Document Dysphagia

Document introduction of content: Definition, introduction and key points, disease burden and epidemiology, causes of dysphagia, clinical diagnosis, treatment options, references, useful web sites and guidelines.

14p vovanvovan2013 13-05-2016 38 1   Download

Clinical Manifestations Food-Borne Botulism After ingestion of food containing toxin, illness varies from a mild condition for which no medical advice is sought to very severe disease that can result in death within 24 h. The incubation period is usually 18–36 h but, depending on toxin dose, can range from a few hours to several days. Symmetric descending paralysis is characteristic and can lead to respiratory failure and death. Cranial nerve involvement, which almost always marks the onset of symptoms, usually produces diplopia, dysarthria, dysphonia, and/or dysphagia.

5p colgate_colgate 21-12-2010 78 3   Download

Sepsis with Skin Manifestations (See also Chap. 18) Maculopapular rashes may reflect early meningococcal or rickettsial disease but are usually associated with nonemergent infections. Exanthems are usually viral. Primary HIV infection commonly presents with a rash that is typically maculopapular and involves the upper part of the body but can spread to the palms and soles. The patient is usually febrile and can have lymphadenopathy, severe headache, dysphagia, diarrhea, myalgias, and arthralgias.

5p thanhongan 07-12-2010 83 3   Download

Clinical Features About 10% of esophageal cancers occur in the upper third of the esophagus (cervical esophagus), 35% in the middle third, and 55% in the lower third. Squamous cell carcinomas and adenocarcinomas cannot be distinguished radiographically or endoscopically. Progressive dysphagia and weight loss of short duration are the initial symptoms in the vast majority of patients. Dysphagia initially occurs with solid foods and gradually progresses to include semisolids and liquids.

5p konheokonmummim 03-12-2010 95 4   Download

Chemoprevention β-Carotene and cis-retinoic acid can lead to the regression of leukoplakia. However, cis-retinoic acid does not reduce the incidence of second primaries Treatment Complications Complications from treatment of head and neck cancer are usually correlated to the extent of surgery and exposure of normal tissue structures to radiation. Currently, the extent of surgery has been limited or completely replaced by chemotherapy and radiation therapy as the primary approach. Acute complications of radiation include mucositis and dysphagia.

5p konheokonmummim 03-12-2010 86 7   Download

Diseases of the striated muscle often also involve the cervical part of the esophagus, in addition to affecting the oropharyngeal muscles. Clinical manifestations of the cervical esophageal involvement are usually overshadowed by those of the oropharyngeal dysphagia. Diseases of the smooth-muscle segment involve the thoracic part of the esophagus and the LES. Dysphagia occurs when the peristaltic contractions are weak or absent or when the contractions are nonperistaltic. Loss of peristalsis may be associated with failure of LES relaxation.

5p ongxaemnumber1 29-11-2010 49 3   Download

Chest pain with dysphagia occurs in DES and related motor disorders. Chest pain resembling DES may occur in esophageal obstruction due to a large bolus. A prolonged history of heartburn and reflux preceding dysphagia indicates peptic stricture. A history of prolonged nasogastric intubation, ingestion of caustic agents, ingestion of pills without water, previous radiation therapy, or associated mucocutaneous diseases may provide the cause of esophageal stricture. If odynophagia is present, candidal, herpes, or pill-induced esophagitis should be suspected.

5p ongxaemnumber1 29-11-2010 58 3   Download

Oropharyngeal motor dysphagia results from impairment of the voluntary effort required in bolus preparation or neuromuscular disorders affecting bolus preparation, initiation of the swallowing reflex, timely passage of food through the pharynx, and prevention of entry of food into the nasal and the laryngeal opening. Paralysis of the suprahyoid muscles leads to loss of opening of the UES and severe dysphagia. Because each side of the pharynx is innervated by ipsilateral nerves, a unilateral lesion of motor neurons leads to unilateral pharyngeal paralysis.

5p ongxaemnumber1 29-11-2010 65 3   Download

Table 38-2 Esophageal Dysphagia Esophageal Mechanical Dysphagia I. Wall defects A. Congenital B. Tracheoesophageal fistula II. Intrinsic narrowing A. Inflammatory esophagitis 1. Viral (herpes simplex, varicella-zoster, cytomegalovirus) 2. Bacterial 3. Fungal (Candida) 4. Mucocutaneous bullous diseases 5. Caustic, chemical, thermal injury 6. Eosinophilic esophagitis B. Webs and rings 1. Esophageal (congenital, inflammatory) 2. Lower esophageal mucosal ring (Schatzki's ring) 3. Eosinophilic esophagitis 4. Host-versus-graft disease, mucocutaneous disorders C.

6p ongxaemnumber1 29-11-2010 58 3   Download

Pathophysiology of Dysphagia Based on anatomic site of involvement, dysphagia may be divided into oral, pharyngeal, and esophageal dysphagia. Normal transport of an ingested bolus through the swallowing passage depends on the size of the ingested bolus and size of the lumen, the force of peristaltic contraction, and deglutitive inhibition, including normal relaxation of UES and LES during swallowing.

8p ongxaemnumber1 29-11-2010 71 3   Download

Harrison's Internal Medicine Chapter 38. Dysphagia Dysphagia: Introduction Dysphagia is defined as a sensation of "sticking" or obstruction of the passage of food through the mouth, pharynx, or esophagus. However, it is often used as an umbrella term to include other symptoms related to swallowing difficulty. Aphagia signifies complete esophageal obstruction, which is usually due to bolus impaction and represents a medical emergency. Difficulty in initiating a swallow occurs in disorders of the voluntary phase of swallowing. However, once initiated, swallowing is completed normally.

5p ongxaemnumber1 29-11-2010 60 3   Download