66. dysphagia

Question 1

differentials dysphagia

Answer 1

oesophageal ca
achalasia
oesophagitis
oesophageal candida
Pharyngeal pouch
Systemic sclerosis
Myasthenia gravis

Question 2

history taking dysphagia?

Answer 2

PC: dysphagia- how long for? come and go or constant? has it got progresisvely worse or same from onset? food and or liquids?

Associated symptoms: pain on swallowing, vomiting- blood?, weight loss, heart burn, history of GORD, noticed bad breath? hoarse voice? melena? weight loss?

other muscles weak eg eyelids, breathing (thinking MD). skin changes swelling of fingers, raynauds (thinking systemic sclerosis)

MHx: GORD
DHx: ALCOHOL, smoking

Question 3

which causes of dysphagia may have pain

Answer 3

oesophageal rupture
achalasia

Question 4

pathophysiology achalasia

Answer 4

a failure of smooth muscle fibres to relax, which can cause the lower esophageal sphincter to remain closed.

failure of distal oesophageal inhibitory neurones

Question 5

most impirtant test achlasia

Answer 5

oesophageal manometry
excessive LOS tone which doesn’t relax on swallowing
considered the most important diagnostic test

Question 6

management achlasia

Answer 6

pneumatic (balloon) dilation

is increasingly the preferred first-line option
less invasive and quicker recovery time than surgery
patients should be a low surgical risk as surgery may be required if complications occur

Question 7

specific feature pharyngeal pouch

Answer 7

halitosis