dysphagia git grace

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Dysphagia

Grace

405100059



Anatomy



Esophagus

• The esophagus is a 25cm-longchannel extending rom the pharynxsamapi gastric

• The transition is called the esophagusinto the stomach os cardiacum

• there is a contraction o the muscletissue that dri!es ood into thestomach "peristaltic#$



• although there is no anatomicalsphincter% &ut the smooth muscleesophagus circularis at the lo'er endo physiological unctions as asphincter that regulates the entry oood rom the esophagus to the

stomach and prevent refux o thestomach contents.



Gastric

• Gastric most 'ide part o thedigesti!e tract that ser!es as shelterto digest ood into the (chyme) and

manage streaming into the smallintestine digesti&ility$

• Gastric has t'o holes "os cardiacum

and pylorus#% t'o arches "cur!aturama*or and cur!atura minor#% and t'osurace "acies anterior and posterior#$



+mall ,ntestine

• small intestine comprises the

duodenum, jejunum, and ileum .



+mall ,ntestine

• Duodenum

– Duodenum approximately 25 cm inlength

– .-shaped surrounding the pancreaticcaput

– Di!ided into our parts% namely pars

superior% pars deccendens% parshori/ontalis "inerior# and the parsascendens



• ars ascendens duodeni – duodenum to *e*unum 'ith an

indentation that called exuraduodeno*e*unal$

– This cur!e 'as detained &y a &andcalled the musculus suspensory

&romuscularis duodeni "Treit/ ligament#• ars Descendens duodeni

– there is a protrusion o the papilla ma*orduodeni ha!e anpullaehepatopancreaticae musculus sphincter"sphincter 3ddi# that unctions regulateexpenditures o &ile and pancreas$



istology



a&ium oris 6 ips

• 7 layers – ars cutanea6outer layer

1$ +tratied 8eratini/ing suamous cell epithelium

2$ air ollicle 'ith se&aceous and s'eat glands

7$ 3r&icularis oris muscle – ars ,ntermedia6:ermillion &order A – ars oral mucosa ;

1$ +tratied non8eratini/ing suamous cell epithelium2$ Tunica propria

a$ a&ialis glands7$ 3r&icularis oris muscle

4$ a&ialis artery5$ +mall chorium



ars cutanea

ars intermedia pars oral mucosa



Tongue6ingua

• There are 7 orms o papillae

– .ircum!alata papillae

A$ .ircum!alata papillae

1$ +econdary papillae

2$ Taste &ud

;$ E&neri glands

– <iliorm papillae "A#

– <ungiorm papillae ";#



.ircum!alata papillae

<iliriorm and <ungiormpapillae



ingual Glands

• arotid glands1$ ars terminalis "serous#2$ +ecretory duct7$ ,ntercalaris duct

4$ ,ntelo&ular tissue• +u&mandi&ular glands

1$ ars terminalis "mucoserous#2$ +ecretory duct7$ Excretory duct

• +u&lingual glands1$ ars terminalis "mucoserous#2$ +ecretory duct



arotid Glands



3esophagusA$ Tunica mucosae

1$ +tratiednon8eratini/ingsuamous cellepithelium

2$ T$ propria7$ T$ muscularis

mucosae

;$ Tunica su&mucosae4$ 3esephagus glands5$ Excretory duct

.$ Tunica muscularis=$ T$ >usc$ .ircular?$ T$>usc$ ongitudinal

D$ Tunica ad!entitia



Gaster• .ardiac

• .orpus

•<undusA$ T$ >ucosae

1$ .olumnar suraceepithelium

2$ Gastric o!eolae

7$ T$propria@undus glands

4$ Elastic mem&ran

5$ T$ >$ >ucosae

;$ T$ +u&mucosae

• yloricA$ T$ >ucosae

1$ .olumnar suraceepithelium

2$ Gastric o!eolae "'ideand deep#

7$ T$propria@pyloric glands

4$ Elastic mem&ran

5$ T$ >$ >ucosae

;$ T$ +u&mucosae

.$ T$muscularis

<undus



Duodenum

A$ T$ mucosae

1$ :ili

2$ .olumnar suraceepithelium@go&let

cell7$ .rypt6o lie&er8uhn

4$ T$>$ >ucosae

;$ T$ su&mucosae

.$ T$muscularis



e*unum

A$ T$ mucosae

1$ :ili

2$ .olumnar suraceepithelium@go&let

cell7$ .rypt6o lie&er8uhn

4$ T$>$ >ucosae

;$ T$ su&mucosae

5$ Berc8ringCs olds

"T6mucosae@T$su&mucosae#

.$ T$muscularis



hysiology



;asic Digesti!e rocesses

1$ >otility

2$ +ecretion

7$ Digestion4$ A&sorption



>outh•

>otility<ood enters the digesti!e system throughthe mouth% 'here itCs che'ed and mixed'ith sali!a to acilitate s'allo'ing

