Choking on drinking water

Introduction Drinking water and coughing is one of the manifestations of dysphagia. There are many causes of this symptom, usually accompanied by other symptoms. Difficulty in swallowing refers to the symptoms caused by obstruction of food from the mouth through the pharynx and esophagus to the stomach. It is manifested as adhesion in the pharynx, sternum or xiphoid immediately after eating or within 8 to 10 seconds. , stagnation, even in severe cases can not swallow food.

Cause

The cause of drinking water and cough:

Central nervous system, cranial nerve diseases (such as acute poliomyelitis, diphtheria neuritis, multiple encephalitis, encephalitis, brainstem encephalitis, etc.);

Parkinson's disease, also known as tremor palsy; myasthenia gravis; esophageal foreign body.

Drinking water and cough are divided into two stages: 1) drinking water 2) coughing, the latter is completed by means of cough reflex, cough reflex: stimulating factor: above the big bronchi is sensitive to mechanical stimulation, and below the secondary bronchi is sensitive to chemical stimulation.

Receptors: the larynx, trachea and bronchial mucosa.

Afferent: vagus nerve, central: medulla

Outgoing: short deep inhalation--> glottis closed--> breather strong contraction, intrapulmonary pressure and intrapleural pressure rise sharply--> glottis suddenly open, gas is rushed out from the lungs, will Foreign matter in the respiratory tract below the throat is discharged.

The drinking process may be due to the inability to complete the closed pharyngeal and tracheal pathways, causing water to enter the tracheal mucosa, causing the body to make a reflection, swallowing movement: oral -> pharynx: closing the lips, the tongue from the tip of the tongue to the back of the tongue Lift, resist the hard and move backwards, push the food group into the throat. (free movement controlled by the cerebral cortex).

The next step is the automatic process: pharyngeal phase: stimulation of swallowing receptors (soft palate and pharyngeal epithelium, X-throatial nerve branch -> lower ganglion -> solitary nucleus), causing reflex action: soft palate rise + swallowing The wall protrudes forward = the nasopharynx is closed, the vocal cord adducts + the throat rises and the front is close to the epiglottis = the passage of the pharynx and trachea is closed. The apnea, the upper esophageal sphincter relaxes, and the bolus is squeezed into the upper esophagus. Esophageal phase: The upper sphincter undergoes a reflex contraction, and the esophagus produces a peristaltic movement from top to bottom.

The food group stimulates the soft palate, the pharynx, and the receptors around the esophagus. It is urged through the center of the medulla, and is transmitted to the esophagus via the vagus nerve (ACh, which can be antagonized by atropine).

an examination

Related inspection

Brain ultrasound examination of brain CT

Check and diagnose the drinking water and cough:

Central nervous system, cranial nerve diseases (such as acute poliomyelitis, diphtheria neuritis, multiple encephalitis, encephalitis, brainstem encephalitis, etc.): First of all, the speech is easy to fatigue, and the speech is unclear (with nasal sound) Dysphagia is first manifested as rapid eating, drinking water can cause cough, liquid can be reversed from the nostrils, severely advanced diseased patients often open, saliva spills, can not talk and swallow.

Parkinson's disease, also known as tremor paralysis: people over the age of 50, the condition is chronic progressive, with typical tremor (often starting from one side of the upper limb, with the hand is significant), rigidity (from one side, gradually to the right Side and body), reduction of voluntary movement (fine movement disorder), difficulty in chewing, swallowing, coughing, difficulty swallowing, mask face, panic gait and other symptoms and signs.

Myasthenia gravis: slow onset, its characteristic symptoms are fatigue after exercise, muscle weakness, involvement of eye muscles, skeletal muscles, difficulty in chewing, eating and swallowing, drinking water coughing, closing eyes, manifested as rest after rest Recovery or relief, so "morning light weight" gradually increased, although the rest of the late, can not alleviate, even invading the respiratory muscles and breathing difficulties.

Foreign body of the esophagus: fishbone, bones, chicken and duck bones swallowed by eating in a hurry or not fully chewed, the old man's dentures are lost and swallowed, and the child will accidentally swallow the mouth with a small toy, causing difficulty in swallowing (the disease is light and can still eat) Semi-liquid, severe or co-infected people may even have difficulty drinking water) with swallowing pain and even respiratory depression.

Differential diagnosis

Drinking water and coughing is one of the manifestations of dysphagia. It is usually not a single occurrence. It is accompanied by various other symptoms and is identified by the clinical symptoms of various diseases that cause water and cough.

Central nervous system, cranial nerve diseases (such as acute poliomyelitis, diphtheria neuritis, multiple encephalitis, encephalitis, brainstem encephalitis, etc.): First of all, the speech is easy to fatigue, and the speech is unclear (with nasal sound) Dysphagia is first manifested as rapid eating, drinking water can cause cough, liquid can be reversed from the nostrils, severely advanced diseased patients often open, saliva spills, can not talk and swallow.

Parkinson's disease, also known as tremor paralysis: people over the age of 50, the condition is chronic progressive, with typical tremor (often starting from one side of the upper limb, with the hand is significant), rigidity (from one side, gradually to the right Side and body), reduction of voluntary movement (fine movement disorder), difficulty in chewing, swallowing, coughing, difficulty swallowing, mask face, panic gait and other symptoms and signs.

Myasthenia gravis: slow onset, its characteristic symptoms are fatigue after exercise, muscle weakness, involvement of eye muscles, skeletal muscles, difficulty in chewing, eating and swallowing, drinking water coughing, closing eyes, manifested as rest after rest Recovery or relief, so "morning light weight" gradually increased, although the rest of the late, can not alleviate, even invading the respiratory muscles and breathing difficulties.

Foreign body of the esophagus: fishbone, bones, chicken and duck bones swallowed by eating in a hurry or not fully chewed, the old man's dentures are lost and swallowed, and the child will accidentally swallow the mouth with a small toy, causing difficulty in swallowing (the disease is light and can still eat) Semi-liquid, severe or co-infected people may even have difficulty drinking water) with swallowing pain and even respiratory depression.

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