  
Culture History ◽  
History Of ◽  
Clinical Signs And Symptoms

In a 1-year evaluation of the indirect fluorescent antibody test for gonorrhea, 16,127 specimens from low-and high-risk groups were examined, and the results were compared with culture, history of exposure to a known patient, and clinical signs and symptoms. The results confirmed the usefulness of the indirect fluorescent antibody test for gonorrhea as a screening procedure, especially for women in the low-risk group. The test is more economic and probably more sensitive than culture for mass screening of asymptomatic women.

scholarly journals Is intraabdominal pressure a predictive factor for mortality and morbidity in abdominal trauma?

2019 ◽  
Vol 2 (1) ◽  
pp. 35-40
Author(s):  
Daniel Ion ◽  
Dan Nicolae Păduraru ◽  
Florentina Mușat ◽  
Octavian Andronic ◽  
Alexandra Bolocan
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Abdominal Trauma ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Management Plan ◽  
Intraabdominal Pressure ◽  
Mortality And Morbidity ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

AbstractThe clinical signs and symptoms of an acute in increase intraabdominal pressure (IAP) are subtle, especially in the conditions of the polytraumatized patient. Thus, abdominal compartment syndrome (ACS) can brutally occur and can have a major impact on the body’s main organs and systems. The purpose of our research was to identify the influence of intraabdominal pressure, intra-abdominal hypertension, and abdominal compartment syndrome, in the evolution of polytraumatized patients. Our study analyzed the patients admitted in the IIIrd Department of General Surgery of University Emergency Hospital in Bucharest between 1st of January 2010 and 31st of December 2018. The value of intraabdominal pressure, on admission, correlated with the risk of IAH/ ACS in patients with abdominal trauma - being major causes of morbidity and mortality. IAP monitoring should become a mandatory part of the management plan for patients with abdominal trauma.

scholarly journals Oropharyngeal dysphagia as dominant and life-threatening symptom in dermatomyositis

2009 ◽  
Vol 66 (8) ◽  
pp. 671-674 ◽  
Author(s):  
Zorana Djakovic ◽  
Sonja Vesic ◽  
Maja Tomovic ◽  
Jelena Vukovic
Keyword(s):  
Aspiration Pneumonia ◽  
Oropharyngeal Dysphagia ◽  
Magnetic Resonance Images ◽  
Inflammatory Myopathies ◽  
Laboratory Findings ◽  
Endoscopic Gastrostomy ◽  
Nutritional Deficit ◽  
Swallowing Pain ◽  
Life Threatening ◽  
Proximal Myopathy

Background. Dysphagia can be a serious problem in patients with inflammatory myopathies. It may be associated with nutritional deficit, aspiration pneumonia, and poor prognosis. Case report. We presented a 60-year-old male, suffering from difficulty in swallowing, pain and weaknes in the proximal parts of his extremities, and skin manifestation. Laboratory findings showed increased creatine kinase and aldolase. Antinuclear antibodies to HEP-2 subtrate revealed titer of 1:40. Electromyoneurography demonstrated evidence of a proximal myopathy. A muscle biopsy revealed myositis. The baruim swallow test was remarkable for regurgitation, and nasal emerging of barium. Nuclear magnetic resonance images of cranium was normal. Tumor markers CEA, and Ca 19-9 were increased. A dose of 1 mg daily prednisolone was administered and percutaneous enteral feeding was performed. Two months later, the patient developed febrile state, aspiration pneumonia, and died due to respiratory failure. Conclusion. In cases of dermatomyositis with the serious dysphagia, percutaneous endoscopic gastrostomy should be performed as soon as possible. Owerall survival rate is low, even with an adequate therapy administration. Inflammatory myopathies should be considered in any patient with oropharyngeal dysphagia.

scholarly journals Chronic Pulmonary Aspergillosis in Patients with Underlying Respiratory Disorders in Cuba—A Pilot Study

2019 ◽  
Vol 5 (1) ◽  
pp. 18 ◽  
Author(s):  
Nathalie Beltrán Rodríguez ◽  
Javier San Juan-Galán ◽  
Carlos Fernández Andreu ◽  
Dulce María Yera ◽  
Miriam Barrios Pita ◽  
...  
Keyword(s):  
Pilot Study ◽  
Close Association ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Igg Antibodies ◽  
Pulmonary Aspergillosis ◽  
Respiratory Condition ◽  
Mortality And Morbidity ◽  
Chronic Pulmonary Aspergillosis ◽  
Clinical Signs And Symptoms

Chronic pulmonary aspergillosis (CPA) is a fungal infection with high mortality and morbidity rates. This disease is caused by several Aspergillus species and affects patients with an underlying respiratory condition. This pilot study aims to recognize CPA among patients with different respiratory diseases. Twenty-one out of 47 patients were classified as CPA based on the examination of clinical signs and symptoms, radiological findings, mycological culture of respiratory samples and analysis of Aspergillus IgG antibodies. There was a close association between high levels of Aspergillus IgG antibodies and the presence of cavities. Although Aspergillus flavus was the predominant species among clinical isolates, the number of isolates was small to reach conclusions on the prevalence of this species as main cause of CPA in Cuba. From the eleven evaluable patients for the treatment with itraconazole (Lozartil®), nine improved their health status while two did not show any recovery. This drug is included in the therapy schemes for aspergillosis in Cuba.

scholarly journals Upper Esophageal Sphincter Dilation for Recalcitrant Dysphagia Secondary to Dermatomyositis

2019 ◽  
Vol 98 (9) ◽  
pp. NP142-NP143
Author(s):  
Mallory J. Raymond ◽  
Nancy L. McColloch ◽  
Jeanne L. Hatcher
Keyword(s):  
Medical Management ◽  
Oropharyngeal Dysphagia ◽  
Autoimmune Disorder ◽  
Upper Esophageal Sphincter ◽  
Esophageal Dysmotility ◽  
Cricopharyngeus Muscle ◽  
Transnasal Esophagoscopy ◽  
Esophageal Sphincter

Dermatomyositis is a rare multisystem autoimmune disorder occasionally accompanied by dysphagia. It is typically treated with immune modulating agents; however, dysphagia is often unresponsive to these. Previous reports have demonstrated the utility of videoflouroscopy and manometry in understanding the etiologies of dysphagia to inform a procedural target, historically the cricopharyngeus muscle. We present a case of dermatomyositis and dysphagia resistant to medical management in a patient found by videoflouroscopy and manometry to have severe oropharyngeal dysphagia, esophageal dysmotility and a cricopharyngeal web. We demonstrate the utility and safety of upper esophageal sphincter dilation by transnasal esophagoscopy even in the setting of multifactorial dysphagia.

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