Ques. 1 What is Dysphagia?
Ans. Difficulty in swallowing (deglutition) of food and drink.
Cases of Dysphagia Verbal :
I. Pain-tuberculous ulcers of tongue, pharyngitis, carcinoma of oesophagus, achalasia etc.
II. Vomiting – (a) Blood-stained with foods taken previously-carcinoma, (b) only the foods-Achalasia.
III. Changes in voice- Advanced carcinoma of oesophagus or thyroid, Bulbar palsy.
IV. Loss of weight-malignancy.
V. Acute onset – Impaction of foreign body, pharyngitis etc. Comparatively short history – carcinoma of tongue, thyroid etc. or Plummer – Vinson Syndrome. Long history – Achalasia.
Ques. 2 What is the physical examination, Diagnosis and treatment of Dysphagia?
Ans. Physical Examination :
1. Soft palate palsy, Bulbar palsy.
2. Tonsils-tonsillitis, quinsy.
3. Neck – (i) any enlargement of thyroid gland, (ii) tracheal tuggings, (iii) swelling near clavicle, (iv) any tenderness and deformity of spine.
4. Chest – (i) Heart – pericardial effusion, (ii) Media-stinum-growth, (iii) Lung-tuberculous lesion, (iv) any aneurysm of aorta.
5. General-for anaemia and koilonychias.
6. Mouth – (i) stomatitis, (ii) any ulceration in the tongue, e.g. tuberculous ulcer, malignant ulcer, glossitis etc.
7. Pharyn-(i) any growth, (ii) any inflammation.
a) Vomiting with dysphagia commonly occurs in cardiospasm and oesophageal diverticula.
b) H/o ingestion of corrosives indicate a cicatricial stenosis.
c) Progress-patients with achalasia usually have a long history with remissions. Dysphagia firstly for solids and later for fluids suggests mechanical obstrucrion. Reverse is true for achalasia.
d) A history of heamatemesis suggests carcinoma or oesophagitis.
e) Hoarseness of voice suggests carcinoma of larynx.
f) Nasal regurgitation of fluids is frequently encountered in cases of palatal paralysis.
g) Posture- In oesophageal hiatus hernia dysphagia occurs in recumbent position and is relieved in upright position.
h) Onset-Sudden onset is suggestive of a foreign body, encephalitis, cerebellar thrombosis or hysterical spasm. Gradual onset is suggestive of stricture, carcinoma and achalasia.
i) Age – In children, dysphagia is mostly due to cleft palate, foreign body or diphtheria. In young females-Plummer-Vision syndrome, achalasia cardia or hysterical spasm.
Special Examination or Investigations :
i. X-ray of chest for-(a) aortic aneurysm, (b) mediastinal growth, (c) pericardial effusion, (d) lung T.B. (e) deformity of spine etc.
ii. Exfoliative cytology.
iii. Oesophagoscopy with biopsy.
iv. Laryngoscopy – for any ulceration of tumour of larynx.
v. Barium swallow X-ray-to visualize the abnormal-lities e.g. cardiospasm, stricture, tumours, oesopeageal diverticula etc.
vii. Blood – T.C., D.C., E.S.R., Hb%.
viii. Vomitus for malignant cells.
Treatment : The treatment of dysphagia depends on aetiology. Homoeopathic Remedies for treatment of Dysphagia.
Ques. 3 Which medicines are good for this case?
Ans. 1) SILICEA – Tongue dry or coated with a slimy mucous, swollen and numb ; difficult swallowing, rigors and suppuration.
2) COLCHICUM- Dysphagia, pain in throat larynx and muscles of neck; constriction in oesophagus, with accumulation of mucous in the throat, which come involuntarily into mouth or is hawked up.
3) CONIUM- Soreness of tongue, esp. about the root ; stiff, swollen, painful tongue, with dryness of mouth and impeded deglutition.
4) MERCURIUS – Dysphagia, he has to press hard to get something down, aching pains in oesophagus; difficulty of swallowing with danger of suffocation; liquids are ejected through nose.