Dysphagia(Difficulty Swallowing),Treatment,Causes,Pathophysiology,Investigations,Types USMLE
gastroenterology medicine.this video gives a deep insight on all relevant causes of dysphagia that are tested in USMLE PLAB exams.Evaluation of dysphagia difficulty swallowing regurgitation and all the relevant tests like barium swallow barium study and endoscopy are fully explained in this video.
"Dysphagia is the sensation of difficulty or abnormality of swallowing. It is due to a structural or a motility abnormality in the passage of solids or liquids from the mouth to the stomach. It ranges from an inability to initiate the swallowing reflex to food or liquid being stuck in the oesophagus. In contrast, odynophagia is pain with swallowing."OROPHARYNGEAL DYSPHAGIA
Characterized with difficulty initating swallowing. Also associated with coughing, choking, or aspiration. Pathognomonic symptom is regurgitation. Will point at throat when asked where the food is stuck.
Oral causes of dysphagia generally involves mastication. Therefore cranial nerves trigeminal, glossopharyngeal, and vagus nerve can cause oropharyngeal dysphagia. Low saliva (sjogren's Syndrome) may also lead to oropharyngeal dysphagia.
Pharyngeal causes of dysphagia maybe related to neuromuscular such as cerebrovascular accidents, myasthenia gravis and parkinsons.
Upperesophageal sphincter due to decrease relaxation.
Zenker's diverticulum can also cause dysphagia.
ESOPHAGEAL DYSPHAGIA
Patient can initiate swallowing okay but there is difficulty after swallowing. Food feels like it is stuck in the substernal and need to rule out other causes of chest pain.
Solids and Liquids causing dysphagia are related to motor pathology. Intermittent causes of dysphagia include dysmotility. If progressive then dysphagia may be caused by achalasia and scleroderma. Remember scleroderma also has heartburn as achalasia doesn't.
Solids only dysphagia is caused primarily by obstruction. Non-progressive forms of dysphagia are caused by lower esophgeal rings and webs and esophagitis. Progressive can be caused by stricture (heartburn) or esophageal cancer (anorexia and weight loss).
