Dysphagia

Grace
405100059
Anatomy
Esophagus

The esophagus is a 25cm-long

channel extending rom the pharynx
samapi gastric

The transition is called the esophagus

into the stomach os cardiacum

there is a contraction o the muscle

tissue that dri!es ood into the
stomach "peristaltic#$

although there is no anatomical

sphincter% &ut the smooth muscle
esophagus circularis at the lo'er end
o physiological unctions as a
sphincter that regulates the entry o
ood rom the esophagus to the
stomach and prevent refux of the
stomach contents.
Gastric

Gastric most 'ide part o the

digesti!e tract that ser!es as shelter
to digest ood into the (chyme) and
manage streaming into the small
intestine digesti&ility$

Gastric has t'o holes "os cardiacum

and pylorus#% t'o arches "cur!atura
ma*or and cur!atura minor#% and t'o
surace "acies anterior and posterior#$
+mall ,ntestine

small intestine comprises the

duodenum, jejunum, and ileum .
+mall ,ntestine

Duodenum-

Duodenum approximately 25 cm in
length

.-shaped surrounding the pancreatic

caput

Di!ided into our parts% namely pars

superior% pars deccendens% pars
hori/ontalis "inerior# and the pars
ascendens
0ars ascendens duodeni-
duodenum to *e*unum 'ith an
indentation that called 1exura
duodeno*e*unal$
This cur!e 'as detained &y a &and
called the musculus suspensory
2&romuscularis duodeni "Treit/ ligament#
0ars Descendens duodeni-
there is a protrusion o the papilla ma*or
duodeni ha!e anpullae
hepatopancreaticae musculus sphincter
"sphincter 3ddi# that unctions regulate
expenditures o &ile and pancreas$
4istology
5a&ium oris 6 5ips

7 layers-

0ars cutanea6outer layer-

1$ +trati2ed 8eratini/ing s9uamous cell epithelium
2$ 4air ollicle 'ith se&aceous and s'eat glands
7$ 3r&icularis oris muscle

0ars ,ntermedia6:ermillion &order- A

0ars oral mucosa- ;

1$ +trati2ed non8eratini/ing s9uamous cell epithelium
2$ Tunica propria
a$ 5a&ialis glands
7$ 3r&icularis oris muscle
4$ 5a&ialis artery
5$ +mall chorium
0ars cutanea
0ars intermedia
pars oral mucosa
Tongue65ingua

There are 7 orms o papillae-

.ircum!alata papillae-
A$ .ircum!alata papillae-
1$ +econdary papillae
2$ Taste &ud
;$ E&neri glands

<iliorm papillae "A#

<ungiorm papillae ";#

.ircum!alata papillae
<iliriorm and <ungiorm
papillae
5ingual Glands

0arotid glands
1$ 0ars terminalis "serous#
2$ +ecretory duct
7$ ,ntercalaris duct
4$ ,ntelo&ular tissue

+u&mandi&ular glands
1$ 0ars terminalis "mucoserous#
2$ +ecretory duct
7$ Excretory duct

+u&lingual glands
1$ 0ars terminalis "mucoserous#
2$ +ecretory duct
0arotid Glands
3esophagus
A$ Tunica mucosae
1$ +trati2ed
non8eratini/ing
s9uamous cell
epithelium
2$ T$ propria
7$ T$ muscularis
mucosae
;$ Tunica su&mucosae
4$ 3esephagus glands
5$ Excretory duct
.$ Tunica muscularis
=$ T$ >usc$ .ircular
?$ T$>usc$ 5ongitudinal
D$ Tunica ad!entitia
Gaster
.ardiac
.orpus
<undus-
A$ T$ >ucosae
1$ .olumnar surace
epithelium
2$ Gastric o!eolae
7$ T$propria@undus glands
4$ Elastic mem&ran
5$ T$ >$ >ucosae
;$ T$ +u&mucosae
0yloric
A$ T$ >ucosae
1$ .olumnar surace
epithelium
2$ Gastric o!eolae "'ide
and deep#
7$ T$propria@pyloric glands
4$ Elastic mem&ran
5$ T$ >$ >ucosae
;$ T$ +u&mucosae
.$ T$muscularis
<undus
Duodenu
m
A$ T$ mucosae
1$ :ili
2$ .olumnar surace
epithelium@go&let
cell
7$ .rypt6o lie&er8uhn
4$ T$>$ >ucosae
;$ T$ su&mucosae
.$ T$muscularis
Ae*unum
A$ T$ mucosae
1$ :ili
2$ .olumnar surace
epithelium@go&let
cell
7$ .rypt6o lie&er8uhn
4$ T$>$ >ucosae
;$ T$ su&mucosae
5$ Berc8ringCs olds
"T6mucosae@T$su&m
ucosae#
.$ T$muscularis
0hysiology
;asic Digesti!e 0rocesses
1$ >otility
2$ +ecretion
7$ Digestion
4$ A&sorption
>outh

