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Dysphagy

Table of contents
Dysphagy
Classification of a dysphagy
Anamnesis of a dysphagy
Physical inspection and assessment

Close concept: swallowing disturbances

The dysphagy, or simply "the complicated swallowing", can be observed owing to impact on the act of swallowing of various factors, including the diseases which are localized throughout a digestive tract from a throat to an esophageal and gastric anastomosis. The dysphagy is always connected with swallowing, and complaints to difficulty of swallowing indicate superficial or internal pathological process in a throat or a gullet.

The act of swallowing is very difficult physiological mechanism which contains both any, and involuntary components. An oral phase of swallowing — any; it consists in creation of a food lump and its moving to a stomatopharynx. When the food lump appears at a back wall of a throat, sensitive receptors "include" an involuntary phase of swallowing therefore the food lump moves to a throat and primary peristaltic wave of muscles of a gullet begins. The detailed description of neuromuscular mechanisms of function of a throat and gullet is not included into a task of this article, however the correct understanding of clinical features and symptoms of a dysphagy requires knowledge of fundamentals of anatomy and physiology of a gullet.

Gullet anatomy

The gullet represents the muscular tube about 20 — 22 cm long located in a postmediastinum between the lower bound of a perstneglotochny muscle and cardial department of a stomach, which is coming to an end at the level or is slightly lower than an esophageal opening of a diaphragm. The proximal part of a muscular gullet is continuation of cross-striped muscles of a throat; it passes into unstriated muscles approximately on border of upper and average thirds of a gullet. At the most upper part of a gullet the upper esophageal sphincter which almost completely consists of a perstneglotochny muscle is located. The upper esophageal sphincter represents a segment of a circular muscular layer of a gullet 2 — 4 cm long which reduction creates pressure about 100 mm of mercury. in the perednezadny direction; thus, and a condition of rest the entrance to a gullet is closed. When swallowing the upper sphincter completely relaxes and pushes a food lump in a gullet. Primary peristaltic wave caused by swallowing through 5 — 6 with reaches the lower esophageal sphincter. At rest it is also closed, at the same time around it at distance of 2 — 4 cm the zone high is supported (from 15 to 25 mm of mercury.) pressure. Anatomically the lower esophageal sphincter is less differentiated, than upper, however it is easy to establish a zone of the high pressure created by the lower esophageal sphincter by means of a manometriya. After swallowing the lower esophageal sphincter also relaxes (at the same time pressure goes down to intragastric level) and during 5 — 10 with remains weakened. At this time the food lump forces the way through a sphincter. The lower esophageal sphincter is reduced when it is reached by a peristaltic wave which moves a food lump to a stomach, and then the cycle comes to the end with recovery of initial supertension.
The mucous membrane of a gullet is provided by a multilayer, scaly flat epithelium and practically does not possess secretory ability. Separate mucous glands of a submucosa allocate insignificant amount of slime.

Function of a gullet

The gullet serves as the channel on which the swallowed secrets, liquid and food masses come from a throat to a stomach. The gullet does not possess vsasyvatelny or a little considerable secretory function and unlike all other structures of a digestive tract of the person has only one function — transfer of food masses, however this function is provided with quite difficult muscular device.



 
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