Dysphasia Lecture Notes

Introduction

• Overview of dysphasia, including oral pharyngeal dysphasia and esophageal dysphasia.
• Encouragement to support the channel and check resources in the description for further learning.

What is Dysphasia?

• Definition: Difficulty swallowing.
• Important types:
  • Oral Pharyngeal Dysphasia: Difficulty initiating swallowing (called deglutition).
  • Esophageal Dysphasia: Difficulty moving substances through the esophagus.

Oral Pharyngeal Dysphasia

• Symptoms:
  • Difficulty initiating swallowing.
  • Symptoms may include coughing, choking, and nasal regurgitation.
• Causes:
  • Neuromuscular Dysfunction: Issues with brain/spinal cord nerves affecting swallowing muscles.
  • Structural Dysfunction: Problems in the upper gastrointestinal tract, particularly the oropharynx and upper esophagus.
• Specific Conditions:
  • Zenker's Diverticulum: A structural problem in older individuals, leading to foul-smelling breath due to food retention.
  • Neuromuscular Disorders: e.g., ALS, Parkinson's, Multiple Sclerosis, Myasthenia Gravis affecting the nerve signals required for swallowing.

Esophageal Dysphasia

• Symptoms:
  • Sensation of food getting stuck in the esophagus.
• Causes:
  • Structural Causes:
    • Esophagitis (inflammation due to various reasons, including GERD).
    • Esophageal Web: A protrusion in the upper esophagus associated with Plummer-Vinson syndrome.
    • Esophageal Ring (Schatzki Ring): A circumferential narrowing in the lower esophagus, often linked to GERD.
    • Tumors or neoplasms causing obstruction.
  • Neuromuscular Causes:
    • Acalasia: High lower esophageal sphincter tone and poor motility in the mid-distal esophagus.
    • Esophageal Spasm: Irregular high-amplitude contractions in the esophagus, not affecting lower esophageal sphincter tone.
    • Scleroderma: Fibrosis of the esophageal muscles leading to low motility and low sphincter pressure.

Diagnosis of Dysphasia

• Oral Pharyngeal Dysphasia:
  • Assess if the issue is structural or functional. A barium swallow test can help identify structural problems.
• Esophageal Dysphasia:
  • Barium swallow may show narrowing but lacks specificity.
  • EGD (Esophago-Gastroscopy): For visualizing esophagus abnormalities and ruling out cancer.
  • Manometry: The gold standard for assessing esophageal motility disorders to identify conditions like acalasia and scleroderma.

Conclusion

• Recap of the key distinctions between oral pharyngeal and esophageal dysphasia.
• Importance of recognizing underlying causes for effective diagnosis and treatment.
• Thank you for engaging with the lecture.