GI signs symptoms dysphagia
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oropharyngeal dysphagia | difficulty in swallowing |
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esophageal dysphagia | difficulty having food pass from mouth down to the esophagus to the stomach |
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odynophagia | painful swallowing |
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alarm symptom that requires immediate evaluation to determine cause and treatment | odynophagia |
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orophagyngeal dysphasia | nasal regurgitation |
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esophageal dysphasia | sensation of food "sticking" after it is swallowed |
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clinical presentation of dysphagia | difficulty swallowing solids or liquids, trouble initiating swallow; coughing, choking, chest pain |
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prevention and screening of dysphagia: identify at risk persons | previous stroke, cervical spinal cord injury |
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symptoms associated with dysphagia | heartburn, weight loss, hematemesis, coffee ground emesis, anemia & regurgitation |
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physical exam for dysphagia | ENT, nueromuscular (CN V, VII, XII), pulmonary & cardiac exam |
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diagnostic workup for dysphagia | CBC & stool for occult blood-evaulate bleeding; LFT-evaluate metastic process; BUN, albumin-evaluate nutritional status; thryoid function test- rule out hypothyroidism; ECG & cardiac workup-if chest pain is presenting symptom; esophageal pH-evaluate GERD |
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standard test for diagnosis & management of esophageal diseases | endoscopy | allows for biopsy & definitive tissue diagnosis
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often done first to differentiate between mechanical lesion and esophageal motlitiy problems | barium swallow or upper GI series | if a motlity problem is suspected barium swallow should be done first; if a mechanical lesion is suspected, an endoscopy is often done first
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differential diagnosis for dysphagia | esophageal cancer, vascular rings, achalasia, radiation injury, scleroderma |
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achalasia | failure of lower esophageal sphincter to relax |
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standard for detecting and evaluating swallowing abnormalities | videofluroscopic swallowing studies |
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management of dysphagia | outpatient-if patient not malnourished & not at high risk for aspiration; goal-treat underlying cause & maintain nutritional status during workup; elderly may have poor fitting dentures that contribute to the problem; use thickened liquids |
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dysphagia: when to consult, refer, hospitalize | refer any patients with new symptoms and no obvious treatable cuase to GI, especially older patient, those with weight loss, bleeding, iron deficiency anemia, history of chronic GERD, heavy alcohol & tobacco use |
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etiology of dysphagia | structural abnormalities, muscular weakness or incoordination of swallow, peristalis or empyting of esophagus |
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