DYSPHAGIA - Approach

To be able to eat a meal that

has been specially and
lovingly prepared is one of
lifes most satisfying
pleasures!
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
Oral stage:
less than 1 sec
Tongue squeezes the food
backwards
the tongue is the mouth; all else is
accessory
Hyoid bone, mylohyoid muscle
Pharyngeal phase
Less than 1 sec

Pharyngeal peristaltic wave

Preceeding wave of relaxation: Crico-

Pharyngeal sphincter
Pharyngeal Phase - contd
Protection of larynx
Apnoea
Elevation of larynx
Closure of laryngeal sphincter
Ary-Epiglottic Fold
False Cords
True vocal cords
Epiglottis
Oesophageal Phase
3 -7 sec 9
Peristaltic stripping wave (3 -5
cm/ sec)
Secondary peristaltic waves

Preceding wave of relaxation: Gastro-

Oesophageal sphincter
Causes
Painful Diseases of Mouth, Pharynx
Stomatitis, Tonsillits,
TB Laryngitis
Retro-Pharyngeal abscess
Neuromuscular Diseases
Bulbar paralysis
Myesthenia gravis
Achalasia
Causes-contd
Extrinsic Compression
Congenital
Atresia
Oesophagitis, Ulceration, Stricture
Reflux
Corrosives
P-V Syndrome(Sideropenic Dysphagia)
Ca oesophagus
Symptomatolgy
True Dysphagia
Difficulty with liquids
Odynophagia
Duration
Nature of Diet
Localisation
Associated symptoms
Regurgitation
Retro/Substernal Pain
Bleeding
Hoarseness, Cough
Loss of Weight
Tiredness, Malaise (Anemia)
Physical Examn
Anemia
Patterson- Kelly/Plummer-Vinson
Syndrome
Liver
Signs of Portal HrT
Ascites
IDL
Vocal Cord Palsy
Tumour
Ulceration
Pooling of saliva in Pyriform Fossa
Local Examn
Cervical Lymph Nodes
Thyroid Gland enlargement
Laryngeal Crepitus
Radiology
X Ray Chest PA
View
X Ray Neck Lat
View
CT Scan
MR Imaging
Radiology - contd
Barium Swallow
examn
Rigid Oesophagoscopy
Oesophageal
Speculum
Rigid
Oesophagoscope
Endoscopy Flexible Fibreoptic

OPD Procedure
LocalAnesthesia
In cervical
ankylosis, trismus
Less complications
Oesophagus - Endoscopic Anatomy

Collapsed lumen
Flattened, stellate
4 Constrictions
Oesophagoscopy: Indications
Diagnostic
Dysphagia
Neck Masses, VC paralysis
Hemetemesis
Oesophagitis
Therapeutic
FB
Dilatation of Srictures
Varices
Stents in Malignancies
Oesophagoscopy: Contraindications
Perforation previously
Cervical Ankylosis, Trauma
Trismus
Aneurysm of Aorta
Oesophagoscopy: Complications
Bleeding
In Biopsy, Dilatation
Perforation
Cervical:
Cervical Tenderness
Surgical Emphysema
Thoracic: (More serious)
Pain Chest, radiating to Back
Surgical Emphysema