This document discusses dysphagia (difficulty swallowing) including its anatomy, physiology, causes, investigation, and management. It covers the anatomy of the oropharynx and hypopharynx. The physiology section describes the three phases of swallowing - oral, pharyngeal, and esophageal. Common causes of dysphagia include presbyphagia, laryngopharyngeal reflux, xerostomia, tonsillitis, epiglottitis, oropharyngeal/hypopharyngeal malignancies, and pharyngeal pouches. Investigations include endoscopy, barium swallow, and manometry. Management is tailored based on the cause and resource availability,
What is a dysphagia? What are the latest trends to deal with the case who has presented to you? This "Seminar Presentation" list some of the latest American College of Surgery guidelines, regarding the management of a case of dysphagia
What is a dysphagia? What are the latest trends to deal with the case who has presented to you? This "Seminar Presentation" list some of the latest American College of Surgery guidelines, regarding the management of a case of dysphagia
Evaluation of a patient with dysphagia: Difficulty in Swallowing.
Esophageal and Pre-esophageal causes.
-Abhinav Kumar, Kasturba Medical College, Mangalore
Prepared from book: "Diseases of Ear, Nose and Throat
Textbook by P. L. Dhingra" 6th Edition
https://books.google.co.in/books?id=0ByMBgAAQBAJ&lpg=PP1&pg=PA347#v=onepage&q&f=false
When one finds difficulty in swallowing, there is probably something wrong in the execution of one of these phases. This condition is called ‘Dysphagia’. This is a common problem in children.
Transforming the Application of Cancer Staging with Intelligent ContentRob Hanna, ECMs
Faced with the task of publishing the next edition of the AJCC Cancer Staging Manual, the staff at the American Joint Committee on Cancer (AJCC) realized that there had to be a better way to facilitate the updates to the content and distribution to a growing number of critical channels. In 2013, they turned their mind to Intelligent Content and enlisted the help of a team of professional technical communicators and information architects to devise a solution.
Over the past four decades, the AJCC has used traditional medical publishers to produce and distribute print versions of the manual and staging forms used by clinicians worldwide to stage all forms of cancer to determine treatment and predict patient outcomes. Every seven years, world-renowned physicians gather to evaluate the science and produce updates to the cancer staging manual. With the rapid developments in cancer research and increased prevalence of electronic health records, the AJCC realized that their business model had to evolve. They required more agile publishing capabilities than the traditional publishers could offer. They also needed more control over their content to fulfill delivery to a growing number of distribution channels.
Over the past year, the AJCC has transformed their content for the most prevalent forms of cancer using a specially-trained team of writers to improve upon the clarity and consistency of the information. This content sits on top of specialized DITA/XML allowing for sophisticated reuse and repurposing of the content. This session will present the business case for the Cancer Staging Content Transformation (CSCoT) project and discuss the wins and challenges of their Intelligent Content strategy.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
5. 3 parts:
1.Nasopharynx:
• From the posterior nasal
apertures to the
nasopharyngeal isthmus
2.Oropharynx:
• Nasopharyngygeal isthmus
to the upper border of
epiglottis
3.Laryngopharynx:
• From upper border of
epiglottis to lower border of
cricoid cartilage
6. Oropharynx
• Middle part of the pharynx behind oral cavity
Communicates with:
• Nasopharynx through nasopharyngeal
(pharyngeal) isthmus
• Oral cavity through the oropharyngeal isthmus
(isthmus of fauces)
• Laryngopharynx at the level of upper border of
epiglottis
“Isthmus of fauces = limit between the mouth cavity proper with the pharynx marked by
constricted aperture Palatopharyngeal and palatoglossal arches”
7. Lateral wall
• Presence of palatine tonsil which lies in the palatine fossa
• Posteriorly the wall is formed by the:
1.Superior constrictor of pharynx
2.Middle constrictor of pharynx
3.Inferior constrictor of pharynx
8. Laryngopharynx
• Lowest part
• Situated behind the larynx
• Extend from upper border of epiglottis to lower
border of cricoid cartilage
• 3 walls:
1.Anterior wall
2.Lateral wall
3.Posterior wall
9.
