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DYSPHAGIA

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Laryngopharyngeal Reflux (LPR) Reflux of gastric acid to larynx/pharynx May ... Neurogenic CVA Motor neurone disease Multiple Sclerosis Parkinson s disease ... – PowerPoint PPT presentation

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Title: DYSPHAGIA


1
DYSPHAGIA
  • Mr Andrew Lale
  • Consultant ENT surgeon

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SWALLOWING
  • 5 minute consultation
  • CAUSES
  • Acute
  • Neurogenic
  • Globus pharyngeus
  • Laryngopharyngeal reflux
  • Strictures and narrowing
  • Pharyngeal Pouches

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CONSULTATION
  • True Dysphagia or feeling of a lump?
  • Dysphagia for what?
  • Regurgitation or Aspiration?
  • Gastro-oesophageal reflux current or past?
  • Change of Diet or weight loss?
  • Odynophagia

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ACUTE DYSPHAGIA
  • History FB. Previous problems.
  • Examination Drooling. Pain. Pyrexia. Odynophagia
  • Treatment
  • Food bolus Buscopan, fizzy drink, refer at 1
    hour
  • FB Refer

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Foreign bodies
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Strictures and narrowing
  • Malignant/benign
  • Cricopharyngeal bar
  • C-spine osteophytes
  • Kyphosis
  • Post cricoid web

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Cricopharyngeal bar
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Osteophytes
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Neurogenic
  • CVA
  • Motor neurone disease
  • Multiple Sclerosis
  • Parkinsons disease
  • Myaesthena gravis

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GLOBUS PHARYGEUS
  • Previously Globus Hystericus
  • Worse when NOT eating or drinking
  • No true dysphagia solids/liquids
  • No odynophagia
  • No reguritation/aspiration
  • Variable history. ?exclude reflux..

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Laryngopharyngeal Reflux (LPR)
  • Reflux of gastric acid to larynx/pharynx
  • May be silent
  • Symptoms include feeling of a lump,
    odynophagia/chronic sore throat, chronic cough
    (especially nightime), hoarse voice and mucous
    in throat.

15
LPR Investigations
  • Nasopharyngoscopy, red post cricoid region.
  • ? Barium swallow?
  • Oesophageal pH manometry

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LPR treatment
  • 6 weeks PPI Gaviscon initially
  • At review further 6 weeks treatment if improving
  • General laryngeal hygiene measures
  • If no better, rigid pharyngo-oesophagoscopy
  • pH manometry ?fundoplication

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Pharyngeal pouches
  • HISTORY
  • Long Hx dysphagia
  • Regurgitation esp at night
  • gurgling swallow
  • Aspiration (recurrent pneumonia)
  • Weight loss and change in Diet.

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Pharyngeal Pouches
  • EXAMINATION
  • Nasopharyngoscopy might show pooling
  • Unlikely to feel anything in neck
  • Barium swallow

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Pharyngeal pouches
  • TREATMENT
  • Surgical if fit for GA
  • (External approach)
  • Endoscopic stapling, low morbidity and high
    success rate.

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Pouches
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Pouches
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Summary Fast track patients
  • Young male patient
  • Short history
  • Odynophagia
  • Smoking and Alcohol
  • Weight loss
  • Aspiration and reguritation

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Summary Globus patients
  • Variable history
  • No true dysphagia
  • Young female
  • No weight loss
  • Associated anxiety

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Summary Pouch patients
  • Older male/female
  • REGURGITATION
  • Gurgling swallow
  • Recurrent chest infections
  • Weight loss

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Thankyou
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