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Dysphagia PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "DYSPHAGIA".

This medical PowerPoint presentation is about dysphagia, a medical term that refers to difficulty or discomfort when swallowing food, liquids, or saliva. It can occur at any age but is more common in older adults and those with certain medical conditions such as stroke, Parkinsons disease, or head and neck cancer.

There are two types of dysphagia: oropharyngeal dysphagia and esophageal dysphagia. Oropharyngeal dysphagia occurs when there is a problem with the muscles or nerves involved in swallowing, which can lead to difficulty initiating swallowing or food getting stuck in the throat. Esophageal dysphagia occurs when there is a problem with the esophagus, such as narrowing or obstruction, which can cause food to get stuck or difficulty in moving food down the esophagus.

Dysphagia can cause malnutrition, dehydration, and aspiration pneumonia, which is why its important to seek medical attention if you have any difficulty with swallowing. Treatment may involve dietary modifications, exercises to improve swallowing, medications, or surgery, depending on the underlying cause of dysphagia.

Tags : dysphagia, head and neck cancer, oropharyngeal dysphagia, esophageal dysphagia, Otolaryngology, Otolaryngology PowerPoint presentation

Published on : Jun 23, 2023 | Views : 2201 | Downloads : 3

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Slide 1-

DYSPHAGIA
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Definition Dysphagia is defined as having difficulty in swallowing which may affect any part of the swallowing pathway from the mouth to the stomach. Approximately half of the dysphagia patients are seen in ENT clinics.
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History and Examination Patients complain that foods or liquids are no longer being swallowed easily and there is a sensation of food sticking. Clinician must try to distinguish oropharyngeal from oesophageal dysphagia
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Oropharyngeal vs.Oesophageal Dysphagia In Oropharyngeal dysphagia, there is difficulty in preparing and transporting the food bolus through the oral cavity as well as initiating the swallow. This may be associated with aspiration or nasopharyngeal regurgitation. In Oesophageal dysphagia, patients complain of food sticking in their lower throat, neck, retro-sternal discomfort or epigastrium.
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Age: Possible causes Children : Foreign body or congenital malformation Middle aged patients: Reflux oesophagitis, hiatus hernia, anaemia, achlasia, globus syndrome. Elderly patients: Malignancy, stricture formation from longstanding reflux, pharyngeal pouch, motility disorders associated with aging and neurological disorders.
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History Onset. Duration Progression Severity of symptoms Types of food intake that causes problems Alleviating factors
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Associated Symptoms Regurgitation Pain on swallowing Hoarseness of voice Otalgia Coughing after eating Frequent chest infections
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Clinical Examination Complete Head and neck examination Inspection of oral cavity Dentition Oropharynx IDL Nasolaryngoscopy Cranial nerve examination ( tongue, gag and cough reflex, hoarseness, vocal cord mobility) Neck for lymph nodes, neck masses, thyroid enlargement, loss of laryngeal crepitus and integrity of laryngeal cartilages.
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Special Investigations Blood tests to exclude anaemia (? Cause or effect) ESR or C-Reactive Protein raised in malignancy or chronic inflammatory process LFT, RFT along with S. Calcium when nutrition is impaired or metastasis is suspected Thyroid function tests if dysphagia is caused by goiter or malignancy of thyroid
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Special Investigations Barium swallow Chest radiograph CT scan examination of neck, chest and abdomen. MRI is indicated when there are neurological causes such as multiple sclerosis, cerebral tx, nasopharyngeal ca. Rigid endoscopy Flexible endoscopy Manometry
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Causes: Congenital Choanal Atresia Cleft lip and palate Unilateral vocal cord paralysis Laryngeal cleft Tracheo-oesphageal fistula Oesophageal atresia Vascular rings
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Acquired: Traumatic Accidental and iatrogenic Blunt trauma, penetrating injuries and compression effects Direct damage and injury to cranial nerves Head injury
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Acquired: Infections Acute pharyngitis, tonsillitis, quinsy Glandular fever Acute supraglottitis Herpetic, fungal and CMV mucosal lesions Candidiasis Tuberculosis Submandibular, parapharyngeal and retropharyngeal abscesses
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Acquired: Inflammatory GERD with or without stricture formation Patterson Brown-Kelly syndrome Autoimmune disorders like scleroderma, Sjogrens disease, rheumatoid arthritis
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Acquired: Oesophageal motility disorders Achlasia Diffuse oesophageal spasm Nutcracker oesophagus
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Acquired: Neoplastic Benign and malignant tumors of oral cavity, pharynx and oesophagus Nasopharyngeal Carcinoma Skull base tumors Leukemia and lymphomas Enlarged mediastinal lymph nodes
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Acquired: Neurological CVA (Stroke) Isolated recurrent laryngeal nerve palsy Parkinson's disease Myasthenia gravis Multiple sclerosis Motor- neuron disease
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Acquired: Drug Induced Drugs causing oesophagitis Swallowing tablets with insufficient water or just before going to bed can cause oesophagitis Oesophagus at the level of aortic arch most vulnerable to contact by acid producing drugs (with pH less than 3) such as tetracyclines, doxycycline, vitamin C and ferrous sulphate
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Acquired: Drug Induced (2) Broad-spectrum antibiotics and chemotherapeutic agents may cause secondary viral ulceration or fungal infections Stevens-Johnson syndrome is a more serious complications of antibiotic therapy with an acute erosive pharyngitis/ oesophagitis as well as delayed oesophageal strictures Inhibitory drug side effects by anticholinergics, tricyclic antidepressants and calcium channel blockers
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Acquired: Drug Induced (3) Excitatory side effects of drugs like cisapride and metaclopramide. Dysphagia can be a complication of drugs like antihypertensives, ACE Inhibitors, anticholinergics, antiemetics, antihistamines, diuretics, and opiates by causing xerostomia
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Miscellaneous Presbydysphagia Foreign bodies Caustic strictures Pharyngeal pouch Patients with tracheostomy
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Key Points Age suggests most likely cause of dysphagia Globus pharyngeus rarely associated with any serious disease Dysphagia of short duration in elderly patient who smoke or drink and which progress from solids to liquids is a classic case of malignancy Referred otalgia with dysphagia is a sinister symptom and poor prognostic sign
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Key Points (2) Neurological causes of dysphagia mostly affect orpharyngeal phase Ingested foreign bodies tend to lodge at sites of constriction Barium study is contraindicated in patients with suspected perforation of oesophagus
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Motility Disorders These conditions include: Achlasia Scleroderma Diffuse Esophageal Spasm Nutcracker Esophagus Up to 30% pts with diagnosis of MI will be found to have an esophageal cause of pain and motility disorders account for over 50% of these patients. Mainstay of investigation is manometry , endoscopy, barium studies
Slide 25-

