MASTERCLASS SLIKKEN
INHOUD
1. Casuïstiek: geïntegreerd redeneren ....................................................................................... 4
2. FEES: Flexible Endoscopic Evaluation of Swallowing ............................................................. 5
Wie doet wat? ......................................................................................................................... 5
FEES versus tracheoscopie ...................................................................................................... 6
Materiaal ................................................................................................................................. 6
Indicaties FEES: logistiek ......................................................................................................... 6
Indicaties FEES: klinisch........................................................................................................... 6
Contra-indicaties ..................................................................................................................... 7
Lokale verdoving ..................................................................................................................... 7
FEES: positionering scoop ....................................................................................................... 8
FEES: procedure ...................................................................................................................... 8
Pathofysiologie tijdens FEES ................................................................................................. 10
3. Divertikel van Zenker ............................................................................................................ 13
Wat – waar? .......................................................................................................................... 13
Incidentie .............................................................................................................................. 13
Behandeling .......................................................................................................................... 14
4. IDDSI ..................................................................................................................................... 16
Consistentie-aanpassingen ................................................................................................... 16
Implementatie....................................................................................................................... 17
Testen .................................................................................................................................... 17
Hoe krijg ik mijn eten tot een bepaalde IDDSI waarde? ....................................................... 20
5. IOPI (Iowa Oral Pressure Instrument) .................................................................................. 21
Tongkracht training ............................................................................................................... 21
1
, Excercise principles ............................................................................................................... 21
IOPI = Iowa Oral Performance Instrument ........................................................................... 21
Tongkracht objectief meten en objectief met biofeedback trainen .................................... 22
6. Therabite .............................................................................................................................. 23
Therabite ............................................................................................................................... 23
7777 Principe ........................................................................................................................ 23
7. Voedingsproblemen en slikstoornissen bij het jonge kind .................................................. 24
Inleiding ................................................................................................................................. 24
Complexiteit van eten ........................................................................................................... 24
Normale eet- en drinkontwikkeling ...................................................................................... 25
Fysiologie van de orofarynx .................................................................................................. 27
Mijlpalen van het slikken ...................................................................................................... 29
Diagnostiek – slokdarm (oesophagaal) ................................................................................. 32
Diagnostiek – keel (faryngeaal) ............................................................................................. 35
Ziektebeeld............................................................................................................................ 36
Orale dysfagie ....................................................................................................................... 40
Faryngeale dysfagie............................................................................................................... 42
(Hoge) oesofagale dysfagie ................................................................................................... 43
Behandeling .......................................................................................................................... 43
8. Onderzoek van slikken aan de hand van manometrie (Rommel) ........................................ 49
Normal swallow physiology .................................................................................................. 49
Orofaryngeale dysfagie ......................................................................................................... 49
Oorzaken van faryngeale dysfagie ........................................................................................ 49
Swallow assessment ............................................................................................................. 49
Signalen en symptomen van orofaryngeale dysfagie ........................................................... 51
Videofluoroscopie (VFS) ........................................................................................................ 51
Functionele pathologie: gebruik van videomanometrie-impedantie................................... 51
2
, HRM: High Resolution Manometry ....................................................................................... 52
Measuring swallow function ................................................................................................. 54
Faryngeale peristatltiek ........................................................................................................ 56
Upper esophageal sphincter (UES): cricopharyngeal muscle: fysiologie .............................. 57
Onvolledige relaxatie UES ..................................................................................................... 58
Measuring swallow function: HRMI metrics ......................................................................... 58
Cricofaryngeale bar ............................................................................................................... 59
Divertikel van Zenker ............................................................................................................ 60
Klinische scenario’s van inadequate UES opening ................................................................ 60
Besluit.................................................................................................................................... 63
Wat is er nog qua state-of-the-art in dysfagie diagnostiek? ................................................ 63
9. Perifere aangezichtsverlamming (PAV) ................................................................................ 65
N. facialis ............................................................................................................................... 65
PAV – kenmerken .................................................................................................................. 65
PAV – oorzaken ..................................................................................................................... 65
Mogelijke oorzaKEN van PAV ................................................................................................ 66
Mogelijke gevolgen/ complicatieS VAN PAV ........................................................................ 68
Diagnostiek............................................................................................................................ 68
Behandeling PAV ................................................................................................................... 69
10. Casuïstieken........................................................................................................................ 71
Divertikel van Zenker ............................................................................................................ 71
Osteofytose/ papegaaienbek ................................................................................................ 72
Late toxiciteit CVA ................................................................................................................. 73
Parkinson............................................................................................................................... 74
11. Info uit de practica “klinisch redeneren” ........................................................................... 77
Algemeen .............................................................................................................................. 77
Tips ........................................................................................................................................ 77
3
, 1. CASUÏSTIEK: GEÏNTEGREERD REDENEREN
