Oral preparatory-Oral-Pharyngeal-Esophageal-First two phases considered voluntary stages (CEREBRAL)-Phases occur when food or liquids prepared for entry to pharynx OR esophagusSix cranial nerves carry motor signals generated by cerebral & brainstem swallowing:-V-VII-IX-X-XI-XIIDysphagiais the result of an abnormal swallow that can involve the oral, pharyngeal, esophageal phases.Aspiration is the passage of food or liquid into the trachea VIA the vocal cordsSilent aspiration is the aspiration that DOESN’T evoke, coughing, choking, & immediate respiratorydistress.Clinical findings of dysphonia, dysarthria-Abnormal gag reflux-Volitional cough-Cough after swallow-Voice change after swallow-Relates to silent aspirationEvans blue tie dye test
Pneumonia Lung abscess formation and important fungal diseaseCH 18-Deep blue dye into the gastrointestinal tract & seeing it can be suctioned from the tracheaPt with tracheostomy are at high risk for silent aspirationIt is estimated that 55% to 70% intubated or tracheostomy pt aspirateChronic pneumonia-Granulomatous inflammation-Granulomasassociated with chronic pneumonia is seen in pt with TB & fungal diseases of the lung-Presentation of those with HIV virus and compromised immune system (DISSEMINATION OF THECAUSATIVE ORGANISM)-TB is the most important organism within the category of chronic pneumoniaFungal infections-Fungi are aerobes-Lung is prime site for fungal infections-When fungal spores are inhaled they may reach to the lung and germinate-Spores produce yeast like / forthy leading to inflammatory response-Polymorphonuclear leukocytes and macrophages move into the infected area & engulf the fungalspores-Pulmonary capillaries dilate / interstitium fills with fluid / alveolar epithelium swells with edema fluid-Regional lymph nodes involvement commonly occurs during this period-Due to the inflammation, it will become consolidatedStructural changes of the lungs associated with fungal diseases-Alveolar consolidation-Alveolar-capillary destruction-Caseous tubercles or granulomas-Cavity formation-Fibrosis & secondary classification of the lung parenchymaVarious types distributed fungal / AIR / SOIL / FORMITES / ANIMALS.Human fungal disease also called mycotic diseaseHistoplasmosis-Most common fungal infection in the USA-Caused by dimorphic fungus( histoplasma capsulatum)-High among river valleys of the Midwest & south (OHIO, MICHIGAN, ILLINOIS, MISSISSIPPI,MISOURI, KENTUCKY, TENNESSEE, GEORGIA, ARKANSAS.)-ALSO CALLED THE OHIO VALLEY FEVER.-80%-90% among the population shows signs of previous infectionsH.capsulatum-Commonly found in soils in riched with bird excreta , like soil near chicken houses / pigon lofts /barns / trees .-Birds do not carry the organisms.
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