Dysphagia is the medical term for symptoms of difficulty swallowing. Although classified under "symptoms and signs" in ICD-10, this term is sometimes used as a condition in itself. People with dysphagia sometimes unconsciously have it.
This may be a sensation that suggests difficulty in the course of solids or fluids from the mouth to the stomach, the lack of pharyngeal sensations or other deficiencies of the swallowing mechanism. Dysphagia is distinguished from other symptoms including odinofagia, which is defined as swallowing pain, and globus, which is a sensation of a lump in the throat. A person may experience dysphagia without odynophagia (painless dysfunction), odynophagia without dysphagia (pain without dysfunction) or both together. Psychogenic dysphagia is known as phagophobia.
Video Dysphagia
Signs and symptoms
Some patients have limited consciousness on their dysphagia, so the lack of symptoms does not exclude the underlying disease. When dysphagia is undiagnosed or untreated, the patient is at high risk of aspiration of the lung and aspiration pneumonia secondary to food or the wrong fluid entering the lungs. Some people come with "silent aspirations" and do not cough or show signs of getting out of aspiration. Undiagnosed dysphagia may also cause dehydration, malnutrition, and kidney failure.
Some signs and symptoms of oropharyngeal dysphagia include difficulty controlling food in the mouth, inability to control food or saliva in the mouth, difficulty initiating swallowing, coughing, choking, frequent pneumonia, unexplained weight loss, gurgly sound or wet after swallowing, regurgitation nose, and dysphagia (complaints of difficulty swallowing patients). When asked where food is getting stuck, patients will often point to the cervical area (neck) as a place of obstruction. The site of obstruction is actually always at or below the level at which the level of obstruction is felt.
The most common symptom of esophageal dysphagia is the inability to swallow solid foods, which the patient describes as 'caught' or 'stuck' before passing through the stomach or vomiting. The pain of swallowing or odophyroid is a typical symptom that can be an indication of carcinoma, although it also has many other causes that are not associated with cancer.
Akalasia is the main exception to the general pattern of dysphagia in ingesting fluids tends to cause more difficulties than ingesting solids. In secrecy, there is an idiopathic destruction of the parasympathetic ganglia from the Auerbach (Myenteric) plexus of the entire esophagus, leading to functional narrowing of the lower esophagus, and peristaltic failure along its length.
Complications
Dysphagia complications may include aspiration, pneumonia, dehydration, and weight loss.
Classification
Dysphagia is classified into the following major types:
- Oropharyngeal dysphagia
- oesophageal and obstructive dysphagia
- Complex neuromuscular symptoms
- Functional dysphagia is defined in some patients because there is no organic cause for dysphagia that can be found.
The following table mentions the possible causes of dysphagia:
Difficulties with or inability to swallow may be caused or worsened by the use of opioids and/or opioid drugs.
Maps Dysphagia
Diagnostic approach
The gold standard diagnosing dysphagia is by performing instrumental evaluations, since the area of ​​interest is invisible to the eye, and the person may not accurately sense dysphagia or localize where the problem is.