• +ecretionEn/yme amylase &egins the digestion ocar&ohydrates

•

Digestionpolysaccharides ---------amylasesali!ary----------- disaccharides maltose

• A&sorption 3 A&sorption

h d E h



harynx and Esophagus• >otility

<ollo'ing che'ing%the tongue propelsthe &olus o oods tothe rear o the throat%'hich initiates thes'allo'ing reex

• +ecretion The esophageal secretion% mucus is the

protecti!e• Digestion 3 Digestion• A&sorption 3 A&sorption



+mall ,ntestine

• >otility

>ixes the ood 'ith pancreatic% &illiary% andsmall intestine *uices to acilitate digestion

•

+ecretion The en/ymes synthesi/ed &y the smallintestine act 'ithin the &rush-&ordermem&rane o the epithelial-cells

•

Digestion The pancreatic en/ymes continuecar&ohydrate and protein digestion in thesmall-intestine lumen$

<at in digested &y pancreatic lipase$



• A&sorption

The small intestine a&sor&s almostpresented to it% rom ingested ood to

digesti!e secretions to sloughed epithelialcells

,n contrast to the almost complete%unregulated a&sorption o ingestednutrients% 'ater% most electrolytes% theamount o iron% and calcium a&sor&ed is!aria&le and su&*ect to control$



;iochemistry

h i i



The Digestive EnzymesDigestive enzymes are en/ymes 'hich help &rea8 do'n ood

su&stances into orms that can &e a&sor&ed and assimilated

&y the &ody$

Digestive enzymes are normally secreted :

1# in the mouth "as part o the sali!a#%

2# &y the stomach

7# released into the small intestines rom the li!er and pancreas$The major enzymes are:

• Amylase% also called ptyalin% is an en/yme that aids the&rea8do'n o starches$ ,t is secreted in the sali!a and thepancreatic *uices$

• Lipase% secreted &y the pancreas% reers to any o se!eralen/ymes that increase the &rea8do'n o ats "lipids#$



• Protease% an en/yme that helps the &rea8do'n oprotein% is also secreted &y the pancreas$ En/ymes

that &rea8do'n protein are 8no'n as a proteolytic en/ymes$

• Pepsin is an en/yme released in the stomach thatalso helps 'ith the &rea8do'n o protein$

•

Pancreatin reers to pancreatic en/ymes$• Bile% also called gall% is released during digestion

'hen ats enter the rst part o the small intestine"duodenum#$ ;ile emulsies ats preparing them orurther digestion and a&sorption in the small intestine$

• Cellulase is an en/yme that &rea8s do'n cellulose



Digestion and A&sorption

• The diet must pro!ide meta&olic uels

– >ainly car&ohydrates and lipids

– protein "or gro'th and turno!er o tissue

proteins# – &er "or &ul8 in the intestinal lumen#

– minerals " containing elements 'ith spesicmeta&olic unctions#

–!itamins and essential atty acids "organiccompounds needed in smaller amounts or othermeta&olic and phsiologic unctions#



• Vitamins

• ipid-solu&le !itamins "A% D% E and B# aredissol!ed in mixed micelles% and passi!elya&sor&ed across the >:>$

