dysphagia

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					Dysphagia
Dysphagia
   Common

 Oropharangeal
 Oesophageal




   Structural or Motility Disorders
Dysphagia
 History
 Examination
 Investiagation
    Radiography, Endoscopy, Manometry

 Management
Dysphagia
   History
     Is it really dysphagia?

           Globus, Xerostomia, Odynophagia

       Oesophageal or Oropharangeal

       Structural or Motility
Dysphagia
   History
       globus - present continuously

       xerostomia

       odynophagia - transient (15-30s)
Dysphagia
   History
        temporal relationships
              onset duration progression
        associated features
        site

       oropharangeal or oesophageal?
Dysphagia
   History

      intermittent? progressive?
      solids and/or liquids
       regurgitation
       chest pain
       other symptoms, past history, etc
Dysphagia
   Orophangeal
     Swallow initiation

     Post nasal regurgitation

     Deglutitive cough

     Repetitive swallow



       bolus in neck, drooling, dysphonia, throat
        clearing, pain on swallowing, sore throat,
Dysphagia
   Oesophageal
     motor or structural ?

     Dysmotility

        dysphagia for solids and liquids

        chest pain

        regurgitation



       Sructural
Dysphagia
   Examination
     Nothing

     Scleroderma/crest/myopathy

     Neurological

     Wasting/cachexia/chest signs

     Cervical lymphadenopathy
Dysphagia
   Investigation
       radiology contrast swallow

       endoscopy

       manometry
Dysphagia
   Management

       Condition specific
Dysphagia
   Common causes
     Stricture benign and malignant

     Achalasia

     Stroke (oropharangeal)
Dysphagia
   Case studies
     65 yo male, long history GORD p/c

      swallowing problems and low
     30 yo female, long history abdo pain,

      variable bowel habit p/c “dysphagia”
     28 yo man heartburn since childhood p/c
      halitosis, regurgitaion and odynophagia
Dysphagia
   References
     Medscape www.medscape.com



           viewarticle/577127_print
           viewprogram/14700_pnt
           viewarticle/578610
Upper GI Bleeding
   Pathology

   Clinical

   Management
Upper GI Bleeding
   Pathology

       Malignancy

       Peptic ulcer disease

       Arterio-venous Malformations and Varices

       Trauma
Upper GI Bleeding
   Clinical
       haematemisis

       maleana

       anaemia
Upper GI Bleeding
   Management
      assessment
           blood pressure, pulse rate (trends)
           conscious state
           perfusion
           urine output
Upper GI Bleeding
   Management
       resuscitate
             iv access
             iv fluids (blood)
             oxygen
             correct clotting
             monitor
Upper GI Bleeding
   Management
       investigations
             FBE, clotting, electrolytes, liver
    function
             gastroscopy
             nuc scan (sulphur colloid/rbc)
             radiology (CT and conventional
    angiography)
Upper GI Bleeding
   Management
       treatment
       non-specific - blood, clotting factors, vit K,

        specific - therapeutic endoscopy
                      inject, heat, clip
                 interventional radiology
                 surgery (stop the bleeding!)
     Examination Answers same template
 All management questions have the
   Diagnosis
         History, examination, investigations (non
          specific and specific)
   Treatment
         Resuscitate

         Non-specific

         Specific

            • Non-operative
            • Operative

				
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posted:12/24/2011
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