Achlasia Failure of relaxation of LES during swallowing due to degeneration of myenteric plexus. Presentation long standing dysphagia and regurgitation Barium swallow: Dilated esophagus with a smooth tapering stricture at its lower end Esophageal manometry: Synchronous contractions and failure to relax 24 Hour pH measurement: Confirms reflux
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Achlasia-Treatment Sequential dilatation of Lower Oesophageal Sphincter with intraluminal balloons under fluoroscopic control Balloon myotomy is safe, effective in 3/4th cases and can be repeated Surgical myotomy (Open/laparoscopic) reserved for failed balloon failures Failed myotomy can be treated with balloon dilatation
Slide 27-

DES & Nutcracker Esophagus Characterized by severe chest pain and dysphagia Primarily involvement of lower 1/3, muscle hypertrophy and high pressure contractions Symptoms intermittent so ambulatory manometry is required Treat with calcium channel blockers or balloon dilatation Results disappointing
Slide 28-

Esophageal Carcinoma EC is increasing in faster in incidence than any other malignancy in developed world with a ten fold rise in the last 20 years This increase is not squamous cell carcinoma but in the incidence of adenocarcinoma Classification of AC Type 1: Lower 1/3 of esophagus Type 2: At oesophago-gastric junction Type 3: In gastric cardia with 5cm of GE Junction Related to damaging effects of GE Reflux. H pylori eradication distal vs. proximal disease
Slide 29-

Risk factors Older age Caucasian race Male gender GERD symptoms Obesity Tobacco use Lower esophageal sphincter–relaxing drugs
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Protective factors Aspirin NSAIDs ? Helicobacter pylori Dietary factors (fruits, vegetables, fiber)
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Barrett's esophagus A well-recognized pre malignant condition for the development of adenocarcinoma and results from chronic gastroesophageal reflux. It is characterized by a metaplastic transformation of the typically squamous epithelium native of the esophagus, to a columnar type highlighted by the presence of goblet cells appreciated on histologic evaluation. The condition entails a 30- to 50-fold greater risk of developing adenocarcinoma.
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Treatment Early esophageal cancers, those confined to the mucosa or upper submucosa of the esophagus, are termed T1, N0, M0. The traditional approach for these early cancers is surgical resection. Primary surgical therapy for cancers limited to the esophagus, stage I or IIa disease, has had good results without the need for or morbidity of chemotherapy More than 50% of those with this cancer present with stage III or IV disease. The prognosis remains dismal, with an overall 5-year survival of approximately 20% More promising have been the results of studies combining neo adjuvant chemotherapy with radiation therapy.
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Palliative Measures Despite advances in diagnosis and treatment, up to 50% of patients have incurable disease at presentation, therefore necessitating palliative measure A variety of therapies have been employed to palliate dysphagia in patients with oesophageal carcinoma including oesophageal dilation, radiation therapy, Nd:YAG laser, thermal electrocoagulation, and sclerotherapy of the tumor.
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Palliative Measures Oesophageal prostheses (stents) have also been used as a method for palliation of malignant dysphagia . Because of improved design, materials, and deployment systems, self-expandable metal stents (SEMS) have become an attractive alternative to palliate EAC.
Slide 35-

Suggested Further Reading Scott Browns Otorhinolaryngology, Head and Neck Surgery, 7th Edition, Volume 2 Chapter: Causes of Dysphagia Author: Elfy B Chevretton Pages: 2025-2036