Dysphagia UMST PDF

Dysphagia Dr Rajab Mugabo  Physiology of Swallowing ◈ The act of swallowing involves three phases: Oral, Pharyngeal, and Esophageal. ◈ Swallowing takes about 8-10 seconds ◈ Before swallowing begins, Oral Preparation of the bolus must occur.  Physiology of...

Dysphagia Dr Rajab Mugabo  Physiology of Swallowing ◈ The act of swallowing involves three phases: Oral, Pharyngeal, and Esophageal. ◈ Swallowing takes about 8-10 seconds ◈ Before swallowing begins, Oral Preparation of the bolus must occur.  Physiology of Swallowing ◈ Pharyngeal and Esophageal Phase:  Causes ◈ Foreign bodies ◈ Surgical causes: Head and neck surgery ◈ Oesophagitis: GERD, infectious oesophagitis, radiation induced oesophagitis, Drug induced oesophagitis. ◈ Tumors: oropharynx, hypopharynx, larynx & oesophagus ◈ CNS disorders: Alzheimer disease, Brain tumors, Guillain-Barré syndrome, Amyotrophic lateral sclerosis (ALS) etc. ◈ Motility disorders: Diffuse esophageal spasms (DES), Achalasia, Scleroderma, Presbyesophagus, Cricopharyngeal dysfunction. ◈ Structural disorders: Zenker’s diverticulum, Plummer-Vinson or Paterson-Kelly syndromes  Evaluation of Dysphagia ◈ History ◈ Review of Systems ◈ Physical Exam ◈ Imaging Studies  History ◈ Duration dietary changes ◈ Weight loss ◈ Odynophagia ◈ Solids or Liquids ◈ Level of sensation of dysphagia ◈ Past surgery to head and neck, trauma, ingestion of caustic substances ◈ Associated symptoms such as with GERD, voice changes, nasal leakage, otalgia  Review of Systems ◈ Ask about common systemic processes associated with dysphagia: ◈ Tobacco/Alcohol ◈ Medications – antihistamines, anticholinergics, antidepressants, antihypertensives ◈ Osteoarthritis ◈ Systemic neuromuscular disorders ◈ Auto-Immune disorders ◈ Psychiatric state  Physical Exam: ◈ General: mental status, drooling, wheezing, dyspnea, voice quality ◈ Cranial nerves ◈ Inspection of the tongue and palate for strength/symmetry ◈ Laryngeal Examination: pooled secretions, vocal cord movement  Imaging Studies ◈ Should be chosen to suit the patient’s symptoms and to confirm a finding. ◈ Plain x-ray Suspected infectious cause of dysphagia with gross displacement of structures ◈ Barium Swallow Excellent to evaluate dynamic (e.g. neuromuscular, aspiration) swallow disorders ◈ Manometry Disorders in which intraluminal pressures must be measured (achalasia, esophageal spasm, etc.) ◈ Fiberoptic Endoscopic Fiberoptic Endoscopic evaluation of swallowing (FEES) ◈ Oesophageal ultrasound Endoscopic assessment of oesophageal tumors ◈ CT Scan & MRI  Treatment ◈ Identify and treat the cause The goals of dysphagia treatment are to maintain adequate nutritional intake for the patient and to maximize airway protection.