Document Dysphagia

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • However, once initiated, swallowing is completed normally. Odynophagia means painful swallowing. Frequently, odynophagia and dysphagia occur together. Globus pharyngeus is the sensation of a lump lodged in the throat. However, no difficulty is encountered when swallowing is performed.Misdirection of food, resulting in nasal regurgitation and laryngeal and pulmonary aspiration during swallowing, is characteristic of oropharyngeal dysphagia.

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  • Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài:Primary localized laryngeal amyloidosis presenting with hoarseness and dysphagia: a case report

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  • Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành hóa học dành cho các bạn yêu hóa học tham khảo đề tài: A radial basis classifier for the automatic detection of aspiration in children with dysphagia

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  • Experience has proven that certain high-risk events, such as auto races and air shows, require particular planning in addition to the more generally applicable guidelines. This manual provides guidance for the particular planning of these high-risk events, as well as guidance to plan for terrorist and criminal activities. FEMA recognizes that no two events or situations are identical.

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  • 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.

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  • The interaction between these two variables, however, provided a better predictor of beverage preference. Similar results, in terms of the interaction between product choice and usage situation were found by Green and Rao (1972), Belk (1974) and Srivastava et al. (1978). In a later study, Srivastava (1980) examined the appropriateness of financial services in a particular situation and found it to be relatively stable across situations, thus providing further support for using consumption situations as a basis for segmenting the market.

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  • For some time now, movie marketing has expanded its boundaries beyond discrete paratexts such as posters, TV ads, trailers, or featurettes, and into such publicity-driven entities such as “Entertainment News” shows, actual news segments covering movie premieres or milestones, and other nebulous promotional venues. The digital environment accelerates such embedments and boundary-crossings. Marketing becomes an increasingly elusive and crucial subject for film historians interested in ecologies of cinematic knowledge.

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  • In some cases, being wherever the consumer is means selling products to them when they are ready to buy. As CG companies continue their experimentation with direct-to-consumer sales—through their own online storefronts or social media—they will need to start thinking more like the retailers with which they have long partnered. This shift in mindset will require changes in the marketing mix to accommodate increased investments in social media, mobile and other digital channels.

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  • We are Marcia Rackow, an artist, and Arnold Perey, an anthropologist, and are consultants on the faculty of the Aesthetic Realism Foundation. Both of us are honored to have studied with Mr. Siegel whose centenary is being celebrated this year, including in Baltimore, MD where he grew up. His birthday, August 16th , was designated "Eli Siegel Day" by the mayor and by the governor. We're proud to study now in classes taught by Ellen Reiss, the Class Chairman of Aesthetic Realism.

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  • 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.

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  • Planning and managing the implementation of policy requires additional skills and experience beyond the subject matter of the policy area concerned (e.g. social inclusion). It requires leadership and management expertise in such things as best practice program and project management methods, resource planning (financial and non-financial) and risk management. Obtaining such skills involves a combination of formal learning, coaching and on the job experience. The APS Policy Implementation Network, agency Centres of Excellence and APS Custodians of Best Practice (e.g.

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  • In the public debate over these policies, however, a number of potential concerns have been raised. Some policymakers worry that higher taxes might cause affluent households to work fewer hours, to decide against investing or starting a new business, to shield their income from taxes through shelters, or even to move to another state. But the research reviewed in this study suggests that modest tax increases on affluent households are unlikely to make substantial changes in their work effort or entrepreneurship, and they are very unlikely to leave the state....

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  • Dedication to resident education: Programs must demonstrate that the faculty are not only qualified in terms of credentials and experience, but are also active participants in teaching and mentoring residents. There should be sufficient depth and breadth within the faculty roster to ensure that the curriculum can be implemented as planned.

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