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