Dysphagia Flashcards
Dysphagia is ?
It is difficulty in swallowing
Causes of dysphagia
- Foreign body- fish bone, etc.
- Corrosive substance- acid, alkali
*Achalasia cardia- progressive intermittent dysphagia first to liquid, usually a long history and-there may be no weight loss.
- Hiatus hernia-
- Tumors
- Retrosternal goiter
- Mediastinal tumors
- Foreign body
- Esophageal infection -
-Stricture
-Scleroderma -
-Chagas disease
- plummer-Vinson syndrome- dysphagia plus iron deficiency anaemia.
Clinical features
*difficulty in swallowing, pain ni swallowing, weight loss, fever, vomiting, weakness, halitosis,
jaundice, cyanosis, pallor, productive sputum
Description of dysphagia In cancer, achalasia, liquid
> Inability to swallow solid- cancer >Inability to swallow liquid- achalasia
Inability to swallow solid and liquid - stricture
Investigations of dysphagia
INVESTIGATION
*Plain X-ray of neck &chest AP, lateral Esophagoscopy- rigid or flexible
Barium swallow: irregular filling defect, shouldering, and rate tail deformity in Caoesophagus, *Dilatedoesophagous with narrow cardia bird beak deformity) in Acalasia)
*Esophageal manometry:
24 hr esophageal pH studies: PH < 4 for > 1hr is diagnostic ofGERD
Note: pH<4 is GERD
* PCV, Hb, FBC Serum albumin
Transferrin
E/U/Cr, Bronchoscopy Abdominal Ultrasound
Treatment for dysphagia
- Foreign body:
removal - GERD
endoscopic
or surgical
*Life style modification
*PPI- proton pump inhibitor *Prokinetics- domperidome
Treatment of achalasia , cancer and stricture
*Medical: botulinum toxin, Calcium Channel Blocker, Nitroglycerin
*Surgery: Modified Heller’s operation: esophagocardiomyotomy
Benign Stricture: dilatation, resection & anastomosis
Cancer- Surgery, Chemotherapy, Radiotherapy, Cytotoxic therapy
What is achalasia cardia pathology
*Achalasia cardia pathology
Depletion of ganglion cells in the
distal oesophagus, neural fibrosis, reduced NO, VIP; mediators of LES relaxation, thickened circular muscle fibres in distal e s o p h a g u s .
