Dysphagia

Headache, abdominal pain, arthralgia, recurrent bone pain, nausea, diarrhea, esophageal ulceration, dysphagia... 

Adverse reactions with the bisphosphonates include nausea, diarrhea, increased or recurrent bone pain, headache, dyspepsia, acid regurgitation, dysphagia, and abdominal pain. 

ISPHOSPHONATES The nurse monitors the patient taking the bisphosphonates for any adverse reactions such as nausea, diarrhea, increased or recurrent bone pain, headache dyspepsia, acid regurgitation, dysphagia, and abdominal pain. Analgesic maybe administered for headache Notify the primary health care provider of adverse reactions such as the return of bone pain or severe diarrhea... 

Lawrence WH, Partyka EK. 1981. Chronic dysphagia and trigeminal anesthesia after trichloroethylene exposure. Arm Intern Med 95 710. 

More specific diagnostic tests may be warranted in patients not responding to empiric (prescription) therapy, those with complicated or alarm symptoms (e.g., weight loss or dysphagia), or those with long-standing symptoms who are at risk for Barrett s esophagus. 

Educate patients about symptoms that suggest the presence of complications requiring immediate medical attention, such as dysphagia or odynophagia. 

A = Autonomic symptoms (drooling, constipation, sexual dysfunction, urinary problems, sweating, orthostatic hypotension, dysphagia)... 

Less common—hoarseness, dysphagia, dizziness, headache, lethargy, chest pain... 

Dysphagia Painful or difficult swallowing, accompanied by a sensation of food being stuck in passage. 

TABLE 45-1 a-Synuclein diseases Idiopathic Parkinson s disease Dementia with Lewy bodies Pure autonomic failure REM sleep behavior disorder Lewy body dysphagia Incidental Lewy body disease Inherited Lewy body diseases Multiple system atrophy... 

Lewy body pathology is also the defining feature of several other, rarer diseases, such as Lewy body dysphagia and pure autonomic failure. In these diseases, Lewy bodies and neurites are largely limited to the enteric and peripheral nervous systems. In Parkinson s disease, Lewy body pathology is also present in the enteric and autonomic nervous systems. 

Hypothyroidism commonly occurs months to years after RAI. The acute, short-term side effects include mild thyroidal tenderness and dysphagia. Long-term follow-up has not revealed an increased risk for development of thyroid carcinoma, leukemia, or congenital defects. 

Further diagnostic evaluation should be performed in those who do not respond to therapy, who present with alarm symptoms (e.g., dysphagia, weight loss), or who have long-standing GERD symptoms. 

Accessory symptoms include seborrhea, sialorrhea, hyperhidrosis, fatigue, dysphagia, and dysarthria. A variant is rabbit syndrome, a perioral tremor. 

Miller, C.D. et al., Procainamide-induced myasthenia-like weakness and dysphagia, Ther. Drug Monit., 15, 251, 1993. 

Besides drugs, other conditions that can lead to mouth dryness are radiation against the neck, fever, concomitant diseases such as rheumatoid arthritis and other connective tissue diseases (scleroderma, sicca syndrome), Parkinson s disease, numeral psychiatric conditions and stroke with paralysis, dysphagia, neglect or oral apraxia. Damage to the mouth can arise due to drug treatment through different mechanisms and here are some examples. 

Huntington s disease, an autosomal dominant disorder, has a mean age-of-onset of 43-48 years. Symptoms appear gradually and worsen over a period of about 15 years until death occurs. Mood disturbance, impaired memory, and hyperrefiexia are often the first signs, followed by abnormal gait, chorea (loss of motor control), dystonia, dementia, and dysphagia. Cases of juvenile onset (<10 years old) are more severe and most frequently occur when the defective allele is inherited paternaily. About 25% of cases have late onset, slower progression, and milder symptoms. 

The onset of botulism occurs generally between 18 and 36 hours after consumption of food products containing botulin toxin. However, it may affect patients earlier or later, even on the tenth day after food consumption. The first symptoms include stomach ache, nausea, vomiting, and diarrhea, followed by neurological disorders. Other symptoms include, skin, mouth and throat dryness, diplopia, blurred vision, dysphonia, dysarthria, dysphagia, and peripheral weakness. In lethal cases of botulism, respiratory muscles are involved. This leads to respiratory failure and death. Because all the symptoms are connected with toxemia, the first step of medical treatment is to provide a patient with antiserum. 

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