CBL 1 DYSPHAGIA :

ANS 3 : Lose weight because you are not getting enough food or liquid. because y
ou are having difficulty swallowing,
Having to cut food into smaller pieces or avoiding certain foods because of trou
ble swallowing.
Loss of weight can be a sign of either severe dysphagia or a malignant tumor.
ANS 1 : Dysphagia means the patient has difficulties swallowing; it is usually c
aused by nerve or muscle problems.
ANS 4 : The esophagus is a 25-cm long muscular tube that connects the pharynx to
the stomach. The length of the esophagus at birth varies between 8 and 10 cm an
d measures about 19 cm at age 15 years.
ANS 5 : The oesophagus is 23-37 cm long with a diameter of 1-2 cm and is divided
into three parts:
cervical:continuous with the oropharynx, commences at the lower border of cricoid
cartilage (at level of C5/6) or cricopharyngeus muscle
thoracic:from thoracic aperture(T1) to the oesophageal hiatus(T10)
abdominal:from oesophageal hiatus and is continuous with the cardia of the stomac
h at the gastro-oesophageal junction
ANS 2 : Dysphagia may occur after a throat , head and neck cancer and mouth canc
er.
Dysphagia may occur after a stroke, throat and mouth cancer, gastroesophageal re
flux disease (GERD), or as a symptom of several different neurological disorders
.
There are two types of dysphagia: oropharyngeal and esophageal
If untreated, dysphagia can lead to aspiration pneumonia
Symptoms can include drooling, hoarsness and unexplained weight loss
The water-swallow test is one way of diagnosing dysphagia.
Dysphagia can eventually result in dangerous levels of malnutrition and dehydrat
ion

Causes of dysphagia
Some snake venom can cause dysphagia.Possible causes of dysphagia can include:
Aging - the muscles used in swallowing naturally become weaker and may cause swa
llowing problems in very old age. Patients should get help, because there is tre
atment for age-related dysphagia
Amyotrophic lateral sclerosis (motor neuron disease) - an incurable form of prog
ressive neurodegeneration - over time the nerves in the spine and brain progress
ively lose function. In the case of motor neuron disease, motor neurons - a type
of nerve cells - are affected
Bell's palsy - either weakness or paralysis of the muscles on one side of the fa
ce due to malfunction of the facial nerve
Cerebrovascular stroke - when some brain cells die due to lack of oxygen because
blood flow is impaired
GERD (gastroesophageal reflux disease) - occurs when gastric acid from the stoma
ch goes up into the esophagus, often causing inflammation of the esophagus - eso
phagitis
Eosinophilic esophagitis - severely elevated levels of eosinophils -- a type of
white blood cell - in the esophagus. These eosinophils grow in an uncontrolled m
anner and attack the gastrointestinal system, leading to vomiting and difficulty

with growth and swallowing food

Multiple sclerosis - the central nervous system (CNS) is attacked by the person'
s own immune system, destroying myelin, which protects the nerves
Myasthenia gravis (Goldflam disease) - the muscles under our voluntary control b
ecome easily tired and weak because there is a problem with how the nerves stimu
late the contraction of muscles. Also an autoimmune disorder
Parkinson's disease & Parkinsonism syndromes - Parkinson's disease is a graduall
y progressive, degenerative neurologic disorder which typically impairs the pati
ent's motor skills, speech, writing, as well as some other functions
Radiation - some patients who received radiation therapy (radiotherapy) to the n
eck and head area may have swallowing difficulties
Cleft lip and palate - types of abnormal developments of the face during pregnan
cy - they are types of clefting congenital deformities, due to incomplete fusing
of bones in the head, resulting in gaps (clefts) in the palate and lip to nose
area
Scleroderma - a group of rare chronic autoimmune diseases in which the skin and
connective tissues tighten and harden; it is a progressive disease
Snake venom and other neurotoxins
Some cancers
Xerostomia (dry mouth) - there is not enough saliva to keep the mouth wet.
CBL 2 GERD :
ANS 1 : GERD (Gastroesophageal reflux disease) . (GERD) is a condition in which
the stomach contents leak backwards from the stomach into the esophagus (the tub
e from the mouth to the stomach). This can irritate the esophagus and cause hear
tburn and other symptoms.
ANS 5 : Antacids are agents that neutralize the gastric acid and raise the gastr
ic pH, so are used to treat dyspepsia and are used as symptomatic relief of pept
ic ulcer. Antacids in common use salts of magnesium, aluminium hydroxide and cal
cium carbonate.
Long-term use of antacids can cause side effects in some users. You might experi
ence:
constipation
diarrhea
headaches
nausea
ANS 4 : Lying down soon after eating will make acid reflux worse.It is best to w
ait three hours after eating before going to bed. And stay away from late-night
snacks, too.
Bending , stooping , lying or eating increae the risk for reflux .
Lying down, bending over or bending and lifting can all cause reflux.
The tendency to reflux increases when you are lying down. This is just due to gr
avity.
A large meal remains in the stomach for several hours, increasing the possibilit
y that stomach acid will seep into the esophagus.
ANS 3 : Common risk factors for GERD include the following:
Obesity Extra weight causes extra pressure on the stomach and diaphragm and can re
sult in reflux.
Peptic ulcers cause reflux because food does not move from the stomach to the sm
all intestine efficiently.
Hiatal hernia (also called diaphragmatic hernia) can weaken the lower esophageal
sphincter.
Pregnancy Levels of the hormone progesterone, which increase during pregnancy, can

