It is defined as difficulty in swallowing It must distinguished from: Globus sensation Odynophagia.
Dysphagia
Food “sticking” after Swallowing, regurgitation Oropharyngeal DysphagiaEsophageal Dysphagia
Videofluorscopic Swallowing assessment & neurological investigation
Liquid worse than solids
Solids worse than liquids
Barium Swallow
Uncoordinated Peristalsis or aspiration
Neurological Disease
Bulbar palsy
Pseudobulbar palsy
Myasthenia gravis
Endoscopy & biopsy
Esophageal Dysphagia
Liquid worse than solids
Solids worse than liquids
Endoscopy & biopsy
Dysmotility
Esophagitis
Stricture
Manometry
Achalasia Non-specific motiliy disorder
Peptic Candidiasis
Malignant
Benign
Ca of esophagus Ca stomach Extrinsic compression
Peptic Fibrous ring
Myasthenia
Systemic sclerosisAchalasia
Sideropenic Web
Malignant stricturePeptic stricture
Dyspepsia (indigestion) is a collective term for any symptoms thought to originate from the upper GIT. Although symptoms often correlate poorly with the underlying diagnosis, a careful history is important to: Elicit symptoms classical of specific disorders like peptic ulcer. Detect alarm features requiring urgent investigation Detect atypical symptoms more suggestive of other disorders e.g. myocardial ischemia.Upper GI disorders: Peptic ulcer disease Acute gastritis Gallstones Motility e.g. esophageal spasm Functional (non-ulcer dyspepsia & IBS)
Other GI disorders: Pancreatic disease (cancer, chronic pancreatitis) Hepatic disease (hepatitis, metastases) Colonic carcinoma
Systemic disease: Renal failure Hypercalcemia
Drugs: NSAIDs Iron & potassium supplements Corticosteroids Digoxin Others: Alcohol Psychological e.g. anxiety, depression
Weight loss Anemia Vomiting Hematemesis and/or malena Dysphagia Palpable abdominal mass
Dyspepsia
Are there “alarm features”? NoYes
Endoscopy
> 55 years
