Dysphagia
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Transcript of Dysphagia
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Dysphagia
Dr. Raid Jastania
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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?