93 Dysphagia: A Hard Pill to Swallow

The purpose of this lecture is to discuss the anatomy involved in swallowing, what a swallowing disease can look like, and how we would treat the issue.

Learning Objectives:

• Describe the anatomy involved in swallowing
• Explain causes for dysphagia in canines and how to diagnose it
• Explain ways to treat dysphagia
• Identify when a dog is showing signs of dysphagia v. regurgitation v. vomiting

Introduction/ Review Material

Food and water are the foundation of our lives. Without either, we cannot function normally. We need to process and digest the food and water that we intake, the same goes for our animals. We do this through our digestive system.

The digestive system begins with the mouth and ends with the anus, with numerous organs in between. For this lecture, we will be focusing on the mouth and esophagus. The normal physiology of the mouth and esophagus are as follows:

1. The teeth grind up the food
2. The tongue shapes it into a compact mass otherwise known as a bolus
3. The upper sphincter of the esophagus permits the bolus to move into the esophagus
4. The bolus moves down the esophagus via peristaltic action
   1. Peristalsis is involuntary movement of food through the digestive tract
5. The lower esophageal sphincter allows food to enter the stomach

What is Dysphagia?

Dysphagia is difficulty chewing and/or swallowing

Causes of Dysphagia

1.  Chewing Difficulties
   1. Missing Teeth
   2. Nerve Malfunction
   3. Pain
2. Swallowing Difficulties
   1. Mixed Signals from Brain
   2. Muscle and Nerve Dysfunction
   3. Pain
   4. Obstruction

How do we Diagnose Dysphagia?

• A Feeding Trial
• Oral Exam
• X-Rays (Using liquid to outline the esophagus)
• Endoscopy (Live Camera View)

How do we Treat Dysphagia?

• Cleaning and fixing teeth that are causing problems
• Pain Medication/ Anti-Inflammatory Medication
• Change Diet and Eating Habits

Dysphagia versus Regurgitation versus Vomiting

There are other disorders of the digestive system that could cause some of the same symptoms we talked about earlier. This may alter how you would treat your animal. It is important to know the differences between them and how to recognize the true issue.

• Dysphagia
  • Difficulty Chewing
  • Pronounced Swallowing
• Regurgitation
  • Quiet
  • Undigested Food Matter
• Vomiting
  • Can hear it
  • Abdominal Muscles Involved
  • Food will be digested

Dysphagia Activity

To better visualize how dysphagia can work, we will break off into groups and mimic its different causes and effects. 

Group 1

 You will need:

• Orbeez
• Plastic water bottle
• A grocery store bag
• Duck Tape

Instructions: Pack the plastic water bottle with Orbeez— don’t hold back! Then, while the water bottle is standing up, attach the plastic grocery store bag as a funnel to the top of the bottle. Securely attach this by applying duck tape around the rim and bag. Now, invert the water bottle. Only a couple should fall into the bag. Your hand simulates the nerve that triggers swallowing. Your hand must be inactive (no squeezing!) for the first minute. You’ll have to try other techniques to get the Orbeez into the bag. Then, after a minute, you may squeeze the bottle. Not the differences and difficulties. 

Group 2

You will need:

• Pretzel Sticks
• Marshmallows

Instructions: Place two pretzel sticks along your gum-line. The tighter packed the pretzels are along your gums, the better. Now, take a large marshmallow and start chewing. While doing this, note the feeling, whether awkward or painful (hopefully not too painful though!). This should simulate the pain caused from sharp edges in teeth that can cause dysphagia. 

Group 3

You will need:

• Dental Teeth Retractors
• Marshmallows

Instructions: Place the dental teeth retractors provided (there should be enough for everyone to use a pair, please do not share) inside your mouth, pushing each cheek off to the side. This should expose your teeth and morph the overall feeling of your mouth coordination. It will feel awkward and funny, that’s the point! Now place a marshmallow within your mouth and try to chew and note the awkward nature of chewing and swallowing. 

After completing your activity, move onto the next one.

Once every group has completed their activities, each group will present on their original starting activity and discuss:

1. The most difficult part
2. What inhibited you from chewing or swallowing and what function did it represent?
3. What could help you chew or swallow under the same conditions?

Knowledge Check