Dysphagia课程.pptVIP

DYSPHAGIA Wendy Funk, M.D. University of Connecticut Health Center January 7, 2005 Definition? Inability to swallow Regurgitation Painful swallowing Coughing/choking Food “sticks” Globus Feels “tight” Importance Approximately 50% of nursing home residents suffer from some form dysphagia Patients are often concerned about the possibility of cancer It is essential that the physician demonstrates serious interest in the patient’s complaints to rule out a malignant or CNS process Swallowing Mechanism is complex Involves the actions of 26 muscles and 5 cranial nerves CN V -- both sensory and motor fibers; important in chewing CN VII -- both sensory and motor fibers; important for sensation of oropharynx taste to anterior 2/3 of tongue CN IX -- both sensory and motor fibers; important for taste to posterior tongue, sensory and motor functions of the pharynx CN X -- both sensory and motor fibers; important for taste to oropharynx, and sensation and motor function to larynx and laryngopharynx; important for airway protection CN XII -- motor fibers that primarily innervate the tongue A normal adult swallows unconsciously 600 times in a 24-hour period Esophageal Anatomy Upper one-third is composed of skeletal muscle Distal two-thirds is smooth muscle NO SEROSA Outer longitudinal, inner circular muscle layer Myenteric plexus of Auerbach, parasympathetic ganglion cells, interspersed among the muscle layers Submucosa – blood vessels/lymphatics, myenteric plexus of Meissner (parasympathetic ganglion cells) Mucosa – stratified squamous epithelium Review The outermost collection, lying between the inner circular and outer longitudinal smooth-muscle layers of the gut, is called the myenteric (or Auerbachs) plexus. Neurons of this plexus regulate the peristaltic waves, consisting of polarized muscular activity, that move digestive products from oral to anal openings. In addition, myenteric neurons control local muscular contractions that are responsible for stationary mix