Zྟྨ‾㔵礠慥獲ྡ ࠀ E︀ྪЉНଂ䰍ਂЈ<Ђ鸰…‡Ɓ㏿ƃࠀƿǀǿȁࠀᇼथᖇYྟྨ湅潤捳灯yꄀ ĀĀ䔀ĀЀяюꨀఏऀༀЀ헰ȀࣰLȀꌀ㳰缀Ѐ耀ఀ㒢蔊Ȁ蜀Ā脀！3茀뼈ခက쀀！яࠁࠀĀȂༀჰ─㘀戀ༀഀ懰鼀ЏЀꠀᄏ吀獥⁴潦⁈祰潬楲ྡ ࠀ E︀ྪЉМଂ䰏ਂЈ<Ђꗀ…‡Ɓࠀƃࠀƿǀ㏿ǿȁࠀኣಱXྟྨ敎慧楴敶ྡ ࠀ E︀ྪЉМଂ䰐ਂЈ<Ђ꒘…‡Ɓࠀƃࠀƿǀ㏿ǿȁࠀ࢘ೋಱXྟྨ潐楳楴敶ྡ ࠀ E︀ྪЉшଂ䰑ਂЈ<Ђ겴…‡Ɓƃࠀƿǀ㏿ǿȁࠀྮ൧ᔬၩ„ྟྨ2牔慥⁴匍浹瑰浯瑡捩污祬漍൲潃獮摩牥漍桴牥搠慩湧獯獩ྡ"3ࠀ 3G㏿︀ྪ3ЉШଂ䰒ਂЈ<Ђ냘…‡Ɓƃࠀƿǀ㏿ǿȁࠀࣅ้༦྆dྟྨ⁈祰潬楲攠慲楤慣楴湯ྡ ࠀ E㏿︀ྪЉЧଂ䰓ਂЈ<Ђ뚈…‡Ɓƃࠀƿǀ㏿ǿȁࠀЩཙݚ႗cྟྨ祓灭潴獭ഠ敲潳癬eꄀ∏ሀ ĀሀĀ䜀ĀЀჿ3юꨀఏሀऀༀЀퟰȀࣰ᐀LȀꌀ㳰缀Ѐ耀㰀㒺蔊Ȁ蜀Ā脀！я茀뼈ခက쀀！3ࠁࠀĀȂༀჰ⨀ff娀昀ༀഀ揰鼀ЏЀꠀᄏ匀浹瑰浯瀍牥楳瑳ྡ"ࠀ G㏿︀ྪЉТଂ䰕ਂЈ<Ђ븼…‡Ɓƃࠀƿǀ㏿ǿȁࠀq໑̙ြ^ྟྨ潎昍汯潬⁷灵ྡ"ࠀ G㏿︀ྪЉrɒ䰖ஂіBґŇ樬�ň⢎ʼn樬�ƿǀｦ3Nj澟Ǒǿȁࠀ̃ඇཱྀ֚ܲlɒ䰗ଂЈ<Ň㰹�ň흲ʼn㰹�ƿǀｦ3Nj澟Ǒǿȁࠀ̃ᆡ֚ඎथrȢ䰚ୂіBZŇ⧵ň▌ʼn�ƿǀｦ3Nj澟Ǒǿȁࠀ̃ඎႊrȢ䰛ଂіBZŇ⧵ň춟ʼn�ƿǀｦ3Nj澟Ǒǿȁࠀ̃લඎrȢ䰜ୂіBZŇ⦹ň㞑ʼn唟ƿǀｦ3Nj澟Ǒǿȁࠀ̃ႊಱቭ൧ZȂ䰝ଂs*ƿǀｦ3Nj澟Ǒǿȁࠀ̃ઢȼઢ̟rȢ䰞ୂіBZŇ⧻ň丘ʼn짇�ƿǀｦ3Nj澟Ǒǿȁࠀ̃લಱ௶้rȢ䰟ஂіBґŇ⩎ň龻ʼn�ƿǀｦ3Nj澟Ǒǿȁࠀ̃ݚࣅrȢ䰠ଂіBґŇ⨒ň젥�ʼn�ƿǀｦ3Nj澟Ǒǿȁࠀ̃ݚಱࣅrȒ䰡ଂіBґŇ珆ňꖂ�ʼn珆ƿǀｦ3Nj澟Ǒǿȁࠀ͇̃૪ЪಱlȢ䰢ଂЈ<ґň䰢 > 55 years
Endoscopy
Test for H pylori
Negative
Positive
Treat Symptomatically or Consider other diagnosis
H pylori eradication
Symptoms resolve
Symptoms persist
No follow up
Vomiting is highly integrated & complex reflex involving both autonomic & somatic neural pathways.
Synchronous contraction of the diaphragm, intercostal muscles, & abdominal muscles
Increases intra-abdominal pressureRelaxation of the lower Esophageal sphincter
Forcible ejection of Gastric contents
Infections: Gastroenteritis Hepatitis Urinary tract infection Drugs: NSAIDs Antibiotics Opiates Digoxin Cytotoxic drugs
Acute abdominal disorders: Appendicitis Cholecystitis Pancreatitis Intestinal obstruction CNS disorders: Vestibular neuritis Migraine Meningitis Raised intracranial pressure
Metabolic:Diabetic ketoacidosisUremiaAddison’s disease.Others:Any severe pain e.g. myocardial infarction. PsychogenicAlcoholismpregnancy
Vomiting is usually associated with: Nausea Retching Salivation Anorexia Or dyspepsia You must distinguish between: True vomiting & regurgitation Acute & chronic vomiting.
You must ask about: Abdominal pain Fever Diarrhea Relationship to food Drug ingestion Headache Vertigo Weight loss
Examination may reveal: Signs of dehydration, fever & infection. Evidence of abdominal mass Evidence of peritonitis Evidence of intestinal obstruction Neurological signs including: Papilledema Nystagmus Photophobia Neck stiffness. Other findings suggestive of: Alcoholism Pregnancy or Bulimia