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Some years back my 70 years old mother came from the family ...
List Of Instruments
The following list has been compiled as a convenient basis f...
The Surgical Dissection Of The Wrist And Hand
A member of such vast importance as the human hand necessaril...
Leucorrhoea And Prolapsus Uteri - Whites Female Weakness
The disease depends in all cases upon _inflammation_ of the u...
THE ability to be easily and heartily amused brings a wholeso...
Breast Sore Nipples On
Take a little warm vinegar or weak acid (see Acetic Acid). Bat...
Breast Swelling In
A blow on the breast, or the drain of nursing a child, along w...
Technic Of Bronchoscopy
Local anesthesia is usually employed in the adult. The patien...
Other Bad Symptoms
These symptoms may present themselves with the rash standing ...
The wet compress on the throat in torpid cases should not be ...
Preparation Of The Patient For Peroral Endoscopy
The suggestions of the author in the earlier volumes in regar...
Sprains Or Racks
A sprain is usually the result of some involuntary stress comi...
Punctures Case V
Mr. Cocking's son, aged 12, received a stab in the palm of th...
Of Punctures Etc
In cases of recent punctured wounds the orifice and surroundi...
Breath And Blood
Often difficulty of breathing, especially in close air, mistak...
This arises generally, from inflammation of the mucous membra...
Disturbances Of The Heart In General
Of prime importance in the treatment of diseases of the hea...
See Armpit Swelling and Bone. ...
It is customary to locate esophageal lesions by denoting the...
A little oil only should be applied to the skin at once. Any s...
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
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