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The Nutrition-Focused History and Physical Examination (NFPE) in Malnutrition
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Esophageal dysphagia symptoms are more focused on the inability to pass a food bolus down the esophagus. The patient will report a blockage or impediment. They may notice that it is worse with solids or liquids. The difference in swallowing between food types may help discern whether there is a neuromuscular component to the disease.
Methods for assigning impairment
Published in Ramar Sabapathi Vinayagam, Integrated Evaluation of Disability, 2019
Esophageal swallowing refers to the transfer of either solid and liquid food through the esophagus at optimum speed. The person with the impaired esophageal function will retain food or liquid in the esophagus after swallowing. In esophageal dysphagia, he/she manifests localized sensation of blockage or discomfort in the retrosternal region, oral and pharyngeal regurgitation and recurrent pneumonia. He/she also exhibits esophageal vomiting, that is, passive vomiting with undigested food, and loss of weight. Video-fluoroscopic imaging can identify stricture esophagus due to corrosive intake, space occupying lesion and esophageal paresis/paralysis. Esophagoscopy and biopsy may confirm space-occupying lesions. Esophageal motility studies may contribute to improving the diagnosis when fluoroscopy and esophagoscopy are unremarkable and noncontributory.
Dysphagia in Older Adults and Its Management
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
SLPs who diagnose dysphagia distinguish between the four stages of normal swallowing, namely, the oral preparatory, oral, pharyngeal, and esophageal stages. These four stages are separated to better assess and understand the swallowing mechanism, even though they are interdependent and are part of one integrated process. The oral preparatory stage involves the preparation of the bolus (food) for the swallow, beginning with the placement of food in the mouth followed by lip closure; oral musculature tension; and mandibular, anterior velar, and lingual movements. In a synchronized manner, each part of the oral cavity (lips, teeth, tongue, jaw, and velum) contributes to the preparation of the bolus. The oral stage commences when the bolus is prepared and propelled to the posterior aspect of the oral cavity before the swallow is triggered. The pharyngeal stage begins when the swallow is triggered and involves velopharyngeal closure, base of tongue excursion, upward and anterior hyolaryngeal movement with inversion of the epiglottis, and adduction of the vocal cords. The esophageal stage commences with the relaxation of the upper-esophageal sphincter and the passage of the bolus into the esophagus. Some symptoms of dysphagia may warrant an assessment of the esophageal stage to ensure that the cause of pharyngeal symptoms do not lie in the esophagus. For example, patients may complain of feeling food “stuck in the throat” (a globus sensation) or may point to the sternum as the source of discomfort. Sometimes these symptoms are suggestive of gastroesophageal reflux and esophageal dysphagia. If a patient’s symptoms are predominantly related to the esophageal stage of the swallow, a referral may be made to a gastroenterologist or to an otolaryngologist, depending on the nature of the deficits and the presenting symptoms.
Dysphagia lusoria in a young woman with chest pain
Published in Baylor University Medical Center Proceedings, 2022
Busara Songtanin, Roy Jacob, Neha Mittal
EGD and barium swallow remain the main tools for evaluating esophageal dysphagia. The diagnosis can be made initially with barium esophagogram follow by CT or magnetic resonance imaging of the chest with or without an angiogram to help define vascular anatomy and plan for surgical intervention.6,7 Findings previously reported on EGD include external pulsatile compression in the esophagus or extrinsic compression, but the diagnosis can be overlooked at endoscopy.8 Medical management includes antacid and dietary modifications. Surgical intervention includes open ligation and transposition to the right carotid artery.9
Clinical Hypnosis in Postoperative, Adult-Onset Dysphagia: A 2-Year Empirical Case Study
Published in International Journal of Clinical and Experimental Hypnosis, 2019
Michael T. M. Finn, Lindsey C. McKernan
Given the patient-centered approach, it was assumed that the patient’s personal meanings around the esophageal dysphagia and related symptoms were prime targets for intervention. Thus, it was considered essential to work with the patient herself to produce imagery that she felt was meaningful to her life. See Table 2 for a list of primary suggestions used, their target, relevant biographical context, and sample wordings.