• Fater-solu&le !itamins% most nota&ly ; !itamins%are a&sor&ed &y passi!e diusion% acilitatedtransport or acti!e transport$

ource Enzim Activator u!strat "unction or



ource Enzim Activator u!strat "unction or#ataliti#product

+ali!a gland H-Amilase

+ali!a

.l- <lour

essence

idrolisis &ond

14 HI producedextrin Hlimit%maltotriosa% andmaltosa

ingual gland ingual lipase Trigliserida ipid acid plus1%2 -diasilgliserol

Gaster epsin

"pepsinogen#

Gaster lipase

cl- rotein and

polipeptida

Trigliserida

Decompose

peptida chain'hich closer'ith aromaticamino acid

ipid acid and

gliserol



ource Enzim Activator u!strat "unction and #ataliti#produce

ancrea

se8socrine

Tripsin

"tripsinogen#

Enteropep

tidase

roein and

polipeptida

Decompose peptida &ond

to 8ar&o8sil !ariousamino acid &asic "argininor lisin#

Bemotripsin

Tripsin roein andpolipeptida

Decompose peptida chainto 8ar&o8sil aromatic acidamino

Elastase Tripsin Elastin otherprotein

Decompose 8ar&o8silamino acid aliati8 chain

Bar&o8sipeptidase A


Decompose 8ar&o8silteminal acid amino chain

'hich aromatic chain or&iurcate aliati8

Bar&o8sipeptidase ;


Decompose 8ar&o8silterminal acid amino chain'hich al8ali chain

Bolipase Tripsin ipid items To open a part o acti!e



lipase pancreas

ancreasipase

Trigliserida >onogiserida and attyacid

ipase .hoesterilester

.holesterol

EsterBolesterilhidrolase

.holesterilester

.holesterol

anc8reasH-amilase

.l- +tarch H-amilase sali!a

Ji&onu8lea

se

JA u8leotida

Deo8siri&onu8lease

DA u8leotida

<osolipase

A2

Tripsin hosolipid <atty acid and

lisophosolipid

ource Enzim Activato u!strat "unction and #ataliti#d



r produce

+mallintest

mucous

Enteropeptidase

Tripsinogen

Tripsin

Aminopeptidase

olipeptida

Decompose to amino chainacid amino terminal rompeptide

Bar&o8sipepti

dase

olipeptid

a

Decompose to amino chain

acid amino terminal rompeptide

Endopeptidase

olipeptida

Decompose to residue&et'een middle o peptide

Dipeptidase Dipeptida 2 amino acid

>altase >altosa%

maltotriosa% H-

Glucose

ource Enzim Activato u!strat "unction and# li i#



r #ataliti#produce

+mall intestmucous

a8tase a8tosa Gala8tosa andglucose

+u8raseK +u8osaImaltotriosa andmaltosa

<ru8tosa andglucose

H-De8strinaseK

H-de8strin%maltosa%maltotriosa

Glucose

Threhalase Trehalosa Glucose

u8lease andother en/ims

u8leat acid entosa%purinand pirimidin

.ytoplasmacell mucous

:ariouspeptidase

Di%tri% andtetrapeptida

Amino acid



Dysphagia

• A eeling that ood stic8s in yourthroat or chest " medscape #

• +ign o a pro&lem 'ith your throat oresophagus Lthe muscular tu&e thatmo!es ood and liuids rom the &ac8o your mouth to your stomach

"emedicinehealth #



• dysphagia can happen to anyone% itis most common in older adults%premature &a&ies% and people 'ith

pro&lems o the &rain or ner!oussystem



• t'o types o pro&lems that can ma8eit hard or ood and liuids to tra!eldo'n your esophagus

– The muscles and ner!es that help mo!eood through the throat and esophagusare not 'or8ing right

–

+omething is &loc8ing your throat oresophagus



Jis8 actors o dysphagia

• .ardio!ascular "angina% acutemyocardial inarction% dia&etesmellitus% high cholesterol% high &lood

pressure and smo8ing status#$• Alcohol consumption

• &ody mass index ";>,# 'ere not

assessed• psychological conditions including

anxiety% depression and neuroticism



+ymptoms o dysphagia • a!e pro&lems getting ood or liuids to go do'n

on the rst try$• Gag% cho8e% or cough 'hen you s'allo'$•

a!e ood or liuids come &ac8 up through yourthroat% mouth% or nose ater you s'allo'$• <eel li8e oods or liuids are stuc8 in some part o

your throat or chest$• a!e pain 'hen you s'allo'$

• a!e pain or pressure in your chest or ha!eheart&urn$

• ose 'eight &ecause you are not getting enoughood or liuid$



.ause o dypshagia

• +tructural deect

– Typical cause more pro&lems ins'allo'ing solids than liuids

– .ause a xed impediment to ood &olusarise rom narro'ing 'iyhin theesophagus " stricture% tumor

