|VIEW THE MOBILE VERSION of www.homemedicine.ca|| Informational|
If pneumonia or gonorrhea is supposed to be the cause of the ...
Additional Rules For The Treatment Of Eruptive Diseases
In all these eruptive diseases, especially small-pox, all I h...
Demonstrations Of The Nature Of Congenital And Infantile Inguinal Herniae And Of Hydrocele
PLATE 39. Fig. 1--The descent of the testicle from the loins ...
There are cases in which the outer skin has been taken off by ...
Dripping Sheet Substitute For The Half-bath
To apply the _dripping sheet_, a tin bathing hat or a large w...
The use of these to give temporary relief, often degenerating ...
Those of our readers who have followed out in practice the sug...
Physical Signs Of Bronchial Foreign Body
In most cases there will be limitation of expansion on the in...
The Relative Position Of The Cranial Nasal Oral And Pharyngeal Cavities
On making a section (vertically through the median line) of t...
The Surgical Dissection Of The Male Bladder And Urethra Lateral And Bilateral Lithotomy Compared
Having examined the surgical relations of the bladder and adj...
Asphyxia Suspended Animation
Use B D current, pretty strong force. Place P. P. at back of ...
Bronchoscopic Appearances In Disease
The first look should note the color of the bronchial mucosa...
Punctures Case Iv
The present case is somewhat more severe than those which hav...
The Fulcrum Of The Bronchoscopic Lever Is At The Upper Thoracic Aperture
Disregard of this rule will cause subglottic edema and will ...
List Of Instruments
The following list has been compiled as a convenient basis f...
Aortic Stenosis Aortic Obstruction
Valvular disease at the aortic orifice is much less common th...
Extraction Of Soft Friable Foreign Bodies From The Tracheobronchial Tree
The difficulties here consist in the liability of crushing or...
The Sitz-bath May Be Taken In A Small Wash-tub If There Is No
proper sitz-bath-tub at hand. It should be large enough to allo...
What is commonly called a "cough and spit" is sometimes due to...
If the case be recent, take the B D current; if old, take A D...
Spasmodic Stenosis Of The Esophagus
Category: DISEASES OF THE ESOPHAGUS
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
Etiology - The functional activity of the esophagus is dependent upon
reflex action. The food is propulsed in a peristaltic wave by the same
mechanism as, and through an innervation (Auerbach and Meissner
plexus) similar to that which controls intestinal movements. The vagus
also is directly concerned with the deglutitory act, for swallowing is
impossible if both vagi are cut. Anything which unduly disturbs this
reflex arc may serve as an exciting cause of spasmodic stenosis.
Bolting of food, superficial erosions, local esophageal disease, or a
small foreign body, may produce spasmodic stenosis. Spasm secondary to
disease of the stomach, liver, gall bladder, appendix, or other
abdominal organ is clinically well recognized. A perpetuating cause in
established cases is undoubtedly nerve cell habit, and in many cases
there is an underlying neurotic factor. Shock as an exciting cause has
been well exemplified by the number of cases of phrenospasm developing
in soldiers during the World War.
Cricopharyngeal spasmodic stenosis usually presents the subjective
symptom of difficulty in starting the bolus of food downward. Once
started, the food passes into the stomach unimpeded. Regurgitation, if
it occurs, is immediate. The condition consists in a tonic
contraction, ahead of the bolus, of the circular fibers of the
inferior constrictor known as the cricopharyngeus muscle, or in a
failure of this muscle to relax so as to allow the bolus to pass. In
either case the disorder may be secondary to an organic lesion. Local
malignant disease or foreign bodies may be the cause. Globus
hystericus, lump in the throat, and the sense of constriction and
choking during emotion are due to the same spasmodic condition.
Diagnosis - At esophagoscopy there will be found marked exaggeration
of the usual spasm which occurs at the cricopharyngeus during the
introduction of the tube. The lumen may assume various shapes, or be
so tightly closed that the folds form a mammilliform projection in the
center. If the spasm gradually yields, and a full-sized esophagoscope
passes without further resistance, it may be stated that the esophagus
is of normal calibre, and a diagnosis of spasmodic stenosis can be
made. Considerable experience is required to distinguish between
normal and pathologic spasm in an unanesthetized individual. To the
less experienced esophagoscopist, examination under ether anesthesia
is recommended. Deep anesthesia will relax the normal cricopharyngeal
reflex closure as well as any abnormal spasm, thus assisting in the
differentiation between an organic stricture and one of functional
character. Under deep general anesthesia, however, it is impossible to
differentiate between the normal reflex and a spasmodic condition,
since both are abolished. Many cases of intermittent esophageal
stenosis supposed to be spasmodic are due to organic narrowness of
lumen plus lodgement of food, obstructive in itself and in the
esophagitis resulting from its presence. The organic narrowing,
congenital or pathologic, is readily recognizable esophagoscopically.
Treatment.--The fundamental cause of the disturbance of the reflex
should be searched for, and treated according to its nature. Purely
functional cases are often cured by the passage of a large
esophagoscope. Recurrences may require similar treatment.
Next: Functional Hiatal Stenosis Hiatal Esophagismus Phrenospasm Diaphragmatic Pinchcock Stenosis
Previous: Diffuse Dilatation Of The Esophagus