How to approach a patient with Dysphagia? | Is it a tumor or dysmotility? | Surgery скачать в хорошем качестве

How to approach a patient with Dysphagia? | Is it a tumor or dysmotility? | Surgery

Dysphagia is an alarm symptom that warrants prompt evaluation to define the exact cause and initiate appropriate therapy. It may be due to a structural or motility abnormality in the passage of solids or liquids from the oral cavity to the stomach. Patients' complaints range from the inability to initiate a swallow to the sensation of solids or liquids being hindered during their passage through the esophagus into the stomach. The terms dysphagia, odynophagia, and globus are defined as follows: ●Dysphagia is a subjective sensation of difficulty or abnormality of swallowing. ●Odynophagia is pain with swallowing. ●Globus sensation is a nonpainful sensation of a lump, tightness, foreign body or retained food bolus in the pharyngeal or cervical area. Globus, on the other hand, is a functional esophageal disorder that is characterized by globus sensation but without an underlying structural abnormality, gastroesophageal reflux disease, or a major esophageal motility disorder. Diagnostic evaluation – The approach to diagnostic testing to determine the cause of esophageal dysphagia is based upon the medical history: •Barium esophagram – We perform a barium contrast esophagram as the initial test (prior to upper endoscopy) in patients with the following (see 'Pre-endoscopy barium esophagram' above): -History/clinical features of proximal esophageal lesion (eg, surgery for laryngeal or esophageal cancer, Zenker's diverticulum, or radiation therapy). -Known complex (tortuous) stricture (eg, postcaustic injury or radiation therapy). •Upper endoscopy – Patients with esophageal dysphagia should be referred for an upper endoscopy to determine the underlying cause, exclude malignancy, and perform therapy (eg, dilation of an esophageal ring) if needed. (See 'Upper endoscopy' above.) •Esophageal manometry – Esophageal manometry should be performed in patients with dysphagia in whom upper endoscopy is unrevealing and/or an esophageal motility disorder is suspected. Although certain motility disorders (eg, achalasia) can be strongly suspected based upon their characteristic radiographic appearance when in advanced stages, confirmation with an esophageal manometry study is required to establish the diagnosis. (See 'Esophageal manometry' above.) All rights reserved to the hosts. Subscribe our Youtube Channel    / @yomal   Join our telegram Channel https://t.me/medicalvideoslka