>otility
<ood enters the digesti!e system through
the mouth% 'here itCs che'ed and mixed
'ith sali!a to acilitate s'allo'ing

+ecretion
En/yme amylase &egins the digestion o
car&ohydrates

Digestion
polysaccharides ---------amylase
sali!ary-----------D disaccharides maltose

A&sorption E3 A&sorption
0harynx and Esophagus

>otility
<ollo'ing che'ing%
the tongue propels
the &olus o oods to
the rear o the throat%
'hich initiates the
s'allo'ing re1ex

+ecretion
The esophageal secretion% mucus is the
protecti!e

Digestion E3 Digestion

A&sorption E3 A&sorption
+mall ,ntestine

>otility
>ixes the ood 'ith pancreatic% &illiary% and
small intestine *uices to acilitate digestion

+ecretion
The en/ymes synthesi/ed &y the small
intestine act 'ithin the &rush-&order
mem&rane o the epithelial-cells

Digestion
The pancreatic en/ymes continue
car&ohydrate and protein digestion in the
small-intestine lumen$
<at in digested &y pancreatic lipase$

A&sorption
The small intestine a&sor&s almost
presented to it% rom ingested ood to
digesti!e secretions to sloughed epithelial
cells
,n contrast to the almost complete%
unregulated a&sorption o ingested
nutrients% 'ater% most electrolytes% the
amount o iron% and calcium a&sor&ed is
!aria&le and su&*ect to control$
;iochemistry
The Digestive Enzymes
Digestive enzymes are en/ymes 'hich help &rea8 do'n ood
su&stances into orms that can &e a&sor&ed and assimilated
&y the &ody$
Digestive enzymes are normally secreted :
1# in the mouth "as part o the sali!a#%
2# &y the stomach
7# released into the small intestines rom the li!er and pancreas$
The major enzymes are:
Amylase% also called ptyalin% is an en/yme that aids the
&rea8do'n o starches$ ,t is secreted in the sali!a and the
pancreatic *uices$
Lipase% secreted &y the pancreas% reers to any o se!eral
en/ymes that increase the &rea8do'n o ats "lipids#$

Protease% an en/yme that helps the &rea8do'n o

protein% is also secreted &y the pancreas$ En/ymes
that &rea8do'n protein are 8no'n as a proteolytic
en/ymes$

Pepsin is an en/yme released in the stomach that

also helps 'ith the &rea8do'n o protein$

Pancreatin reers to pancreatic en/ymes$

Bile% also called gall% is released during digestion

'hen ats enter the 2rst part o the small intestine
"duodenum#$ ;ile emulsi2es ats preparing them or
urther digestion and a&sorption in the small intestine$

