TABLE 92 Dysphagia

Process and Problem Timing

Factors That Aggravate

Factors That Relieve

Associated Symptoms and Conditions

Transfer Dysphagia, due to motor disorders affecting the pharyngeal muscles

Acute or gradual onset and a variable course, depending on the underlying disorder

Esophageal Dysphagia

Mechanical Narrowing

■ Mucosal rings and webs Intermittent

Esophageal stricture

■ Esophageal cancer

Motor Disorders

■ Diffuse esophageal spasm

Scleroderma

Achalasia

Intermittent, may become slowly progressive

May be intermittent at first; progressive over months

Intermittent

Intermittent, may progress slowly

Intermittent, may progress

Attempts to start the swallowing process

Solid foods Solid foods

Solid foods, with progression to liquids

Solids or liquids

Solids or liquids Solids or liquids

Regurgitation of the bolus of food

Regurgitation of the bolus of food

Regurgitation of the bolus of food

Maneuvers described below; sometimes nitroglycerin

Repeated swallowing, movements such as straightening the back, raising the arms, or a Valsalva maneuver (straining down against a closed glottis)

Aspiration into the lungs or regurgitation into the nose with attempts to swallow. Neurologic evidence of stroke, bulbar palsy, or other neuro-muscular conditions

Usually none

A long history of heartburn and regurgitation

Pain in the chest and back and weight loss, especially late in the course of illness

Chest pain that mimics angina pectoris or myocardial infarction and lasts minutes to hours; possibly heartburn

Heartburn. Other manifestations of scleroderma

Regurgitation, often at night when lying down, with nocturnal cough; possibly chest pain precipitated by eating

TABLE 9-3 m Constipation

Problem

Process

Associated Symptoms and Setting

Life Activities and Habits

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