Examination of case of Dysphagia
HISTORY
Age-
Sex-
Mode of onset & progress-
Regurgitation-
Pain-
Vomitus-
Coughing-
Loss of weight-
Past History-
PHYSICAL EXAMINATION
General Survey-
Examination of the Mouth & Pharynx-
Examination of the neck-
The chest-
The abdomen-
The spine-
Special Investigation for Dysphagia
Causes of Dysphagia:
In the Mouth- Tonsillitis, Quinsy (Peritonsillar abscess), Certain varieties of stomatitis, Ca of tongue & Paralysis of the soft palate (due to diphtheria in children & bulbar paralysis in adults).
In the Pharynx-
In the Lumen- impaction of foreign body (eg coin, tooth and denture)
In the wall- acute pharyngitis, malignant growth, hysterical spasm, Paterson-Kelly syndrome
Outside the wall- Retropharyngeal abscess, enlarged cervical lymph node, malignant thyroid etc.
In the Oesophagus-
In the Lumen- impaction of foreign body
In the wall-
atresia of esophagus
benign stricture- may be due to reflux esophagitis, swallowed corrosives, tuberculosis, scleroderma, radiotherapy etc.
spasm- Paterson-Kelly syndrome, achalasia, webs & rings, diffuse esophageal spasm
diverticulum
neoplasm-mainly malignant
nervous disorders- bulbar paralysis, post vagotomy
miscellaneous- Crohn's disease
Outside the wall- malignant or any large thyroid swelling, retrosternal goitre, pharyngeal diverticulum, aneurysm of the aorta, mediastinal growth, dysphagia lusoria, perioesophagitis after vagotomy, Hiatus hernia particularly paraoesophageal (type II) & tight oesophageal hiatus repair.
Examination of Abdominal Injuries
History-
Physical Examination
General Survey-
Local Examination-
INSPECTION:
Skin over the abdomen-
Respiratory movements-
Contour-
Umbilicus-
PALPATION:
Tenderness & Rebound tenderness-
Muscle guarding & Rigidity-
Swelling-
Fluid thrill-
PERCUSSION:
Obliteration of liver dullness-
Shifting dullness-
Percuss the suprapubic region-
AUSCULTATION:
General Examinations-