DYSPHAGIA

DYSPHAGIA

Dysphagia means difficulty in swallowing

What are the causes of dysphagia ?it can be divided into

Oral causes like
 
painful conditions as stomatitis , glossitis , ulcers  mechanical factors as ankloglossia , cancer tongue cleft palate fracture or dislocation of the mandible

 Pharyngeal causes as

painful conditions like pharngitis , tonsillitis , paratonsillar abscess  mechanical factors as foreign body , retropharyngeal abscess , diverticulm , tumours , pharyngeal pouch ,

plummer vinson syndrome

hysterical causes

oesophageal causes

 as 1- in the lumen like foreign body 2- in the wall as stricture tumours , oesophagitis , scleroderma , achalasia 3- compression from outside as cancer thyroid or goitre and mediastinal syndrome 

 Cardio-oesophageal causes

as 1- achalsia 2- hiatus hernia 3- cancer cardia or lower thrid of the oesohpagus 4- reflux oesophagitis and peptic ulcer of the lower end of the oesophagus


 Discussion of commonest causes of dysphagia

Achalasia of the oeosphagus
 
 Which affect female more than male and most patient are in the third and fourth decades the onset is insidious with intermittent dysphagia often more marked with fluid than solids . regurgitation of food more several hours after meals and is often mistaken by the patient for vomiting , there may be retrosternal discomfort rarely amounting to pain . in advanced cases the nutrition suffers and loss of weight occurs

 Plummer -Venson syndrome 

Occurs in women around 40 years of age . there is long standing dysphagia due to achalasia of the circopharyngeus muscle and chronic inflammation of the mucous

membrane . examination reveals glossitis , spoon -shaped nails (koilonychia) splenomegaly and hypochromic anaemia

Pharyngeal pouch or median pharyngeal diverticulum

 Occurs typically in elderly males there is a history of long standing dysphagia recently aggravated and associated with reguritation of undigested food after meals eructation of gas gurgling noises in the neck and an irritable cough due to overflow of food into the larynx . in about one third of the cases the pouch is large enough to form a swelling in the neck which is enlarges when patient drinks and can be emptied by pressure . in advanced cases progressive loss of weight occurs and may lead to cachexia the barium swallow shows a flask - shaped pouch with a fluid level

 

 carcinoma of the oesophagus 

 Is commonest in men over the age of 50 . there is steadily increasing dysphagia first to solids and latter to fluids regurgitation is slight because the upper oesophagus dilates only slightly . there may be retrosternal , interscapular or epigastric discomfort during deglutition but pain is absent . there is often excessive salivation and cough from regurgitation of mucus into the larynx . in late cases progressive cachexia and dehydration supervene the barium swallow shows an irregular rat - tail filling defect and less often an unlcer crater or a polypoidal mass . retrograde radiography in trendelenburg,s position indicate the longitudinal extend of the tumour . esophagoscopy visualizes the growth and allows removal of biopsy specimens , bronchoscopy may reveal paralysis of a vocal cord or involvement of the bronchial tree by the tumour or by enlarged mediastinal glands

  

 Benign stricture

Usually swallowing of corrosives as lye strictures but may result from ulceration of the oesophagus , reflux oeosphagitis haitus herna or instrumental injury . the dysphagia is usually progressive and associated with regurgitation of swallowed food and retrosternal discomfort and in longstanding cases loss of weight occurs the barium swallow shows dilatation of the oesophagus above a long tapering stricture usually involving the lower third oesophagoscopy reveals a white fibrous narrowing with a fine slit like opening

tags:dysphagia