1. FAISAL GHANI SIDDIQUI MBBS; FCPS; MCPS (HPE); PGD (BIOETHICS) faisal@lumhs.edu.pk www.lumhs.edu.pk/faculties/surgery/gsurgery/about-dr.faisalghani.html

2. PREAMBLE

3. DIFFICULTY IN SWALLOWING RESULTS FROM ANY PATHOLOGY THAT INTERFERES WITH THE NORMAL SWALLOWING MECHANISM

4. ORAL PHARYNGEAL OESOPHAGEAL

5. ORAL PHASE FOOD BOLUS ROLLED BACK BY THE TONGUE INTO THE PHARYNX PHARYNGEAL PHASE FOOD PASSES THROUGH THE PHARYNX INTO THE OESOPHAGUS OESOPHAGEAL PHASE FOOD PASSES THROUGH THE OESOPHAGUS INTO THE STOMACH

6. HIGH (OROPHARYNGEAL) DYSPHAGIA OCCURING AT OR ABOVE CRICOPHARYNGEUS LOW (OESOPHAGEAL) DYSPHAGIA OCCURING BELOW CRICOPHARYNGEUS

7. DYSPHAGIA -CAUSES

9. DYSPHAGIA -DIAGNOSIS

10. HIGH (OROPHARYNGEAL) DYSPHAGIA ASSOCIATED WITH CHOKING OR COUGHING IMMEDIATELY AFTER SWALLOWING SWALLOWING SOLIDS EASIER THAN LIQUIDS

11. DYSPHAGIA DUE TO OESOPHAGEAL CARCINOMA SHORT DURATION (< 3 MONTHS) PROGRESSIVE ASSOCIATED WEIGHT LOSS

12. DYSPHAGIA DUE TO MOTILITY DISORDERS LONG HISTORY INVOLVES BOTH SOLIDS AND LIQUIDS DYSPHAGIA MAY DISAPPEAR, BEING REPLACED WITH REGURGITATION & NOCTURNAL COUGH

13. OFTEN UNREWARDING MOVEMENTS OF TONGUE, PALATE, & MUSCLES OF FACIAL EXPRESSION CERVICAL LYMPHADENOPATHY WEIGHT LOSS

14. ENDOSCOPY BARIUM SWALLOW MANOMETRY EUS

15. PATIENTS WITH HIGH DYSPHAGIA WITH NO OBVIOUS NEUROLOGICAL CAUSE SHOULD BE REFERRED TO ENT SPECIALIST FLEXIBLE LARYNGOSCOPY FLEXIBLE NASOENDOSCOPY RIGID ENDOSCOPY

16. OESOPHAGEAL DYSPHAGIA BIOPSIES TO DIFFERENTIATE MALIGNANT & BENIGN STRICTURES THERAPEUTIC; DILATATION OF BENIGN STRICTURES / MOTILITY DISORDERS STENTING IN INOPERABLE TUMOURS

18. OESOPHAGEAL DYSPHAGIA Demonstrates different structural pathologies Hiatus hernia | Strictures Achalasia | Tumours

19. PATIENTS WITH NO STRUCTURAL ABNORMALITY ON ENDOSCOPY REQUIRE FURTHER INVESTIGATION WITH MANOMETRY TO EXCLUDE MOTILITY DISORDERS

20. USED FOR STAGING OF HISTOLOGICALLY PROVEN OESOPHAGO-GASTRIC CARCINOMA WALL PENETRATION LYMPH NODE INVOLVEMENT EXTRINSIC OESOPHAGEAL COMPRESSION

21. HIGH DYSPHAGIA HISTORY SUGGESTIVE OF NEUROLOGICAL CAUSE NO ENT REFERRAL ORO- PHARYNGO- LARYNGOSCOPY YES VIDEO- FLOUROSCOPY & MANOMTERY