Dysphagia

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Dysphagia Dr. Raid Jastania

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Dysphagia. Dr. Raid Jastania. Reference and Contact. Robbins Basic Pathology http://www.pathoma.com/ [email protected] http://uqu.edu.sa/staff/ar/4180114. Before we start:. - PowerPoint PPT Presentation

Transcript of Dysphagia

Page 1: Dysphagia

Dysphagia

Dr. Raid Jastania

Page 2: Dysphagia

Reference and Contact

• Robbins Basic Pathology• http://www.pathoma.com/

[email protected]• http://uqu.edu.sa/staff/ar/4180114

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Before we start:

• 70 year old man presented with difficulty in swallowing. It started with difficulty in swallowing solid food. Later he had difficulty in swallowing liquids too.

• Barium swallow shows stricture in the lower esophagus. Endoscopy is done and a biopsy is taken.

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Before we start

• What are the diseases causing problems in swallowing?

• What are the symptoms of Diseases in swallowing?

• What is the normal physiology and the abnormal pathophysiology of swallowing?

• What are the common disease of esophagus?

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By the end of this session the student should be able to:

• Define dysphagia, odynophagia, aphagia,

• Describe the physiological process of swallowing

• Develop an approach to list the etiological causes of dysphagia

• Compare Mechanical dysphagia and motor dysphagia

• Describe common developmental defects: Atresia, rings, web diverticula

• Explain Reflux esophagitis, Barrett esophagus

• List common types of carcinoma of esophagus

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By the end of this session the student should be able to:

• Define dysphagia, odynophagia, aphagia,

• Describe the physiological process of swallowing

• Develop an approach to list the etiological causes of dysphagia

• Compare Mechanical dysphagia and motor dysphagia

• Describe common developmental defects: Atresia, rings, web diverticula

• Explain Reflux esophagitis, Barrett esophagus

• List common types of carcinoma of esophagus

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Definitions:

• Dysphagia is: a sensation of “sticking” or obstruction of food through the mouth, pharynx or the esophagus

• Apahgia is: complete esophageal obstruction• Odynophagia: is painful swallowing

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By the end of this session the student should be able to:

• Define dysphagia, odynophagia, aphagia,

• Describe the physiological process of swallowing

• Develop an approach to list the etiological causes of dysphagia

• Compare Mechanical dysphagia and motor dysphagia

• Describe common developmental defects: Atresia, rings, web diverticula

• Explain Reflux esophagitis, Barrett esophagus

• List common types of carcinoma of esophagus

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Swallowing

• Oral phase: • voluntary

• Pharyngeal phase: • involuntary deglutition

reflex

• Esophageal phase: • deglutition inhibition, • Peristalsis

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By the end of this session the student should be able to:

• Define dysphagia, odynophagia, aphagia,

• Describe the physiological process of swallowing

• Develop an approach to list the etiological causes of dysphagia

• Compare Mechanical dysphagia and motor dysphagia

• Describe common developmental defects: Atresia, rings, web diverticula

• Explain Reflux esophagitis, Barrett esophagus

• List common types of carcinoma of esophagus

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Pathophysiology of dysphagia

• What are the structures involved (controls) swallowing?

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Pathophysiology of dysphagia

• What are the structures involved (controls) swallowing?– Nervous system, vagus nerve– Mouth, tongue– Pharynx, larynx, esophagus– Skeletal muscle– Smooth muscle– Upper and lower esophageal sphincter

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Pathophysiology of dysphagia• What are the structures involved (controls) swallowing?

– Nervous system, vagus nerve– Mouth, tongue– Pharynx, larynx, esophagus– Skeletal muscle– Smooth muscle– Upper and lower esophageal sphincter

• Pathology can be:– Structural or– Functional

• In the Esophagus: Pathology can be:– Mechanical or– Motor

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Mechanical Dysphagia

• Obstruction:– Large food bolus– Narrowing of the esophagus– Compression of the esophagus

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Mechanical Dysphagia

• Obstruction:– Large food bolus– Narrowing of the esophagus

– Inflammatory: esophagitis– Developmental: web, ring– Stricture: congenital, peptic, inflammatory– Neoplasm: Benign, Malignant

– Compression of the esophagus– Retropharyngeal mass– Mediastinal mass– Pancreatic tumor

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Motor Dysphagia

• Disease in striated muscle:– Pharynx, upper esophageal sphincter, upper

esophagus– Cerebrovascular accident– Polymyositis, dermatomyositis

• Disease in the smooth muscle:– Mid and lower esophagus, Lower esophageal

sphincter– Achalasia– Scleroderma

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By the end of this session the student should be able to:

• Define dysphagia, odynophagia, aphagia,

• Describe the physiological process of swallowing

• Develop an approach to list the etiological causes of dysphagia

• Compare Mechanical dysphagia and motor dysphagia

• Describe common developmental defects: Atresia, rings, web diverticula

• Explain Reflux esophagitis, Barrett esophagus

• List common types of carcinoma of esophagus

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Developmental Defects in the Esophagus

• Esophageal Atresia:– Absence of lumen– Newborn with aspiration

• Trachio esophageal Fistula

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Developmental Defects in the Esophagus

• Esophageal Ring and Web:– Episodic dysphagia to

solid food

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Developmental Defects in the Esophagus

• Esophageal Diverticula:– Episodic food

regurgitation, – may be painful

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By the end of this session the student should be able to:

• Define dysphagia, odynophagia, aphagia,

• Describe the physiological process of swallowing

• Develop an approach to list the etiological causes of dysphagia

• Compare Mechanical dysphagia and motor dysphagia

• Describe common developmental defects: Atresia, rings, web diverticula

• Explain Reflux esophagitis, Barrett esophagus

• List common types of carcinoma of esophagus

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Esophagitis

• Inflammation of the esophagus

• Start in the mucosa• Causes:

• Intubation• Corrosoives, irritant,

acidity• Chemotherapy• Reflux esophagitis• Hiatal hernia• infections

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Barrett Esophagus• Replacement of the

normal stratified squamous epithelium with intestinal (goblet cell) metaplasia

• Complication of reflux disease

• Complications: ulceration, stricture, dysplasia, carcinoma 30-100 x risk

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Esophageal Carcinoma

• Squamous cell carcinoma

• Adenocarcinoma• Risk factors:– Esophagitis– Barrett– Achalasia– Alcohol– Smoking

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By the end of this session the student should be able to:

• Define dysphagia, odynophagia, aphagia,

• Describe the physiological process of swallowing

• Develop an approach to list the etiological causes of dysphagia

• Compare Mechanical dysphagia and motor dysphagia

• Describe common developmental defects: Atresia, rings, web diverticula

• Explain Reflux esophagitis, Barrett esophagus

• List common types of carcinoma of esophagus

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Further questions and reading

• What is the role of Salivary glands in swallowing?

• What are the signs and symptoms of diseases of the GI tract?

• What are the diseases of the stomach, small and large intestine?