APPROACH TO A PATIENT OF DYSPHAGIA -PPTX

DYSPHAGIA

1. DYSPHAGIA -Approach

2. “To be able to eat a meal that
has been specially and
lovingly preparedis one of
life’s most satisfying
pleasures!”

3. DEGLUTITION
= The process by which a bolus of food
(liquid/solid) is transferred from the
buccal cavity to the stomach
3 Phases
 Oral
 Pharyngeal conscious
control
 Oesophageal

4. Oral stage:
less than 1 sec
Tongue squeezes the food
backwards
“ the tongue isthe mouth; all else is
accessory”
Hyoid bone, mylohyoid muscle

5. Pharyngeal phase
Less than 1 sec
Pharyngeal peristaltic wave
Preceeding wave of relaxation: Crico-
Pharyngeal sphincter

6. Pharyngeal Phase -contd
Protection of larynx
Apnoea
Elevation of larynx
Closure of laryngeal sphincter
Ary-Epiglottic Fold
False Cords
True vocal cords
Epiglottis

7. Oesophageal Phase
3 -7 sec 9
Peristaltic stripping wave(3 -5
cm/ sec)
Secondary peristaltic waves
Preceding wave of relaxation: Gastro-
Oesophageal sphincter

8. Causes
Painful Diseases of Mouth, Pharynx
Stomatitis, Tonsillits,
TB Laryngitis
Retro-Pharyngeal abscess
Neuromuscular Diseases
Bulbar paralysis
Myesthenia gravis
Achalasia

9. Causes-contd
Extrinsic Compression
Congenital
Atresia
Oesophagitis, Ulceration, Stricture
Reflux
Corrosives
P-V Syndrome(Sideropenic Dysphagia)
Ca oesophagus

10. Symptomatolgy
True Dysphagia
Difficulty with liquids
Odynophagia
Duration
Nature of Diet
Localisation

11. Associated symptoms
Regurgitation
Retro/Substernal Pain
Bleeding
Hoarseness, Cough
Loss of Weight
Tiredness, Malaise (Anemia)

12. Physical Examn
Anemia –
Patterson-Kelly/Plummer-Vinson
Syndrome
Liver
Signs of Portal HrT
Ascites

13. IDL
Vocal Cord Palsy
Tumour
Ulceration
Pooling of saliva in Pyriform Fossa

14. Local Examn
Cervical Lymph Nodes
Thyroid Gland enlargement
Laryngeal Crepitus

15. Radiology
X Ray Chest PA
View
X Ray Neck Lat
View
CT Scan
MR Imaging

16. Radiology -contd
Barium Swallow
examn

17. Rigid Oesophagoscopy
Oesophageal
Speculum
Rigid
Oesophagoscope

18. Endoscopy –Flexible Fibreoptic
OPD Procedure
LocalAnesthesia
In cervical
ankylosis, trismus
Less complications

19. Oesophagus -Endoscopic Anatomy
Collapsed lumen
Flattened, stellate
4 Constrictions

20. Oesophagoscopy: Indications
Diagnostic
Dysphagia
Neck Masses, VC paralysis
Hemetemesis
Oesophagitis
Therapeutic
FB
Dilatation of Srictures
Varices
Stents in Malignancies

21. Oesophagoscopy: Contraindications
Perforation previously
Cervical Ankylosis, Trauma
Trismus
Aneurysm of Aorta

22. Oesophagoscopy: Complications
Bleeding
In Biopsy, Dilatation
Perforation
Cervical:
Cervical Tenderness
Surgical Emphysema
Thoracic:(More serious)
Pain Chest, radiating to Back
Surgical Emphysema