One of the gold standards for diagnosing oropharyngeal dysphagia is the modified barium swallow study (MBSS), also known as the videofluoroscopic swallowing study (VFSS/fluoroscopy). This is the lateral and anterior-posterior (AP) view of the x-ray movement that provides objective information about the structure and physiology of swallowing. The oral, pharyngeal, and esophageal phases of ingestion were analyzed. The oral phase components evaluated are: lip closure, bolus control, lingual movement initiation, mastication, bolus transport, and oral residue after swallowing. The pharyngeal phase problems examined were: velopharyngeal closure, pharyngeal swallowing, elevation of the larynx, anterior hyoid movement, epiglottic inversion, laryngeal vestibule closure and reaction time, tongue base retraction, pharyngeal constriction or stripping wave, and pharyngeal residue after swallowing. The esophagus was analyzed for cleaning versus food retention, fluid and barium pills. Any retention is monitored to see if the crack returns to the upper esophagus or back to the pharynx and airway. The doctors tested various foods, fluids, and potentially barium tablets. It is important to test various viscosities and volumes. Usually this test involves thin/plain liquid, thick fluid/thick nectar, thick liquid/honey thick enough, pudding/puree, cracker or cake, mixed consistency, and barium pills taken with liquid or with puree (depending on the baseline method of the person ). Clinicians determine whether the swallow is safe (lacking aspiration) and efficient (less residue). The goal is to find out why the person has difficulty swallowing and find out what can be done to improve safety and efficiency. Sometimes regular fluids can easily lead to aspiration, and doctors can test various safe maneuvers, postures, and swallowing strategies to prevent aspiration depending on a person's specific anatomy and physiology. One method to improve the safety of a liquid bolus is to change the bolus consistency (ie, thickening the liquid into thick liquid/thick nectar, thick liquid/thick honey, or thick thick fluid/pudding). If there are many residues after ingestion, there are also techniques to be tested to reduce this. See the treatment section below for more on compensation strategies versus rehabilitation techniques for swallowing.
Another gold standard for diagnosing dysphagia is the Evaluation of Fiber Optic Endoscopy for Swallowing (COST). This involves similar testing of food and fluids, along with the implementation of strategies to find out why dysphagia occurs and what can be done about it. Duration of examination is not limited by radiation exposure; therefore, the person can be supervised in a more natural environment during the meal. Endoscopy is very thin and usually well tolerated even without nose turning.
The study of barium swallow/esophagram/top GI studies can evaluate the entire esophagus well. Barium is given in large volumes to completely alter and evaluate the esophageal lumen. This study can also evaluate for reflux, unlike VFSS. Diverticulum Zenker can be seen in VFSS and on esophagram. The barium can fill the pouch and then overflow, with food/fluid returning to the pharynx with risk of aspiration after ingestion. Akalasia is best evaluated on barium walet/esophagram, and this shows the "beak bird" that taps the distal throat, this is also described as the appearance of "rat tail". In the esophageal stricture, the barium fluid may remain above the stricture and then gradually trickle downward. Strictures can sometimes be seen in VFSS if doctors suspect stricture or esophageal dismotility. Doctors can scan the esophagus after providing solid foods such as cakes or bread. It is helpful to scan the esophagus on VFSS because it is a test that can test different kinds of solids. Barium swallow/esophagram usually only tests barium liquid and barium tablets.
- Eesophagoscopy and laryngoscopy can provide a luminal picture.
- Chest X-rays can show the level of air fluid in the mediastinum. Pott's disease and aortic calcification aneurysm can be easily diagnosed. â € <â € <
- The study of esophageal motility is useful in cases of secretia and diffuse esophageal spasms.
- Exfoliative cytology may be performed on esophageal lavage obtained by esophagus. Can detect malignant cells in the early stages.
- Ultrasound and CT scans are not useful in finding the cause of dysphagia; but can detect mass in the mediastinum and aortic aneurysm.
- FEE (evaluation of Fibreoptic swallowing endoscopy), sometimes by sensory evaluation, usually by Speech Doctor or Deglutologist. This procedure involves patients who eat a different consistency as above.
- Swallowing and swallowing can potentially be used for dysphagia screening, but this approach is still in the early stages of the study.
Differential diagnosis
All causes of dysphagia are considered as differential diagnoses. Some of the common ones are:
- esophageal atresia
- Paterson-Kelly Syndrome
- Diverticulum Zenker
- Esophageal varices
- Stricting benign
- Achalasia
- Esophageal diverticles
- Scleroderma
- Diffuse esophageal spasms
- Polymyositis
- Web and ring
- Esophageal cancer
- Eosinophilic esophagitis
- Hiatus hernia, especially the type of paraesophageal
- Dysphagia lusoria
- Gastroesophageal reflux
- Parkinson's disease
- Multiple Sclerosis
Oesophageal dysphagia is almost always caused by disease in or adjacent to the esophagus but occasionally the lesion is present in the pharynx or stomach. In many pathological conditions that cause dysphagia, the lumen becomes increasingly narrowed and unstable. Initially only a fibrous solid substance that causes difficulties but then the problem can extend to all solids and then even to the liquid. Patients with difficulty swallowing may benefit from thickened fluid if the person is more comfortable with the fluid, although, so far, no scientific research has proven that thickened fluid is beneficial.