10. Wall Structure
Anterior • Laryngeal inlet
• Posterior surface of cricoid and
arytenoid cartilage
Lateral • Piriform fossa:
-On each side of laryngeal inlet
-Boundaries:
Medially: aryepiglottic fold
Laterally: thyroid cartilage &
thyrohyoid membrane
Posterior • Formed by contrictor muscles
-superior constrictor m.
-middle contrictor m.
-inferior constrictor m.
14. Deglutition
• Swallowing
• A mechanism that moves food or liquid from the
mouth through the pharynx and esophagus into
the stomach .
• is facilitated by the secretion of saliva and mucus.
• Normal deglutition is a smooth coordinated
process that involves a complex series of voluntary
and involuntary neuromuscular contractions and
typically is divided into three distinct phases:
1)Oral
2)Pharyngeal
3)Esophageal
19. Phase Activity
Oral Voluntary • Food rolled into the bolus
• Tongue arches to push bolus backwards into the
oropharynx
Pharyngeal Involuntary • Elevation of the soft palate to close nasopharyngeal
passage
• Pressure of the food on the pharyngeal wall
stimulates mechanoreceptor to inhibit breathing
• Raise larynx and close glottis
• Passage of bolus downwards ,epiglottis seals off
larynx
• Wave of contraction sweep the pharyngeal muscles ,
bolus moves into esophageal sphincter
Esophageal involuntary • Reflex relaxation of UES
• Sphincter closes when bolus has passed through
• Glottic opens, breathing resumes
• Peristaltic wave moves the bolus forward
• LES relaxes through action of vasointestine peptide
hormone
• Allow entry of bolus into the stomach
22. Dysphagia
• Difficulty in swallowing
• Sensation of obstruction of passage of food
bolus through the pharynx and oesophagus
within 15 seconds of bolus leaving the mouth
• Odynophagia Pain with deglutition
23. Globus pharyngeus
• Sensation of lump or tightness in throat with no
organic causes
• Hypothesis
• GERD
• Oesophageal Dysmotility
• Psychogenic origin
• Common in middle age, no sex preponderance
• No true dysphagia, no weight loss, continual need
to swallow
24. Presbyphagia
• Physiological changes that occurs in deglutition with ageing
• Reduction in muscle mass and strength
• Resulting in chronic dysphagia a/w malnutrition and
aspiration
• Manage by modifying consistency of food and swallowing
therapy
• Commonly affect the oesophageal phase and its location
involved is usually oesophagus
25. Laryngopharyngeal Reflux (LPR) vs GERD
LPR GERD
Has laryngeal scarring, odynophagia Has heartburn, chest pain
Daytime / Upright Refluxer Nocturnal / Supination Refluxer
Normal Oesophageal Motility Oesophageal dysmotility
Normal gastric acid clearance Prolonged gastric acid clearance
Not associated with oesophagitis Associated with oesophagitis
Primary Defect is Upper
Oesophageal Sphincter
Primary Defect is Lower
Oesophageal Sphicter
Increased risk of upper aerodigestive
tract cancer
Increased risk of oesophageal
cancer
Has globus pharyngeus Has retching and regurgitative
sensation
32. Acute Tonsilitis
• Inflammation of tonsils
• Can cause narrowing if too enlarge and can
obstruct food bolus going down
• Irritation by the food cause odynophagia
• Diagnosed by tonsillar surface swab
• Treatment includes pain relief (PCM), preventing
further inflammation (NSAIDs) and antibiotic
treatment.
• Tonsillectomy in indicated cases.
33. Acute Epiglottitis
• Inflammation of supraglottic region of the
oropharynx (epiglottis, arytenoid, aryepiglottic
folds)
• Food bolus going down the pharynx can irritate
the epiglottis and can cause odynophagia
• Manage by intubating to protect airway,
cricothyroidotomy in severe cases.
