Question

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PHC 271

Case Study (2)

A 52-year-old gentleman comes to your office with a history of intermittent difficulty swallowing solid food. His symptoms have been present for the past 5 years. He points to his supraclavicular notch when describing where the food feels stuck, although he can chew his food and transfer it into his posterior pharynx without difficulty. He does not choke or cough while eating. Drinking water will usually relieve his symptoms, although on several occasions he has self-induced vomiting. His symptoms are slightly worse now than they were several years ago, which prompted today's visit. Feeling any better and had ongoing fever and cough

According to the above case answer the following questions : ( in 1000 words)

1. What is the likely diagnosis of this case? Explain, how would you classify the disease clinically and mention all the clinical manifestation? Define the disease and what are the most common causes of this is disease likely in the patient?
2. Explain the pathophysiology of this disorder?
3. Are there any risk factors for the disease? If yes, then write down the common risk factors of the disease?
4. What lifestyle changes could make a difference for this patient?

5. Discuss the public health approaches in reducing and in the prevention of this health problem?

Answer 1

Diagnosis:
dysphagia: it is difficulty swallowing foods that take more time to swallow even solid foods from mouth to
stomach. dysphagia usually caused by nerve or muscle problems that cause difficulty swallowing. some conditions like acid reflux symptoms, heartburn, epiglottitis, esophagitis, goiter, cancer esophagus cause this disease.
This disease can be classified into four categories as per the location of the impartment that is oropharyngeal, esophageal and obstructive, esophagogastric, and para esophageal.
The oropharyngeal stage that obstruction begins from tongue and striated muscles of mastication when involuntary swallowing reflex difficulty occurs from anterior oral cavity to oropharynx. in the esophageal stage from the pharynx to esophagus involuntary contraction of the upper esophagus force the food through the mid and distal esophagus. it takes 8 to 20 seconds to bolus the food into the stomach.
Esophagogastric stage obstruction forms from the esophagus to the stomach. parapharngeal stage obstruction starts from just above the esophagus to the stomach. clinical manifestation of this disease include feeling something obstructed in the throat, regurgitation, heartburn, cough, pain while swallowing,
difficulty swallowing solid foods, drooling, hoarse voice, weight loss, etc. patient having difficulty swallowing solid foods for the last 5 years, especially having an obstruction in the supraclavicular notch, however the dysphagia mostly due to the esophageal disorder. now from the initial stage patients getting symptoms worse that make them into getting more worsening symptoms.
The most common cause for this patient disorder due to neurologic conditions or muscular disorders that cause skeletal muscle disorder and acid reflux disease, ulcer in the esophagus, stricture, and carcinoma causes the swallowing difficulty.
when there are lesions in the cerebral cortex cause swallowing disorder that decrease muscle motion when mastication and bolus propulsion.
risk factors for this disorder include stroke, Parkinsons disease, Huntington disease, multiple sclerosis, gastroesophageal reflux disease, etc.
Lifestyle modification for this patient to have small meals with a time interval, having liquid and soft foods. avoiding sticky foods and getting dietician opinions for nutritional choices.
Advice the patient to involve in the swallowing technique that helps dysphagia if it is caused by neurological problems. Advise the patient to avoid alcohol, tobacco, and caffeine, etc. avoid eating just before bedtime
advises the patient to chew the food thoroughly before swallowing.