Choking on swallowing

Introduction Difficulties in swallowing occur when a part of a normal human swallowing reflex arc is damaged. Some patients with difficulty swallowing may cause swallowing due to mistakenly swallowed food into the trachea. Dysphagia refers to the stagnation of the pharyngeal, posterior sternal, or esophageal stagnation of food from the mouth to the stomach and during the transportation of the cardia. For patients with dysphagia, clinicians must pay attention to the fact that dysphagia caused by organic diseases must be distinguished from pseudo-dysphagia. The latter has no underlying lesions of esophageal obstruction. The patient only complains of blockage-like blockage after the pharynx and sternum. Feeling, but often can not clearly point out specific parts, and there is no difficulty in eating liquid or solid food, such patients are often accompanied by other symptoms of neurosis.

Cause

Causes of swallowing cyanosis: the swallowing reflex arc is damaged.

Oropharyngeal disease

Oropharyngeal inflammation, oropharyngeal injury, pharyngeal diphtheria, phary

2. Esophageal disease

Esophagitis, benign esophageal cancer, esophageal cancer, esophageal foreign body, esophageal muscle dysfunction (cardiac achalasia, diffuse esophageal fistula, etc.), extreme enlargement of the thyroid gland. Among them, esophageal cancer is an important cause.

3. Neuromuscular diseases

Medullary palsy, myasthenia gravis, organophosphate insecticide poisoning, polymyositis, dermatomyositis, pharyngeal achalasia and so on.

4. Systemic diseases

Rabies, tetanus, botulism, iron deficiency dysphagia (Plummer-Vinson syndrome).

an examination

Related inspection

EEG examination blood routine

Diagnosis of swallowing cyanosis: Patients with frequent swallowing and coughing symptoms can be diagnosed.

Laboratory examination

(1) Drinking water test: The patient takes a sitting position and places the stethoscope between the patient's xiphoid process and the left rib arch. Drinking a sip of water, normal people can hear jet murmur after 8-10s, if there is esophageal obstruction or movement disorder, Then you can't hear the sound or delay, and even the obstruction can even vomit the water.

(2) Esophageal acid drop test is important for the diagnosis of esophagitis or esophageal ulcer.

(3) 24-hour pH monitoring of the esophagus is important for the diagnosis of acidic or alkaline reflux.

(4) Conduct examinations on immunology and tumor markers.

2. Other auxiliary inspections

(1) X-ray examination

X-ray chest radiograph can understand whether there is any foreign body in the mediastinum or esophagus with or without space-occupying lesions; esophageal X-ray barium meal examination can observe the presence or absence of tincture to determine the lesion as obstructive or muscle peristalsis. If necessary, use gas sputum double contrast to understand the changes of esophageal mucosal folds. Endoscopy and biopsy can directly observe esophageal lesions, such as esophageal mucosal congestion, edema, erosion, ulcers or polyps, cancer and so on. Endoscopic biopsy is important for the differentiation of esophageal ulcers, benign tumors and esophageal cancer.

(2) Esophageal manometry

Esophageal manometry can determine the functional state of esophageal movement, generally using the side hole of the catheter for low pressure irrigation. Such as pressure 10mmHg, LES pressure / intragastric pressure <0.8, suggesting gastroesophageal reflux. However, it has been found that the LES pressure of the gastroesophageal refluxer overlaps with the normal person. After that, the pressure is measured by the catheter extraction method, and the LES pressure value at the end of the expiratory phase is taken as the standard.

Differential diagnosis

Swallowing cyanosis should identify whether the neuron is damaged or muscle paralysis. Patients with frequent swallowing and cough symptoms can be diagnosed.

Esophageal cancer

More common in male patients over the age of 40, the typical symptoms are progressive dysphagia, most patients can clearly point out that the obstruction site behind the sternum, may be accompanied by swallowing pain; advanced patients may have esophageal reflux, esophageal exfoliative cytology for early Diagnosis is important, and esophagoscopy or endoscopy combined with biopsy can determine the diagnosis of esophageal cancer.

2. Esophageal achalasia

Most of the dysphagia is intermittent, the course of disease is longer, the lower part of the esophagus (ie above the stenosis) is obviously dilated, the esophageal reflux is common, the reflux is large, and the bloody mucus is not included, especially in the supine at night, it can be awakened by cough and even Causes aspiration pneumonia. X-ray swallowing examination showed that the cardia obstruction was fusiform or funnel-shaped, and the edge was smooth. After inhaling the isoamyl nitrite, the cardia could be dilated temporarily, allowing the expectorant to pass; the esophageal manometry was only a non-peristaltic small contraction wave.

3. Gastric-esophageal reflux

Causes of dysfunction of the lower esophageal sphincter, loss of function of the anti-gastroesophageal reflux barrier, and the contents of the stomach and duodenum often flow back into the esophagus. In the later stage, benign esophageal stricture is often performed. The lower part of the esophagus is measured by LES pressure and 24 hours in the esophagus. pH monitoring, Bilitee-2000 bile monitor to determine the bilirubin absorption value, to help the diagnosis of acid and alkali reflux.

4. Benign stricture of the esophagus

The stenosis is caused by corrosive factors, postoperative esophageal surgery, injury, and reflux esophagitis. X-ray swallowing examination showed that the lumen was narrow, but the edges were neat, and there were no signs of stenosis, and esophagoscopy or gastroscopy could confirm the diagnosis.

5. Diffuse esophageal fistula

More secondary to reflux esophagitis, corrosive esophagitis and other diseases, often confused with angina pectoris, the main symptoms are dysphagia and swallowing pain, mostly induced by mental factors such as emotional excitement. Swallowing pain can be located in the front chest, even to the forearm, and nitroglycerin can often relieve pain.

6. Other

Esophageal fistula, mediastinal tumor, enlarged lymph nodes around the esophagus, enlarged left atrium, aortic aneurysm, etc., such as compression of the esophagus can lead to difficulty swallowing. However, according to symptoms, signs, X-ray, CT, MRI and other auxiliary examinations can be diagnosed separately.

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