6. Dysphagia Flashcards
What is dysphagia?
Difficulty swallowing
What is odynophagia?
Painful swallowing
What is globus?
Common sensation of a lump in the throat without dysphagia
What are the differentials for dysphagia?
Functional high dysphagia- stroke, parkinsons
Functional low dysphagia- Achalasia
Structural low dysphagia- cancer, stricture
What are neurological causes of dysphagia?
Achalasia, myasthenia gravis, oesophageal spasm
What are structural causes of dysphagia?
Pharyngeal pouch, stricture and oesophageal cancer
What 3 things should you establish in the presentic complain for dysphagia?
Duration- short (days to weeks): cancer, longer: chronic motility disorders
Is it progressive or intermittent- progressive: stricture, intermittent: motility disorder
Does dysphagia occur with solids, fluids or both?
What causes of dysphagia occurs with solids only usually?
Strictures, may be benign or malignant
What causes of dysphagia occurs with fluids only?
Motility disorder like achalasia
What causes of dysphagia occurs with solids and fluids?
Severe strictures, cancer
What associated symptoms should you ask about in someone with dysphagia?
Any pain, halitosis- pharyngeal pouch, cough, regurgitation, hoarseness of the voice- laryngeal nerve involvement, gargling- pharyngeal pouch
FLAWS- cancer
What PMHx is relevant in someone with dysphagia?
GORD and peptic ulcers
What drugs can contribute to dysphagia?
Calcium channel blockers and nitrates- relax smooth muscle
NSAIDs, aspirin, steroids, bisphosphonates- predispose to peptic ulceration
What 5 features are relevant on examination in someone with dysphagia?
Cranial enrve pathology Signs of GI malignancy- virchow's node Neck mass Features of CREST syndrome Koilonychia- suggests severe iron deficiency anaemia
What are 4 of the main investigations for dysphagia?
Barium swallow, endoscopy, videofluoroscopy, manometry