34. Malignancy of
Oropharynx and Hypopharynx
Oropharynx
Tonsils, base of tongue, soft palate, posterior
pharyngeal wall to hyoid bone level
Hypopharynx
From hyoid bone level to inferior border of
cricoid cartilage, including piriform fossae,
posterior pharyngeal wall, postcricoid region
35. Malignancy of
Oropharynx and Hypopharynx
Squamous cell carcinomas are the most common
neoplasm.
• Progressive dysphagia
• Weight loss
• Vocal cord palsy Dysphonia
• Aspiration
• Referred Otalgia
• Neck metastasis
• Airway compromise
• Can be painless in oropharynx
36. Malignancy of
Oropharynx and Hypopharynx
• Investigation
• Rigid endoscopy under GA (Map tumour extend)
• CT Neck and Chest
• MRI Neck and Chest
• Management
Non Invasive
• Nutritional and diet control
• Swallowing therapy
• Nasogastric tube insertion for nutritional supply
• Gastrostomy for cases unable to apply NGT
Invasive
• Surgery or
• Laser therapy
• Concurrent chemoradiotherapy
37. Pharyngeal pouch
• AKA Zenker’s Diverticulum
• Natural weakness in posterior aspect of
hypopharynx between the fibres of
thyropharyngeus and cricopharyngeus of
inferior pharyngeal constrictor.
• Pulsion diverticula form at the area with least
support, at Killian’s dehiscence.
38.
39.
40. Pharyngeal pouch
• Signs and symptoms
• Progressive dysphagia
• Weight loss
• Regurgitation of undigested food (in the pouch)
• Halitosis
• Coughing
• Gurgling sound during swallowing on neck
• X-Ray Finding
• Rising Tide sign
41.
42. Management
• Small – Observe
• Large – Endoscopic Stapling
• Large and difficult to staple – Excise pouch
43. Oesophageal Dysphagia
- Difficulty swallowing several seconds after
initiating first swallow
- Associated with sensation of food stuck in
oesophagus
- Pathological site
- Oesophagus body
- Lower oesophageal sphincter
- Cardia of the stomach
48. Oesophageal Achalasia
• Due to impaired oesophageal peristalsis and
lack of lower oesophageal sphincter relaxation
during deglutition
• Common in 20 – 60 years old
• Dysphagia affect both solid and liquid food
• Complication: Cough, aspiration pneumonitis
and chest pain
49. Oesophageal Achalasia
• Investigation: Barium swallow,
endoscopy and manometry
• Treatments : Balloon dilation, chemical
denervation and surgical myotomy of
lower oesophageal sphincter
Retained level of barium
Bird beak’s appearance
53. History Taking
• What kind of food produces dysphagia?
• Liquid
• Solid
• Nature of dysphagia
• Intermittent
• Continual
• Progressive
• Associated SSx
• Coughing
• Regurgitation
• Choking
54. Physical Examination
• Profound weight loss (Malignancy or Achalasia)
• Glossopharyngeal nerve (CN IX)
• Vagus nerve (CN X)
• Uvula movement
• Palatal movement
• Gag reflex
• Cough reflex (Rarely done)
• Neck Examination – Thyroid Malignancy
• Inspection of Limbs – Scleroderma, Weakness
(Neuromuscular Disorder)
55. Goals of Management
• Improve food transfer to the stomach
• Prevent aspiration pneumonitis
• Treat underlying causes
Treatment method is based on aetiological
approach.
56. Management Cascade
• Oropharyngeal Dysphagia
Status of Centre Management Option(s)
Limited Resources Swallowing Rehabilitation
- Head and Body Posture
- Air-way closure maneuver
Diet Modification
Importance of Oral Hygiene
Feeding Tube
Better Resources Surgical Gastrostomy
Percutaneous Gastrostomy
Endoscopic Gastrostomy