tailieunhanh - Chapter 038. Dysphagia (Part 5)

Diseases of the striated muscle often also involve the cervical part of the esophagus, in addition to affecting the oropharyngeal muscles. Clinical manifestations of the cervical esophageal involvement are usually overshadowed by those of the oropharyngeal dysphagia. Diseases of the smooth-muscle segment involve the thoracic part of the esophagus and the LES. Dysphagia occurs when the peristaltic contractions are weak or absent or when the contractions are nonperistaltic. Loss of peristalsis may be associated with failure of LES relaxation. Weakness of contractile power occurs due to muscle weakness, as in scleroderma or impaired cholinergic effect. Nonperistaltic contractions and failure of. | Chapter 038. Dysphagia Part 5 Diseases of the striated muscle often also involve the cervical part of the esophagus in addition to affecting the oropharyngeal muscles. Clinical manifestations of the cervical esophageal involvement are usually overshadowed by those of the oropharyngeal dysphagia. Diseases of the smooth-muscle segment involve the thoracic part of the esophagus and the LES. Dysphagia occurs when the peristaltic contractions are weak or absent or when the contractions are nonperistaltic. Loss of peristalsis may be associated with failure of LES relaxation. Weakness of contractile power occurs due to muscle weakness as in scleroderma or impaired cholinergic effect. Nonperistaltic contractions and failure of LES relaxation occur due to impaired inhibitory innervation. In diffuse esophageal spasm DES inhibitory innervation only to the esophageal body is impaired whereas in achalasia inhibitory innervation to both the esophageal body and LES is impaired. Dysphagia due to esophageal muscle weakness is often associated with symptoms of gastroesophageal reflux disease GERD . Dysphagia due to loss of the inhibitory innervation is typically not associated with GERD but may be associated with chest pain. The causes of esophageal motor dysphagia are also listed in Table 38-2 they include scleroderma of the esophagus achalasia DES and other motor disorders. Approach to the Patient Dysphagia Figure 38-1 shows an algorithm of approach to a patient with dysphagia. Approach to the patient with dysphagia. ENT ear nose and throat VFSS videofluoroscopic swallowing study. HISTORY The history can provide a presumptive diagnosis in 80 of patients. The site of dysphagia described by the patient helps to determine the site of esophageal obstruction the lesion is at or below the perceived location of dysphagia. Associated symptoms provide important diagnostic clues. Nasal regurgitation and tracheobronchial aspiration with swallowing are hallmarks of pharyngeal paralysis or a .