6. Dysphagia Flashcards
What is dysphagia?
Difficulty swallowing
What is odynophagia?
Painful swallowing
What is globus?
Sensation of a lump in the throat without dysphagia
What are the differentials for dysphagia?
Functional high dysphagia: Stroke, Parkinson’s
Functional low dysphagia: Achalasia
Structural low dysphagia: Cancer, stricture
What 3 things should you establish in the presenting complaint for dysphagia?
Duration?
Short (days to weeks)= cancer. Longer= chronic motility disorders
Progressive or intermittent?
Progressive= stricture. intermittent= motility disorder
Solids, fluids or both?
What causes of dysphagia occurs usually only with solids?
Strictures (benign or malignant)
What causes of dysphagia occurs with fluids only?
Motility disorders e.g. achalasia
What causes of dysphagia occurs with solids and fluids?
Severe strictures
Cancer
What associated symptoms should you ask about in someone with dysphagia?
Cough Halitosis: pharyngeal pouch Heartburn/ water brash Hoarseness of the voice: laryngeal nerve involvement Gurgling/ dysphonia: pharyngeal pouch FLAWS: cancer Neurological symptoms Rheumatological symptoms
What PMHx is relevant in someone with dysphagia?
GORD
Peptic ulcers
What drugs can contribute to dysphagia?
CCB’s + nitrates: relax smooth muscle
NSAIDs, aspirin, steroids, bisphosphonates: predispose to peptic ulceration
What 5 features are relevant on examination in someone with dysphagia?
Cranial nerve pathology Signs of GI malignancy: virchow's node Neck mass Features of CREST syndrome Koilonychia: severe iron deficiency anaemia
What are 4 of the main investigations for dysphagia?
Barium swallow
Endoscopy
Videofluoroscopy
Manometry
What is new onset dysphagia assumed to be in middle aged to elderly patients until proven otherwise?
Carcinoma
What does CREST syndrome comprise of?
Calcinosis Raynauds Esophageal dysmotility Sclerodactyly Telangiectasia
