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Difficulty Swallowing Intro
吞咽困难的介绍
When a patient says they are having difficulty swallowing, they may be referring to one or a combination of the following symptoms:
当患者说他们吞咽困难时，他们可能指的是以下症状的一个或组合症状：
- Dysphagia, which means food is unable to pass through smoothly or gets stuck.
-吞咽困难，这意味着食物无法顺利通过喉咙或卡住。
- Odynophagia, which means that swallowing is painful.
-吞咽痛，意思就是吞咽导致疼痛。
- Reflux and regurgitation, which means food or gastric secretions come back into the throat or mouth.
-反流，意味着食物或胃分泌物回到喉咙或嘴巴里。
- Aspiration, in which the food or drink goes down the trachea instead of the esophagus.
-吸入，食物或饮料送入气管而不是食道。
This can further lead to aspiration pneumonia.
这可能进一步导致吸入性肺炎。
- Gagging, in which patient may feel that the food is causing them to throw up and vomit.
-呕吐，病人可能会感到食物导致他们呕吐。
- Globus pharyngeus: a feeling of a lump in the throat.
-咽部异感症：感觉到喉咙被卡住。
- Xesrostomia, it means dry mouth which may itself lead to dysphagia or odynophagia.
-口干症，指口腔干燥，可能导致吞咽困难或吞咽疼痛。
Our main goal in this presentation is to discuss an approach to a patient with dysphagia, it's relevant history and workup, and what are the main differentials and some general management options for dysphagia.
我们这个报告的主要目的是讨论吞咽困难患者的治疗方法、相关的病史和检查，以及吞咽困难的主要区别和一些一般的治疗选择。
Many specialists have to deal with patients of dysphagia, such as Otorhinolaryngologists, gastroenterologists, speech therapists, dentists, internists and geriatricians to name a few.
许多专科医生都要与吞咽困难的病人打交道，例如耳鼻喉科医生、肠胃科医生、语言治疗师、牙医、内科医生和老年科医生等。
Dysphagia is a fairly common cause of morbidity in the elderly population.
吞咽困难是老年人发病的一个相当常见的原因。
The swallowing mechanism
吞咽机制
Let's begin by reviewing the physiology of the swallowing mechanism.
我们先来回顾一下吞咽机制的生理学。
It is generally divided into three phases:
它通常分为三个阶段：
Oral phase, in which the food is chewed and lubricated to form a bolus.
口腔阶段，在这一阶段，食物被咀嚼和润滑，形成团状物。
Pharyngeal phase, in which the movements of the soft palate, larynx and epiglottis separate the air passage from the food passage so that food and drink are not aspirated into the nose or trachea.
咽部阶段，软腭、喉部和会厌的运动将气道与食物通道分开，这样食物和饮料就不会被吸入鼻子或气管。
Esophageal phase, in which the food passes down the esophagus, via peristalsis, into the stomach.
食道期，食物通过蠕动沿食道向下进入胃。
A disruption in any one of these phases could result in dysphagia and difficulty in the pharyngeal phase especially could lead to aspiration.
这些阶段中的任何一个阶段的中断都可能导致吞咽困难，尤其是咽部阶段的困难可能导致误吸。
Classification of Dysphagia
吞咽困难的分类
Dysphagia is classified according to site, whether it is oropharyngeal or esophageal, and the type of disorder, whether it is a structural disorder or a motility/propulsive disorder.
吞咽困难按部位分类，是口咽还是食管，以及障碍类型，是结构性障碍还是动力/推进性障碍。
The differential diagnosis for dysphagia could also be divided according to the cause: Congenital, Infections, Trauma, Inflammatory, Autoimmune, Neoplastic, Neurological, Motility disorders, Iatrogenic, and Mechanical causes.
吞咽困难的鉴别诊断也可以根据病因分为：先天性、感染、创伤、炎症、自身免疫、肿瘤、神经、运动障碍、医源性和机械原因。
History and Workup
病史和检查
So as you have seen, a multitude of conditions can cause dysphagia.
如你所见，很多情况都会导致吞咽困难。
When a patient presents with difficulty swallowing, here are a few important points to consider in taking the patient's history: - Is it true dysphagia?
当患者出现吞咽困难时，在记录患者病史时需要考虑以下几个要点：真的是吞咽困难吗？
Or other related problem like odynophagia, etc.
还是其他相关问题，比如食欲不振等等。
- What is the onset and duration?
-发作时间和持续时间是什么？
- Any coughing or airway issues?
-有咳嗽或呼吸道问题吗？
To check for aspiration.
检查是否有误吸。
- Is it continuous, worsening or intermittent?
-它是持续的、日益恶化的还是间歇性的？
- What is the location?
-位置在哪里？
Is it oropharyngeal or esophageal dysphagia?
是口咽部还是食道部吞咽困难？
- Is it more for solid food or liquids?
-是固体食物还是液体食物出现吞咽困难？
- Is there associated regurgitation or reflux?
-是否有相关的反流？
- Does the patient have Pain? Weight loss? And/or dehydration?
-病人有哪里表现出疼痛吗？体重减轻了吗？有脱水症状吗？
This is to assess the general condition of the patient.
这是为了评估病人的一般情况。
