# file - OUTLINE.txt
# $Id: OUTLINE.txt,v 1.1 2005/01/09 13:24:46 adrian Exp adrian $
# $Log: OUTLINE.txt,v $
# Revision 1.1  2005/01/09 13:24:46  adrian
# Initial revision
#

Dysphagia
~~~~~~~~~
Defintions
	Swallowing
	Dysphagia
	Odynophagia
	Vomiting
	Regurgitation

Review of swallowing
	Concept of pump, sphincter and resevoir
	Functional and mechanical causes of dysphagia

Disorders of the first phase
	Pump - Muscles of mouth and pharynx
	Sphincter - Upper esophageal sphincter
	Resevoir - Esophagus

Disorders of the second phase
	Pump - Esophageal muscle
	Sphincter - Lower esophageal sphincter
	Resevoir - Stomach

History
	Solids or Liquids
	Progressive or intermittent
	Associated symptoms - Heartburn, regurgitation
	Location of hold up
	Aspiration and cough

Examination
	Signs of anemia and iron deficiency
	Weight loss
	Cachexia
	Lymphadenompathy
	Change in voice
	Fullness in side of neck

Investigation
	Contrast swallow
	Upper gastrointestinal endoscopy
	Manometry
	24 hour pH metry

Pharyngeal pouch
	Anatomy
	History
	Examination
	Investigation
	Treatment

Bolus obstruction
	Do not do contrast swallow first
	Underlying problem

Achalasia and pseudo-achalasia
	History
	Social isolation
	Investigation
		- Upper GI endoscopy
		- Manometry
	Treatment
		- Botox
		- Pneumatic dilatation
		- Heller's myotomy
	Prognosis

Benign esophageal stricture
	History
	Investigation
		- Contrast swallow
		- Upper GI endoscopy + biopsy
		- Manometry
		- pH metry
	Treatment
		- PPI with Clo status evaluation
		- Dilatation (Endoscopic)
		- ? anti-reflux surgery

Malignant esophageal stricture
	Epidemiology
		- Rising rate of adenocarcinoma
		- Similarity of adenocarcinoma of the cardia and esophageal
		  adeoncarcinoma
	History
	Investigation
		- Contrast swallow
		- Upper GI endoscopy + biopsy
		- Endoscopic Ultrasound
		- Radiological staging
		- Neo-adjuvant therapy
		- Resection versus palliation
			* Palliative resection versus resection with the intent of cure
		- Adjuvant therapy
		- Systemic therapy

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