Transcript Dysphagia

Dysphagia
Prof. Dr. Faisal Ghani Siddiqui
[email protected]
www.lumhs.edu.pk/faculties/surgery/gsurgery/about-dr.faisalghani.html
Learning Objectives
• What is dysphagia?
• What are types of dysphagia?
• What are the causes of dysphagia?
• How to investigate a patient with
dysphagia?
• Difficulty in swallowing
• Normal swallowing reflex
• 5 cranial nerves
• 30 muscles
• Oral phase
• Pharyngeal phase
• Oesophageal phase
Dysphagia
High type
Low type
Causes of Dysphagia
• High (Oropharyngeal)
– Neuromuscular disorders
– Mechanical
• Low (Oesophageal)
– Motility disorders
– Mechanical
High (Oropharyngeal) Dysphagia
Neuromuscular
•CVA
•Parkinson’s disease
•MS
•Mysthania gravis
•Muscular dystrophy
•Bulbar / pseudobulbar palsy
High (Oropharyngeal) Dysphagia
Mechanical
• Pharyngeal pouch
• Oropharyngeal tumours
Low (Oesophageal) Dysphagia
Motility disorders
•Achalasia
•Diffuse oesophageal spasm
•Chaga’s disease
Low (Oesophageal) Dysphagia
Mechanical
• Oesophageal carcinoma
• Benign stricture
• Extrinsic compression
• Dysphagia
• Odynophagia
• Globus
History
• Duration
• Stable, intermittent, progressive
• Speed of progression
• Liquids or solids
Investigations
Diagnostic
• Endoscopy
• Barium swallow
• Manometry
Staging
• CT
• Diagnostic laparoscopy
• EUS
• Biopsies
• Dilatation
• Stenting / laser ablation
Conventional barium swallow
Double contrast barium swallow
Manometry
-patients with no structural abnormality
on endoscopy
Investigations for Staging
• CT or MRI
• Staging laparoscopy
• EUS