loosen the lower esophageal sphincter. Also, the growth of the fetus can exert
pressure on the stomach.
Diabetes Some patients who have diabetes also have gastroparesis, a condition in w
hich the stomach takes longer to empty, allowing the contents of the stomach to
reflux. (This also can happen in people whose stomach nerves and/or muscles do n
ot work properly.)
Asthma Researchers are still investigating exactly how asthma increases the risk f
or GERD. In some cases, reflux starts as a result of continuous coughing and pre
ssure in the lungs. Also, some medications prescribed for asthma may loosen the
lower esophageal sphincter.
Connective tissue disorders sometimes cause reflux because thicker muscular tiss
ues keep the stomach muscles from relaxing and contracting properly.
Zollinger-Ellison syndrome is a condition characterized by high levels of stomac
h acid, usually caused by a tumor in the pancreas or small intestine (called a g
astrinoma). Zollinger-Ellison syndrome increases the risk for reflux.
Foods do not cause GERD, but in some people, certain foods can trigger reflux. C
ommon foods that can worsen symptoms include onions, tomato sauce, mint, carbona
ted drinks, chocolate and other foods containing caffeine, as well as spicy food
s and foods with a high fat content. Other triggers include alcohol, smoking, la
rge meals, and lying down too soon after eating.
Some medications and dietary supplements can worsen GERD symptoms. In some cases
, medications interfere with how the lower esophageal sphincter works. Examples
include sedatives, tranquilizers, antidepressants, calcium channel blockers, and
narcotics, among others.
Regular use of certain antibiotics and nonsteriodal anti-inflammatory drugs (NSA
IDs) can increase inflammation of the esophagus, as can iron, potassium, and vit
amin C supplements. A physician or pharmacist can give specific advice on whethe
r a certain medication can affect GERD symptoms.
ANS 2 : the lower espophageal sphincter between the esophagus and the stomach us
ually prevents stomach contents from coming back up.
The prominent smooth muscle of the lower oesophagus acts as a internal phincter
to prevent reflux.
The normal antireflux mechanism consists of several components, any one of whic
h may malfunction and render an individual prone to the development of GERD. The
LES is clearly the most important component because gastroesophageal reflux alm
ost always occurs when the sphincter pressure equals that of the stomach. Usuall
y, an LES pressure of just 2 to 3 mm Hg above intragastric pressure is sufficien
t to prevent reflux.
Furthermore, the unique anatomy of the proximal stomach (e.g., the angle of His,
mucosal flap valve, posterolateral location of the fundus) serves to keep gastr
ic contents away from the gastroesophageal junction, making it less likely for r
eflux to occur when the LES relaxes

Gastroesophageal reflux disease (commonly known as GERD) is a chronic digestive

disease. The condition occurs when stomach acid flows back up from the stomach i
nto the esophagus. In some cases, bile may flow into the esophagus as well. Many
of the uncomfortable and painful signs and symptoms of GERD are caused by the b
ackwash of acid irritating the lining of the esophagus.
The condition is characterized by improper closure of the lower esophageal sphin
cter (LES). The LES is basically a ring of muscles that prevents stomach content

s and acids to move back up into the esophagus, the tube that connects your mout
h to the stomach.
Acid refluxis a condition where the lower oesophageal sphincter (the muscular rin
g at the lower end of the oesophagus) is abnormally relaxed and allows the stoma
ch's acidic contents to flow back or 'reflux' into the gullet (oesophagus).

The main cause of GERD is the chronic failure of the lower esophageal sphincter
(LES) to close after a person has eaten.
TREATMENT : Antacids , Medications to reduce acid production , Medications to bl
ock acid production , Medications to strengthen the lower esophageal sphincter .

SYMPTOMS
There are several common symptoms of GERD, including:
Acid reflux (regurgitating food or sour liquid)
Dry cough
Chest pain
Heartburn (burning feel in the chest and, in some cases, the throat)
A sour taste in the mouth
Difficulty swallowing
Feeling as though there is a lump in the throat
Feeling as though there is food stuck behind the breastbone
Nausea after eating
Hiccups
Sore throat
Hoarseness or changes in the voice
If GERD is not managed well, other complications can arise over time. These incl
ude:
esophageal strictures (scarring of the lining of the esophagus), which reduce th
e diameter of the esophagus and make swallowing difficult
esophagitis , pharyngitis , Barrett's hyperplasia or Barrett's esophagus .
Overweight people are more likely than those with healthy weights to suffer hear
tburn. That s because increased pressure on the abdomen contributes to reflux. Pre
gnant women are also more prone to heartburn, because the LES relaxes in respons
e to the high levels of the hormone progesterone that occur during pregnancy.
Why does stomach acid travel up the oesophagus?
The trouble is caused by the faulty oesophageal sphincter, the muscular ring at
the lower end of the oesophagus, near the diaphragm.
The sphincter is designed to prevent the stomach contents from flowing upward
functions as one-way valve.
If the sphincter does not work properly, stomach acid flows into the oesophagus.
The reflux tendency increases when the stomach contains a lot of gastric juice o
r food and when there is increased pressure in or on the stomach.

it

conditions can cause gastro-oesophageal reflux? Hiatus hernia , Overweight , Pre

gnancy , Meals , Tobacco , Constipation .
What can be done to prevent gastro-oesophageal reflux?
The following changes in lifestyle can reduce the risk of developing reflux:
try to lose weight if you are overweight
avoid large, high-fat meals and bedtime snacks
limit coffee intake
reduce alcohol consumption
stop smoking.
Gastro-oesophageal reflux disorders are mainly treated by medicines that reduce
stomach acid.
This often starts with medicines called proton pump inhibitors such as omeprazol
e (eg Losec), lansoprazole (eg Zoton) or pantoprazole.

CBL 3 : LIVER CIRRHOSIS