Documente Academic
Documente Profesional
Documente Cultură
Dysphagia
Greek dys (difficulty, disordered) and phagia
(to eat)
Sensation that food is hindered in its passage
from the mouth to the stomach
Most patients complain that food sticks,
hangs up, stops, or just won't go down
right
History
Three questions are crucial:
(1) What type of food or liquid causes symptoms?
Mechanical vs neuromuscular defect
Primarily solids
Structural lesion- peptic stricture, ring, or malignancy
Both solid and liquid
a motility disorder like achalasia or scleroderma
(2) Is the dysphagia intermittent or progressive?
Esophageal rings tend to cause intermittent solid food
dysphagia
Strictures and cancer cause progressive dysphagia
(3) Does the patient have heartburn?
Complication of GERD- Esophagitis, stricture & Barretts
History
Location of dysphagia
Esophageal Anatomy
Muscular tube connecting the pharynx
to the stomach
Esophagus begins where the inferior
pharyngeal constrictor merges with the
cricopharyngeus
Upper esophageal sphincter (UES)
18 to 26 cm in length
Lower esophageal sphincter (LES)
Thickened circular smooth muscle
40cm from incisors
Extrinsic indentations
Anterior body of C7 (worsen by
osteophytes)
Arch of the aorta, the left mainstem
bronchus
Diaphragmatic hiatus
DYSPHAGIA
DYSPHAGIA-Difficulty
feeding or swallowing
3 types of Dysphagia
Oral
Pharyngeal
Esophageal
Location of dysphagia
Limited value (Referred from
any site)
Weight loss
Significance and duration of
the disease
Dietary changes
Nature and severity of
disease.
Dysphagia must be
distinguished from
odynophagia
Associated with an
inflammatory condition
(esophagitis)
Physiology of
Swallowing:
Oral Phase
Pharyngeal Phase
Physiology of
Swallowing
Pharyngeal and Esophageal Phase:
Causes of Dysphagia
accident
Ptosis of the eyelids
Indications of myasthenia gravis (end-of-the-day
weakness)
Parkinsons disease
Other neurological diseases including cervical
dystonia, cervical hyperostosis and ArnoldChiari
deformity (hindbrain herniations)
Specific deficits of the cranial nerves involved in
swallowing can also help in pinpointing the origin of
the oropharyngeal disturbance establishing a
diagnosis.
Treatment options
Oropharyngeal dysphagia
Nutrition and diet. Diet change, with softer
available than barium swallow and endoscopy, but can be very useful
in selected cases. It is based on recording the esophageal lumen
pressure using either solid-state or perfusion techniques. Manometry is
indicated when an esophageal cause of dysphagia is suspected
following an inconclusive barium swallow and endoscopy and following
adequate antireflux therapy (with healing of esophagitis shown
endoscopically). The three main causes of dysphagia that can be
diagnosed using esophageal manometry are achalasia, scleroderma
(ineffective esophageal peristalsis), and esophageal spasm.
Radionuclide esophageal transit scintigraphy. The patient swallows a
radiolabeled liquid (for example, water mixed with 99mtechnetium sulfur
colloid), and the radioactivity within the esophagus is measured.
Patients with esophageal motility disorders typically have a delayed
disappearance of the radiolabel from the esophagus. The technique is
primarily used for research purposes, but it is now beginning to be
used for clinical purposes in some specialized institutions.
TERIMA KASIH