•

>otility disorders – >otility a&normalities o the oropharynx

or esophagus



Term o dysphagia

• 3ropharyngeal dysphagia transerdysphagia – euromuscular disease% local mechanical

lesions% upper esophageal sphincterdisorders

• Esophageal dysphagia non-transerdysphagia

– >otility disorders achalasia – ,ntrinsic mechanical lesions

– Extrinsi8 mechanical lesions



<unctional dysphagia

• Jome ,,,

– +ense o solid and6or liuid oodsstic8ing% lodging or passing a&normally

through the esophagus – A&sence o e!idence that

gastrorsophageal reux is the cause othe symptom

– A&sence o histopatology-&asedesophageal motility disorders

$o% is dysphagia



$o% is dysphagiadiagnosed&

• An otolaryngologist% 'ho treats ear% nose%and throat pro&lems

• A gastroenterologist% 'ho treats pro&lems

o the digesti!e system• A neurologist% 'ho treats pro&lems o the

&rain% spinal cord% and ner!ous system

•

A speech-language pathologist% 'hoe!aluates and treats s'allo'ingpro&lems



• M-rays$ These pro!ide pictures o your nec8 orchest$

• A &arium s'allo'$ This is an M-ray o the throatand esophagus$ ;eore the M-ray% you 'ill drin8 a

chal8y liuid called &arium$ ;arium coats theinside o your esophagus so that it sho's up&etter on an M-ray$

• :ideoesophagography$ This test uses a type o&arium s'allo' that allo's your esophagus to &e

!ideotaped$• aryngoscopy$ This test loo8s at the &ac8 o your

throat% using either a mirror or a &er-optic scope$



• Esophagoscopy or upper gastrointestinalendoscopy$ During these tests% a thin% exi&leinstrument called a scope is placed in your mouthand do'n your throat to loo8 at your esophagusand perhaps your stomach and upper intestines$

+ometimes a small piece o tissue is remo!ed or a&iopsy$ A &iopsy is a test that chec8s orinammation or cancer cells$

• >anometry$ During this test% a small tu&e is placeddo'n your esophagus$ The tu&e is attached to acomputer that measures the pressure in your

esophagus as you s'allo'$• p monitoring% 'hich tests ho' oten acid rom the

stomach gets into the esophagus and ho' long itstays there$



Jegurgitation

• +pitting up is the mild !omiting orregurgitation o ood% mil8% and sali!athat can occur in inants$ +pitting up

is not orceul and does not containlarge amounts o ood and uids



• ,n inants% this !al!e is not 'ell de!elopedand can more easily allo' ood to go &ac8up the eeding tu&e and cause spittingup$ ;ecause the inantNs stomach is small%

eeding too much or s'allo'ing too muchair can help push ood past the !al!e$ Asthe inant gro's and the !al!e de!elops%ood is less li8ely to pass this !al!e and

tra!el up the esophagus$ Also% as theinant &egins to ta8e solid oods% thespitting up usually decreases



'hen to call the doctor

• , the &a&y sho's signs o dehydration• , 'eight loss is a concern

• , the spitting up is orceul and shoots

out o the mouth "plyoric stenosis#• , other 'orrisome signs o illness

appear% including e!er% diarrhea%diOculty &reathing% or a&normal

ussiness• , the material &eing spit up contains

excessi!e mucous or &lood

'hen to go to the



'hen to go to thehospital

• , the inant stops &reathing%&ecomes limp% or has any &lue colorchange during a spitting up episode

• , the spit up appears green or &ro'n

• , or any reason the child appears to&e seriously ill and in your *udgment

cannot 'ait to &e seen at thedoctorNs oOce



Exam and tests

• &ased on a detailed history andphysical examination

• M-rays or &lood tests are reuired

only in rare cases to exclude othermore serious causes o the spittingup$



+el-.are at ome

• ;urp the inant reuently "ater e!ery1-2 ounces# to pre!ent the &uild-up oair in the stomach$

• <eed more slo'ly to allo' the stomachcontents more time to empty into theintestines$

• ;e careul not to eed too much at atime and to stop eeding 'hen theinant seems ull$



• Beep the inant upright ater eedingor at least 15 minutes$ This allo'sgra!ity to help pre!ent the stomach

contents rom coming up$• Try to a!oid signicant acti!ity

immediately ater eeds$ Agitation o

the stomach contents may result inmore spitting up

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