Cellulase is an en/yme that &rea8s do'n cellulose

Digestion and A&sorption

The diet must pro!ide meta&olic uels -

>ainly car&ohydrates and lipids

protein "or gro'th and turno!er o tissue

proteins#

2&er "or &ul8 in the intestinal lumen#

minerals " containing elements 'ith spesi2c

meta&olic unctions#

!itamins and essential atty acids "organic

compounds needed in smaller amounts or other
meta&olic and phsiologic unctions#

Vitamins

5ipid-solu&le !itamins "A% D% E and B# are

dissol!ed in mixed micelles% and passi!ely
a&sor&ed across the >:>$

Fater-solu&le !itamins% most nota&ly ; !itamins%

are a&sor&ed &y passi!e diGusion% acilitated
transport or acti!e transport$
ource Enzim Activator u!strat "unction or
#ataliti#
product
+ali!a gland H-Amilase
+ali!a
.l- <lour
essence
4idrolisis &ond
1-4 HI produce
dextrin Hlimit%
maltotriosa% and
maltosa
5ingual gland 5ingual lipase Trigliserida 5ipid acid plus
1%2 -
diasilgliserol
Gaster 0epsin
"pepsinogen#
Gaster lipase
4cl- 0rotein and
polipeptida
Trigliserida
Decompose
peptida chain
'hich closer
'ith aromatic
amino acid
5ipid acid and
gliserol
ource Enzim Activator u!strat "unction and #ataliti#
produce
0ancrea
s
e8socrin
e
Tripsin
"tripsinoge
n#
Enteropep
tidase
0roein and
polipeptida
Decompose peptida &ond
to 8ar&o8sil !arious
amino acid &asic "arginin
or lisin#
Bemotripsi
n
Tripsin 0roein and
polipeptida
Decompose peptida chain
to 8ar&o8sil aromatic acid
amino
Elastase Tripsin Elastin other
protein
Decompose 8ar&o8sil
amino acid aliati8 chain
Bar&o8sipe
ptidase A
Tripsin 0roein and
polipeptida
Decompose 8ar&o8sil
teminal acid amino chain
'hich aromatic chain or
&iurcate aliati8
Bar&o8sipe
ptidase ;
Tripsin 0roein and
polipeptida
Decompose 8ar&o8sil
terminal acid amino chain
'hich al8ali chain
Bolipase Tripsin 5ipid items To open a part o acti!e
lipase pancreas
0ancreas
5ipase
Trigliserida >onogiserida and atty
acid
5ipase .hoesteril
ester
.holesterol
Ester
Bolesteril
hidrolase
.holesteril
ester
.holesterol
0anc8reas
H-amilase
.l- +tarch H-amilase sali!a
Ji&onu8lea
se
JEA Eu8leotida
Deo8siri&o
nu8lease
DEA Eu8leotida
<osolipase
A2
Tripsin 0hosolipid <atty acid and
lisophosolipid
ource Enzim Activato
r
u!strat "unction and #ataliti#
produce
+mall
intest
mucous
Enteropeptida
se
Tripsinoge
n
Tripsin
Aminopeptida
se
0olipeptid
a
Decompose to amino chain
acid amino terminal rom
peptide
Bar&o8sipepti
dase
0olipeptid
a
Decompose to amino chain
acid amino terminal rom
peptide
Endopeptidas
e
0olipeptid
a
Decompose to residue
&et'een middle o peptide
Dipeptidase Dipeptida 2 amino acid
>altase >altosa%
maltotrios
a% H-
de8strin
Glucose
ource Enzim Activato
r
u!strat "unction and
#ataliti#
produce
+mall intest
mucous
5a8tase 5a8tosa Gala8tosa and
glucose
+u8raseK +u8osaI
maltotriosa and
maltosa
<ru8tosa and
glucose
H-
De8strinaseK
H-de8strin%
maltosa%
maltotriosa
Glucose
Threhalase Trehalosa Glucose
Eu8lease and
other en/ims
Eu8leat acid 0entosa%purin
and pirimidin
.ytoplasma
cell mucous
:arious
peptidase
Di%tri% and
tetrapeptida
Amino acid
Dysphagia

A eeling that ood stic8s in your

throat or chest " medscape #

+ign o a pro&lem 'ith your throat or

esophagus Lthe muscular tu&e that
mo!es ood and li9uids rom the &ac8
o your mouth to your stomach
"emedicinehealth #

dysphagia can happen to anyone% it

is most common in older adults%
premature &a&ies% and people 'ith
pro&lems o the &rain or ner!ous
system

t'o types o pro&lems that can ma8e

it hard or ood and li9uids to tra!el
do'n your esophagus-

The muscles and ner!es that help mo!e

ood through the throat and esophagus
are not 'or8ing right

+omething is &loc8ing your throat or

esophagus
Jis8 actors o dysphagia

.ardio!ascular "angina% acute

myocardial inarction% dia&etes
mellitus% high cholesterol% high &lood
pressure and smo8ing status#$

