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Dysphagia

Definition. Difficulty in swallowingObstruction of the passage of food through mouth pharynx and esophagus. . Aphagia- Complete obstruction. Bolus impaction- emergencyOdynophagia- Painful swallowingGlobus pharyngeus- lump in throatPhagophobia- fear of swallowing- Hysteria, Rabies, Tetanus,

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Dysphagia

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    1. Dysphagia Dr. Kartik Ganesh

    2. Definition Difficulty in swallowing Obstruction of the passage of food through mouth pharynx and esophagus

    3. Aphagia- Complete obstruction. Bolus impaction- emergency Odynophagia- Painful swallowing Globus pharyngeus- lump in throat Phagophobia- fear of swallowing- Hysteria, Rabies, Tetanus, Pharyngeal paralysis

    4. Anatomy

    6. Deglutition Reflex

    11. Oropharyngeal dysphagia- Mech

    12. Oropharyngeal dysphagia- Motor

    13. Esophageal dysphagia- Mech

    14. Esophageal dysphagia- Motor Cervical Esophageal disorders Thoracic Esophageal Disorders- Weak LES tone- Idiopathic, Scleroderma, Myopathy (visceral, myotonic), Alcohol, DM, Anti cholinergics Nutcracker Esophagus, Hypertensive LES- Increased Muscle contraction Diffuse Esophageal Spasm, Achalasia (Ca, lymphoma, Chagas), Contractile lower esophageal ring- Inhibitory innervation disorders

    15. Associated Clinical features Nasal regurgitation, tracheobronchial aspiration with swallowing- TEF, Pharyngeal paralysis Hoarseness of voice- before- larynx - after- RLN involvement by ? Ca esophagus Hiccough- distal esophageal lesion U/L wheeze- Mediastinal mass involving bronchus + esophagus Transient- Inflammation Progressive over a short period, weight loss- Ca Chest pain- diffuse esophageal spasm, large bolus obstruction HIV/ immunocompromised states- HSV, CMV, Candida, Kaposi, lymphoma

    16. Only to solids- mechanical dysphagia Liquid+ solid- advanced stages Episodic- Benign disease characterised by lower esophageal ring Signs of bulbar or pseudobulbar palsy Thyroid enlargenment, spine Skin- Scleoderma, Pemphigoid or epidermolysis bullosa

    17. Diagnostic

    18. Approach Dysphagia Find anatomic site first.

    19. Treatment options TREAT THE CAUSE Swallowing therapy Exercises that can stimulate the nerves that are used to trigger swallowing reflex, and strengthen the muscles that are used during swallowing. Physical techniques – postural variation. Dietary changes  Incorporating food and liquids that are easier to swallow Mashed potatoes,  Scrambled eggs and cheese Feeding tubes In severe cases of dysphagia There are two types of feeding tubes: Nasogastric tube,  10-28 days Percutaneous endoscopic gastrostomy (PEG) tube, a tube that is surgically implanted directly into your stomach, which passes through a small incision on the surface of your stomach, or abdomen. 2-3 years

    20. Esophageal or ‘low’ dysphagia Surgery Balloon Dilation Botulinum toxin can be used to treat achalasia It paralyses the over-stiff muscles that are preventing food from reaching the stomach

    21. Thank you…

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