|I It was with a little alarm and a good deal of pleasurable excitement that I looked forward to my first grown-up visit to Mervyn Grange. I had been there several times as a child, but never since I was twelve years old, and now I was o... Read more of The Closed Cabinet at Mystery Stories.ca|| Informational|
Medical ArticlesPunctures Case V
Mr. Cocking's son, aged 12, received a stab in the palm of th...
Direct laryngoscopy, bronchoscopy, esophagoscopy and gastrosc...
Temperature Of The Sick-room
The _temperature of the sick-room_ should not be much above 6...
Wounds Bleeding Of
After sending for a surgeon the first thing to be looked at in...
TO be truly at peace with one's self means rest indeed. Th...
[As I have never practiced farther South than Cincinnati, and...
Eyes Hazy Sight
Frequently, after inflammation, and even when that has ceased,...
Exercise While Fasting
The issue of how much activity is called for on a fast is co...
Independent aspirating tubes involve delay in their use as c...
Smoking, a Senseless Habit. Smoking is the curious act of dra...
Bile On The Stomach
Take half a teacupful of hot water every ten minutes for ten h...
The Real Truth About Salt And Sugar
First, let me remind certain food religionists: salt is salt ...
This, in various forms, as brandy, whiskey, rum, wine, cordial...
The prognosis is very uncertain. This infirmity is often cure...
See Children's Sleep. ...
Bruises Case Xv
The following case was far more severe, but the mode of treat...
In all fevers, to cool down the excessive heat of the patient ...
The Journey Down The Food Tube
The Flow of Saliva and Appetite Juice. We are now ready to st...
Interpretation Of Tracings
The interpretation of the arterial tracing shows that the nea...
Bromids And Chloral
If there is much restlessness and the circulation is good, th...
Paralysis Of The Esophagus
Category: DISEASES OF THE ESOPHAGUS
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
The passage of liquids and solids through the esophagus is a purely
muscular act, controlled, after the propulsive usually voluntary start
given to the bolus by the inferior constrictor, by a reflex arc having
connection with the central nervous system through the vagus nerve.
Gravity plays little or no part in the act of deglutition, and alone
will not carry food or drink to the stomach. Paralysis of the
esophagus may be said to be motor or sensory. It is rarely if ever
unassociated with like lesions of contiguous organs.
Motor paralysis of the esophagus is first manifested by inability to
swallow. This is associated with the accumulation of secretion in the
pyriform sinuses (the author's sign of esophageal stenosis) which
overflows into the larynx and incites violent coughing. Motor
paralysis may affect the constrictors or the esophageal muscular
fibers or both.
Sensory paralysis of the esophagus by breaking the continuity of the
reflex arc, may so impair the peristaltic movements as to produce
aphagia. The same filling of the pyriform sinuses will be noted, but
as the larynx is usually anesthetic also, it may be that no cough is
produced when secretions overflow into it.
Etiology.--1. Toxic paralysis as in diphtheria.
2. Functional paralysis as in hysteria.
3. Peripheral paralysis from neuritis.
4. Central paralysis, usually of bulbar origin.
Embolism or thrombosis of the posterior cerebral artery is a
reported cause in two cases. Lues is always to be excluded as the
fundamental factor in the groups 3 and 4. Esophageal paralysis is not
uncommon in myasthenia gravis.
Esophagoscopic findings are those of absence of the normal
resistance at the cricopharyngeus, flaccidity and lack of sensation of
the esophageal walls, and perhaps adherence of particles of food to
the folds. The hiatal contraction is usually that normally
encountered, for this is accomplished by the diaphragmatic
musculature. In paralysis of sensation, the reflexes of coughing,
vomiturition and vomiting are obtunded.
Diagnosis.--Hysteria must not be decided upon as the cause of
dysphagia, until after esophagoscopy has eliminated paralysis.
Dysphagia after recent diphtheria should suggest paralysis of the
esophagus. The larynx, lips, tongue, and pharynx also, are usually
paralyzed in esophageal paralysis of bulbar origin. The absence of the
cricopharyngeal resistance to the esophagoscope passed without
anesthesia, general or local, is diagnostic.
Treatment.--The internist and neurologist should govern the basic
treatment. Nutrition can be maintained by feeding with the
stomach-tube, which meets no resistance to its passage. Should this be
contraindicated by ulceration of the esophagus, gastrostomy should be
Next: Lues Of The Esophagus
Previous: Diverticulum Of The Esophagus