4
INHOUD
1. Casuïstiek: geïntegreerd redeneren ....................................................................................... 4
2. FEES: Flexible Endoscopic Evaluation of Swallowing ............................................................. 5
Wie doet wat? ......................................................................................................................... 5
FEES versus tracheoscopie ...................................................................................................... 6
Materiaal ................................................................................................................................. 6
Indicaties FEES: logistiek ......................................................................................................... 6
Indicaties FEES: klinisch........................................................................................................... 6
Contra-indicaties ..................................................................................................................... 7
Lokale verdoving ..................................................................................................................... 7
FEES: positionering scoop ....................................................................................................... 8
FEES: procedure ...................................................................................................................... 8
Pathofysiologie tijdens FEES ................................................................................................. 10
3. Divertikel van Zenker ............................................................................................................ 13
Wat – waar? .......................................................................................................................... 13
Incidentie .............................................................................................................................. 13
Behandeling .......................................................................................................................... 14
4. IDDSI ..................................................................................................................................... 16
Consistentie-aanpassingen ................................................................................................... 16
Implementatie....................................................................................................................... 17
Testen .................................................................................................................................... 17
Hoe krijg ik mijn eten tot een bepaalde IDDSI waarde? ....................................................... 20
5. IOPI (Iowa Oral Pressure Instrument) .................................................................................. 21
Tongkracht training ............................................................................................................... 21
1
, Excercise principles ............................................................................................................... 21
IOPI = Iowa Oral Performance Instrument ........................................................................... 21
Tongkracht objectief meten en objectief met biofeedback trainen .................................... 22
6. Therabite .............................................................................................................................. 23
Therabite ............................................................................................................................... 23
7777 Principe ........................................................................................................................ 23
7. Voedingsproblemen en slikstoornissen bij het jonge kind .................................................. 24
Inleiding ................................................................................................................................. 24
Complexiteit van eten ........................................................................................................... 24
Normale eet- en drinkontwikkeling ...................................................................................... 25
Fysiologie van de orofarynx .................................................................................................. 27
Mijlpalen van het slikken ...................................................................................................... 29
Diagnostiek – slokdarm (oesophagaal) ................................................................................. 32
Diagnostiek – keel (faryngeaal) ............................................................................................. 35
Ziektebeeld............................................................................................................................ 36
Orale dysfagie ....................................................................................................................... 40
Faryngeale dysfagie............................................................................................................... 42
(Hoge) oesofagale dysfagie ................................................................................................... 43
Behandeling .......................................................................................................................... 43
8. Onderzoek van slikken aan de hand van manometrie (Rommel) ........................................ 49
Normal swallow physiology .................................................................................................. 49
Orofaryngeale dysfagie ......................................................................................................... 49
Oorzaken van faryngeale dysfagie ........................................................................................ 49
Swallow assessment ............................................................................................................. 49
Signalen en symptomen van orofaryngeale dysfagie ........................................................... 51
Videofluoroscopie (VFS) ........................................................................................................ 51
Functionele pathologie: gebruik van videomanometrie-impedantie................................... 51
2
, HRM: High Resolution Manometry ....................................................................................... 52
Measuring swallow function ................................................................................................. 54
Faryngeale peristatltiek ........................................................................................................ 56
Upper esophageal sphincter (UES): cricopharyngeal muscle: fysiologie .............................. 57
Onvolledige relaxatie UES ..................................................................................................... 58
Measuring swallow function: HRMI metrics ......................................................................... 58
Cricofaryngeale bar ............................................................................................................... 59
Divertikel van Zenker ............................................................................................................ 60
Klinische scenario’s van inadequate UES opening ................................................................ 60
Besluit.................................................................................................................................... 63
Wat is er nog qua state-of-the-art in dysfagie diagnostiek? ................................................ 63
9. Perifere aangezichtsverlamming (PAV) ................................................................................ 65
N. facialis ............................................................................................................................... 65
PAV – kenmerken .................................................................................................................. 65
PAV – oorzaken ..................................................................................................................... 65
Mogelijke oorzaKEN van PAV ................................................................................................ 66
Mogelijke gevolgen/ complicatieS VAN PAV ........................................................................ 68
Diagnostiek............................................................................................................................ 68
Behandeling PAV ................................................................................................................... 69
10. Casuïstieken........................................................................................................................ 71
Divertikel van Zenker ............................................................................................................ 71
Osteofytose/ papegaaienbek ................................................................................................ 72
Late toxiciteit CVA ................................................................................................................. 73
Parkinson............................................................................................................................... 74
11. Info uit de practica “klinisch redeneren” ........................................................................... 77
Algemeen .............................................................................................................................. 77
Tips ........................................................................................................................................ 77
3
, 1. CASUÏSTIEK: GEÏNTEGREERD REDENEREN
4
