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-

• 1. Examination of the Mouth & Pharynx-

  2. Examination of the neck-

  3. The chest-

  4. The abdomen-

  5. 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-

    • 1. atresia of esophagus

      2. benign stricture- may be due to reflux esophagitis, swallowed corrosives, tuberculosis, scleroderma, radiotherapy etc.

      3. spasm- Paterson-Kelly syndrome, achalasia, webs & rings, diffuse esophageal spasm

      4. diverticulum

      5. neoplasm-mainly malignant

      6. nervous disorders- bulbar paralysis, post vagotomy

      7. 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:

1. Skin over the abdomen-

2. Respiratory movements-

3. Contour-

4. Umbilicus-

PALPATION:

1. Tenderness & Rebound tenderness-

2. Muscle guarding & Rigidity-

3. Swelling-

4. Fluid thrill-

PERCUSSION:

• 1. Obliteration of liver dullness-

  2. Shifting dullness-

  3. Percuss the suprapubic region-

AUSCULTATION:

General Examinations-

Differential diagnosis of Abdominal Injuries