Dysphagia may manifest as a result of pathology of the autonomic nervous system including stroke and ALS, or because of rapid iatrogenic correction of electrolyte imbalance.
Treatment
There are many ways to treat dysphagia, such as swallowing therapy, dietary changes, tube feeding, certain medications, and surgery. Treatment for dysphagia is administered by a group of specialists known as a multidisciplinary team. Multidisciplinary team members include: speech language pathologist specializing in swallowing disorders (ingestion of the therapist), primary physician, gastroenterologist, nursing staff, respiratory therapist, dietician, occupational therapist, physical therapist, pharmacist, and radiologist. The role of multidisciplinary team members will differ depending on the type of swallowing disorder that is present. For example, swallowing therapists will be directly involved in the treatment of patients with oropharyngeal dysphagia, whereas gastroenterologists will be directly involved in the treatment of oesophageal disorders.
Care strategy
Implementation of treatment strategies should be based on a thorough evaluation by multidisciplinary teams. Treatment strategies will vary from patient to patient and should be tailored to meet the specific needs of each patient. Treatment strategies were selected based on a number of different factors including diagnosis, prognosis, reaction to compensatory strategy, severity of dysphagia, cognitive status, respiratory function, caregiver support, and motivation and patient interest.
Oral vs. delivery nonoral
Adequate nutrition and hydration should be maintained at all times during the treatment of dysphagia. The overall goal of dysphagia therapy is to maintain, or return the patient to, feeding by mouth. However, this should be done while ensuring adequate nutrition and safe hydration and swallowing (no aspiration of food to the lungs). If oral feeding increases feeding time and increases effort during swallowing, so there is not enough food ingested to maintain weight, additional nonoral feeding methods of nutrients may be needed. In addition, if patients aspirate food or fluids to the lungs despite using compensatory strategies, and therefore unsafe to eat orally, nonoral eating may be necessary. Nonoral feeding includes receiving nutrients through methods that pass through oropharyngeal mechanisms including nasogastric tubes, gastrostomy, or jejunostomy.
Treatment procedures
Compensation Care Procedures - designed to alter the flow of food/fluids and relieve symptoms, not directly alter the physiology of swallowing.
- Postural Techniques
- Food Consistency (Diet) Changing
- Modifying the Volume and Speed ​​of Food Presentations
- Techniques to Raise Mouth Sensory Awareness
- Intraoral Prosthetic
Therapeutic Treatment Procedures - designed to alter and/or improve the physiology of swallowing.
- Exercise Range of Oral and Faring Movement
- Resistance Practice
- Bolus Control Training
- Swallowing Maneuvers
- swallow Supraglottic
- Super-supraglottic swallow
- Any attempt
- Mendelsohn maneuver
Patients may require a combination of treatment procedures to maintain adequate safe and nutritious swallowing. For example, postural strategies can be combined with swallowing maneuvers to enable patients to swallow in a safe and efficient manner.
Epidemiology
Swallowing disorders can occur in all age groups, due to congenital anomalies, structural damage, and/or medical conditions. Swallowing problems are a common complaint among older individuals, and the incidence of dysphagia is higher in the elderly, in stroke patients, and in patients admitted to acute care hospitals or chronic care facilities. Dysphagia is a symptom of many different causes, which can usually be obtained through careful history by treating physicians. The official evaluation of oropharyngeal dysphagia is performed by a medical speech pathologist or occupational therapist.
Etymology
The word "dysphagia" comes from the Greek dys which means bad or irregular, and the root phag - means "to eat".
See also
- MEGF10
- Pseudodysphagia, irrational fear to swallow or strangle
- Aphagia
References
External links
- Dysphagia in Curlie (based on DMOZ)
Source of the article : Wikipedia
0 Comments