some clinical features that may be associated with dysphagia include:
coughing and choking while or soon after eating or drinking
wet sounding voice associated with eating
chest congestion after eating or drinking
slow eating
a single mouthful of food taken in as multiple swallows
extra effort while chewing or swallowing
tiredness while eating
rise of temperature thirty minutes to an hour after eating
weight loss
change in laryngeal sensation
food coming out of the nose
pain while swallowing
feeling of a lump in the throat
recurrent pneumonia
the folowing specific points in the history obtained about a dysphagic patient are also diagnostically helpful:
regarding the swallowing of fluid:
if the patient can swallow fluid as quickly as usual but has difficulty with food apparently getting stuck, then suspect a stricture. It may be benign or malignant.
if the patient cannot swallow fluid as quickly as usual, then this suggests that there is either a motility disorder such as achalasia, a neurological disorder, or a severely narrowed oesophageal lumen
if the neck bulges or gurgles on drinking, then suspect a pharyngeal pouch
regarding the movement of swallowing
if constant and painful then suspect a malignant stricture
the rapidity of onset is important - see aetiology
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