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Dysphagia

Dysphagia. Dr. Raid Jastania. Reference and Contact. Robbins Basic Pathology http://www.pathoma.com/ Jastania@hotmail.com http://uqu.edu.sa/staff/ar/4180114. Before we start:.

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Dysphagia

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  1. Dysphagia Dr. Raid Jastania

  2. Reference and Contact • Robbins Basic Pathology • http://www.pathoma.com/ • Jastania@hotmail.com • http://uqu.edu.sa/staff/ar/4180114

  3. 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.

  4. 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?

  5. 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

  6. 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

  7. 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

  8. 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

  9. Swallowing • Oral phase: • voluntary • Pharyngeal phase: • involuntary deglutition reflex • Esophageal phase: • deglutition inhibition, • Peristalsis

  10. 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

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

  12. 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

  13. 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

  14. Mechanical Dysphagia • Obstruction: • Large food bolus • Narrowing of the esophagus • Compression of the esophagus

  15. 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

  16. 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

  17. 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

  18. Developmental Defects in the Esophagus • Esophageal Atresia: • Absence of lumen • Newborn with aspiration • Trachio esophageal Fistula

  19. Developmental Defects in the Esophagus • Esophageal Ring and Web: • Episodic dysphagia to solid food

  20. Developmental Defects in the Esophagus • Esophageal Diverticula: • Episodic food regurgitation, • may be painful

  21. 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

  22. Esophagitis • Inflammation of the esophagus • Start in the mucosa • Causes: • Intubation • Corrosoives, irritant, acidity • Chemotherapy • Reflux esophagitis • Hiatal hernia • infections

  23. 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

  24. Esophageal Carcinoma • Squamous cell carcinoma • Adenocarcinoma • Risk factors: • Esophagitis • Barrett • Achalasia • Alcohol • Smoking

  25. 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

  26. 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?

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