faisal ghani siddiqui mbbs; fcps; mcps (hpe); pgd (bioethics) [email protected]
TRANSCRIPT
FAISAL GHANI SIDDIQUIMBBS; FCPS; MCPS (HPE); PGD (BIOETHICS)
[email protected]/faculties/surgery/gsurgery/about-dr.faisalghani.html
DYSPHAGIA
PREAMBLE
DYSPHAGIA & ITS TYPES?
DIAGNOSTIC PROTOCOL
NORMAL SWALLOWING REFLEX
DIFFICULTY IN SWALLOWING
RESULTS FROM ANY PATHOLOGY THAT INTERFERES WITH THE
NORMAL SWALLOWING MECHANISM
DYSPHAGIA
ORALPHARYNGEAL
OESOPHAGEAL
SWALLOWING REFLEX -3 PHASES
ORAL PHASEFOOD BOLUS ROLLED BACK BY THE
TONGUE INTO THE PHARYNX
PHARYNGEAL PHASEFOOD PASSES THROUGH THE
PHARYNX INTO THE OESOPHAGUS
OESOPHAGEAL PHASEFOOD PASSES THROUGH THE
OESOPHAGUS INTO THE STOMACH
HIGH (OROPHARYNGEAL)
DYSPHAGIA OCCURING AT OR ABOVE CRICOPHARYNGEUS
LOW (OESOPHAGEAL)
DYSPHAGIA OCCURING BELOW CRICOPHARYNGEUS
TYPES OF DYSPHAGIA
DYSPHAGIA -CAUSES
HIGH (OROPHARYNGEAL) DYSPHAGIANEUROLOGICAL / NEUROMUSCULAR
• CVA• PARKINSON’S DISEASE• MULTIPLE SCLEROSIS• MYSTHAENIA GRAVIS• BULBAR / PSEUDOBULBAR PALSY
MECHANICA / STRUCTURAL • PHARYNGEAL POUCH• TUMOURS
DYSPHAGIA -CAUSES
LOW (OESOPHAGEAL) DYSPHAGIAPRIMARY MOTILITY DISORDERS • ACHALASIA
• DIFFUSE OESOPHAGEAL SPASM• NUTCRACKER OESOPHAGUS
SECONDARY MOTILITY DISORDERS
• CHAGA’S DISEASE
MECHANICAL (INTRINSIC DISEASES)
• OESOPHAGEAL CARCINOMA• BENIGN STRICTURE
MECHANICAL (EXTRINSIC DISEASES)
• BRONCHOGENIC CARCINOMA• THORACIC AORTIC ANEURYSM• GOITRE• DYSPHAGIA LUSORIA
DYSPHAGIA -DIAGNOSIS
HISTORY
INVESTIGATIONS
PHYSICAL EXAMINATION
HIGH (OROPHARYNGEAL) DYSPHAGIA
ASSOCIATED WITH CHOKING OR COUGHING IMMEDIATELY AFTER SWALLOWING
SWALLOWING SOLIDS EASIER THAN LIQUIDS
HISTORY
DYSPHAGIA DUE TO OESOPHAGEAL CARCINOMA
SHORT DURATION (< 3 MONTHS)
PROGRESSIVE
ASSOCIATED WEIGHT LOSS
HISTORY
DYSPHAGIA DUE TO MOTILITY DISORDERS
LONG HISTORY
INVOLVES BOTH SOLIDS AND LIQUIDS
DYSPHAGIA MAY DISAPPEAR, BEING REPLACED WITH REGURGITATION & NOCTURNAL COUGH
HISTORY
OFTEN UNREWARDING
MOVEMENTS OF TONGUE, PALATE, & MUSCLES OF FACIAL EXPRESSION
CERVICAL LYMPHADENOPATHY
WEIGHT LOSS
PHYSICAL EXAMINATION
ENDOSCOPYBARIUM SWALLOW
MANOMETRYEUS
INVESTIGATIONS
PATIENTS WITH HIGH DYSPHAGIA WITH NO OBVIOUS NEUROLOGICAL CAUSE SHOULD BE
REFERRED TO ENT SPECIALIST
FLEXIBLE LARYNGOSCOPY
FLEXIBLE NASOENDOSCOPY
RIGID ENDOSCOPY
ENDOSCOPY
OESOPHAGEAL DYSPHAGIA
BIOPSIES TO DIFFERENTIATE MALIGNANT & BENIGN STRICTURES
THERAPEUTIC; DILATATION OF BENIGN STRICTURES / MOTILITY DISORDERS
STENTING IN INOPERABLE TUMOURS
ENDOSCOPY
OESOPHAGEAL DYSPHAGIA
Demonstrates different structural pathologies
Hiatus hernia | Strictures Achalasia | Tumours
BARIUM SWALLOW
PATIENTS WITH NO STRUCTURAL ABNORMALITY ON ENDOSCOPY
REQUIRE FURTHER INVESTIGATION WITH MANOMETRYTO EXCLUDE
MOTILITY DISORDERS
MANOMETRY
USED FOR STAGING OF HISTOLOGICALLY PROVEN
OESOPHAGO-GASTRIC CARCINOMA
ENDOSCOPIC ULTRASOUND
WALL PENETRATION
LYMPH NODE INVOLVEMENT
EXTRINSIC OESOPHAGEAL COMPRESSION
HIGH DYSPHAGIA
HISTORY SUGGESTIVE OF NEUROLOGICAL CAUSE
NO
ENT REFERRAL
ORO-PHARYNGO-
LARYNGOSCOPY
YES
VIDEO-FLOUROSCOPY &
MANOMTERY