Alcohol consumption

&ody mass index ";>,# 'ere not

assessed

psychological conditions including

anxiety% depression and neuroticism
+ymptoms o dysphagia -

4a!e pro&lems getting ood or li9uids to go do'n

on the 2rst try$

Gag% cho8e% or cough 'hen you s'allo'$

4a!e ood or li9uids come &ac8 up through your

throat% mouth% or nose ater you s'allo'$

<eel li8e oods or li9uids are stuc8 in some part o

your throat or chest$

4a!e pain 'hen you s'allo'$

4a!e pain or pressure in your chest or ha!e

heart&urn$

5ose 'eight &ecause you are not getting enough

ood or li9uid$
.ause o dypshagia

+tructural deect

Typical cause more pro&lems in

s'allo'ing solids than li9uids

.ause a 2xed impediment to ood &olus

arise rom narro'ing 'iyhin the
esophagus " stricture% tumor

>otility disorders

>otility a&normalities o the oropharynx

or esophagus
Term o dysphagia

3ropharyngeal dysphagia transer

dysphagia

Eeuromuscular disease% local mechanical

lesions% upper esophageal sphincter
disorders

Esophageal dysphagia non-transer

dysphagia

>otility disorders - achalasia

,ntrinsic mechanical lesions

Extrinsi8 mechanical lesions

<unctional dysphagia

Jome ,,,

+ense o solid and6or li9uid oods

stic8ing% lodging or passing a&normally
through the esophagus

A&sence o e!idence that

gastrorsophageal re1ux is the cause o
the symptom

A&sence o histopatology-&ased
esophageal motility disorders
$o% is dysphagia
diagnosed&

An otolaryngologist% 'ho treats ear% nose%

and throat pro&lems

A gastroenterologist% 'ho treats pro&lems

o the digesti!e system

A neurologist% 'ho treats pro&lems o the

&rain% spinal cord% and ner!ous system

A speech-language pathologist% 'ho

e!aluates and treats s'allo'ing
pro&lems

M-rays$ These pro!ide pictures o your nec8 or

chest$

A &arium s'allo'$ This is an M-ray o the throat

and esophagus$ ;eore the M-ray% you 'ill drin8 a
chal8y li9uid called &arium$ ;arium coats the
inside o your esophagus so that it sho's up
&etter on an M-ray$

:ideoesophagography$ This test uses a type o

&arium s'allo' that allo's your esophagus to &e
!ideotaped$

5aryngoscopy$ This test loo8s at the &ac8 o your

throat% using either a mirror or a 2&er-optic scope$

Esophagoscopy or upper gastrointestinal

endoscopy$ During these tests% a thin% 1exi&le
instrument called a scope is placed in your mouth
and do'n your throat to loo8 at your esophagus
and perhaps your stomach and upper intestines$
+ometimes a small piece o tissue is remo!ed or a
&iopsy$ A &iopsy is a test that chec8s or
in1ammation or cancer cells$

>anometry$ During this test% a small tu&e is placed

do'n your esophagus$ The tu&e is attached to a
computer that measures the pressure in your
esophagus as you s'allo'$

p4 monitoring% 'hich tests ho' oten acid rom the

stomach gets into the esophagus and ho' long it
stays there$
Jegurgitation

+pitting up is the mild !omiting or

regurgitation o ood% mil8% and sali!a
that can occur in inants$ +pitting up
is not orceul and does not contain
large amounts o ood and 1uids

,n inants% this !al!e is not 'ell de!eloped

and can more easily allo' ood to go &ac8
up the eeding tu&e and cause spitting
up$ ;ecause the inantNs stomach is small%
eeding too much or s'allo'ing too much
air can help push ood past the !al!e$ As
the inant gro's and the !al!e de!elops%
ood is less li8ely to pass this !al!e and
tra!el up the esophagus$ Also% as the
inant &egins to ta8e solid oods% the
spitting up usually decreases
'hen to call the doctor

, the &a&y sho's signs o dehydration

, 'eight loss is a concern

, the spitting up is orceul and shoots

out o the mouth "plyoric stenosis#

, other 'orrisome signs o illness

appear% including e!er% diarrhea%
diOculty &reathing% or a&normal
ussiness

, the material &eing spit up contains

excessi!e mucous or &lood
'hen to go to the
hospital

, the inant stops &reathing%

&ecomes limp% or has any &lue color
change during a spitting up episode

, the spit up appears green or &ro'n

, or any reason the child appears to

&e seriously ill and in your *udgment
cannot 'ait to &e seen at the
doctorNs oOce
Exam and tests

&ased on a detailed history and

physical examination

M-rays or &lood tests are re9uired

only in rare cases to exclude other
more serious causes o the spitting
up$
+el-.are at 4ome

;urp the inant re9uently "ater e!ery

1-2 ounces# to pre!ent the &uild-up o
air in the stomach$

<eed more slo'ly to allo' the stomach

contents more time to empty into the
intestines$

;e careul not to eed too much at a

time and to stop eeding 'hen the
inant seems ull$

Beep the inant upright ater eeding

or at least 15 minutes$ This allo's
gra!ity to help pre!ent the stomach
contents rom coming up$

Try to a!oid signi2cant acti!ity

immediately ater eeds$ Agitation o
the stomach contents may result in
more spitting up