FORMAT FOR PPT IN1.ppt for mbbs student 2nd yr

Microbiology

1. Dysphasia 08/08/2025

2. 1. Definition • Dysphagia: Difficulty in swallowing, can involve solids, liquids, or both. 2. Anatomy and Physiology (Relevant in Surgery) • Normal swallowing involves coordinated activity of oral cavity, pharynx, larynx, and esophagus. • Disruption in any part can result in dysphagia.

3. 3. Classification • Oropharyngeal dysphagia: Difficulty initiating swallow, problems in mouth or pharynx (often neurological). • Esophageal dysphagia: Sensation of food sticking after swallowing, usually due to structural or motility issues of the esophagus.

4. Datta Meghe Medical College Etiology in Surgical Practice • Structural causes : • Strictures (benign or malignant, e.g., due to tumor or previous surgery). • Foreign bodies. • Post-surgical complications (anastomotic strictures, edema, wrap too tight post-fundoplication).

5. Datta Meghe Medical College • Motility causes: • Achalasia. • Diffuse esophageal spasm. • Disorders from nerve injury during head, neck, or thoracic surgery.

6. 5. Clinical Features • Difficulty swallowing solids, progressing to liquids. • Sensation of food/objects “sticking” in the throat/chest. • Cough, regurgitation, recurrent pneumonia (risk of aspiration). • Weight loss, malnutrition if chronic.

7. 6. Preoperative Assessment • Careful history: onset, progression, associated symptoms (pain, weight loss, voice change). • Physical examination: oral cavity, pharynx, neck. • Investigations: • Barium swallow: assesses structure and function. • Endoscopy: excludes obstruction, tumors, strictures. • High-resolution manometry: detects motility disorders.

8. Surgical Causes and Implications • Dysphagia can be a sign of surgical complications (wrap too tight in fundoplication, anastomotic stenosis). • Post head/neck cancer resections: nerve injury, structural alteration. • After anti-reflux surgery (Nissen, partial fundoplication): transient dysphagia is common (usually resolves in 3 months). Persistent dysphagia may require intervention

9. Condition Surgical Role Notes Achalasia Heller’s myotomy, POEM Laparoscopic approach preferred, possible wrap Esophageal cancer Resection, stenting, feeding Dysphagia often presenting symptom Benign stricture Dilation, resection, stenting Post-op, corrosive injury, chronic reflux Hiatus hernia Repair, fundoplication Large hernias can cause dysphagia

10. 9. Management in Surgical Setting • Non-surgical: Nutrition support, swallow therapy, dilation for benign strictures. • Surgical: • Correction of anatomical cause (e.g., stricture, diverticula, tumor). • Myotomy for motility disorders. • Esophagectomy in advanced cases or unresponsive achalasia. • Revisional surgery if persistent postoperative dysphagia (e.g., loosening a wrap)

11. 10. Complications • Aspiration (pneumonia). • Malnutrition, weight loss. • Psychological impact.

12. 11. Postoperative Dysphagia • Often transient. • Persistent cases: assess for anatomical/motility issue, may need endoscopic dilation or revisional surgery.