TAILIEUCHUNG - macleod’s clinical diagnosis (2nd edition): phần 2

part 2 present the content: dysphagia; dyspnoea; fatigue; fever; gastrointestinal haemorrhage: haematemesis and rectal bleeding; haematuria; haemoptysis; headache; jaundice; joint swelling; leg swelling; limb weakness; low back pain; nausea and vomiting; transient loss of consciousness: syncope and seizures. | Dysphagia Patients with dysphagia require prompt assessment to exclude serious pathology. Unless the history clearly points to a functional oropharyngeal cause oesophageal investigation is necessary to rule out mechanical obstruction - in particular malignancy. Oropharyngeal dysphagia I Bulbar palsy Lower motor neuron palsies of cranial nerves IXXII result in weakness of the tongue and muscles of chewing swallowing. The tongue is flaccid with fasciculation often with a change in voice Table . Causes include motor neuron disease MND and brainstem tumour or infarction. Pseudobulbar palsy Bilateral upper motor neuron lesions of cranial nerves IX XII produce a small contracted and slowly moving tongue and pharyngeal muscles with a brisk jaw jerk Fig. . There may be associated speech disturbance and emotional lability Table . Causes include cerebrovascular disease demyelination and MND. Myasthenia gravis Fatigability of oropharyngeal muscles causes increasing swallowing difficulty after the first few mouthfuls. Dysphagia may occur before other features of myasthenia are readily apparent. Pharyngeal pouch The pouch is formed by posterior herniation of the pharyngeal mucosa between the thyroph-aryngeus and cricopharyngeus muscle and is usually found in elderly patients. In addition to dysphagia there is classically regurgitation of undigested food halitosis the feeling of a lump in the neck and gurgling after swallowing liquids. Parkinson s disease and stroke These frequently cause swallowing difficulty but other features are usually more prominent. Inadequate saliva Inadequate saliva . anticholinergics connective tissue disease such as Sjogren s syndrome may lead to problems with forming a manageable bolus. I Other causes These include myopathies myotonic dystrophy and tumours of the pharynx or larynx. Oesophageal dysphagia structural Both structural disease and dysmotility may cause dysphagia Structural causes usually cause dysphagia for solids .

• Y khoa - Dược
• Macleod’s clinical diagnosis
• Clinical diagnosis
• Gastrointestinal haemorrhage
• Haematemesis and rectal bleeding
• Limb weakness
• BMC Musculoskeletal Disorders
• Hip osteoarthritis
• Muscle weakness
• Lower limb muscle strength
• Muscle atrophy
• báo cáo khoa học
• báo cáo hóa học
• công trình nghiên cứu về hóa học
• tài liệu về hóa học
• cách trình bày báo cáo
• báo cáo y học
• công trình nghiên cứu về y học
• tài liệu về y học