[9] Dysphagia Flashcards
How long is the oesophagus?
25cm
How long is the distance from the oesophageal junction to the lips?
40cm
Where does the oesophagus start?
At the level of the cricoid cartilage (C6)
Where does the oesophagus lie in the neck?
In the visceral column
Where does the oesophagus run after the neck?
In the posterior mediastinum
Where does the oesophagus pass through the diaphragm?
At the right crus of the diaphragm, at T10
How long does the oesophagus continue in the abdomen before entering the cardia?
2-3 cm
Where are the locations of narrowing of the oesophagus?
Level of cricoid
Posterior to left main bronchus and aortic arch
Lower oesophageal sphincter
What is the oesophagus divided into?
3rd
What do the divisions of the oesophagus represent?
Change in musculature, from striated, to mixed, to smooth
What is the oesophagus lined by?
Non-keratinising squamous epithelium
What is the Z-line?
Transition from squamous epithelium to gastric columnar
What are the categories of causes of dysphagia?
Inflammatory
Neurological/motility disorders
Mechanical obstruction
What are the inflammatory causes of dysphagia?
Tonsillitis or pharyngitis
Oesophagitis
Oral candidiasis
Apthous ulcers
Give two examples of causes of oesophagitis
GORD
Candida
What are the local neurological/motility causes of dysphagia?
Achalasia
Diffuse oesophageal spasm
Nutcracker oesopahgus
Bulbar/pseudobulbar palsy
What can cause a bulbar/pseudobulbar palsy?
CVA
Motor neurone disease
What are the systemic neurological causes of dysphagia?
Systemic sclerosis
Myasthenia gravis
What are the categories of mechanical oesophagus obstruction?
Luminal
Mural
Extra-mural
What can cause luminal obstruction of the oesophagus?
Foreign body
Large food bolus
What can cause mural obstruction of the oesophagus?
Benign strictures
Malignant strictures
Pharyngeal pouch
What can cause benign oesophageal strictures?
Web, e.g. Plummer Vinson
Oesophagitis
Trauma, e.g. OGD
Where can malignant strictures occur causing dysphagia?
Pharynx
Oesophagus
Stomach
What are the extra-mural causes of oesophageal obstruction?
Retrosternal goitre Rolling hiatus hernia Lung cancer Enlarged mediastinal lymph nodes Thoracic aortic aneurysm
Give an example of something that can cause enlarged mediastinal lymph nodes
Lymphoma
How is dysphagia investigated?
Upper GI endoscopy
Ba swallow
Manometry
What is a pharyngeal pouch also known as?
Zenker’s Diverticulum
What is a pharyngeal pouch?
An outpouching between crico- and thyro-pharyngeal components of the inferior pharyngeal constrictor
What is the area of weakness where a pharyngeal pouch can form called?
Killian’s dehiscence
In what direction does a pharyngeal pouch occur?
The defect usually occurs posteriorly, but the swelling usually bulges to the left side of the neck
How does a pharyngeal pouch lead to dysphagia?
Food debris leads to pouch expansion, which leads to oesophageal compression and therefore dysphagia
How does pharyngeal pouch present?
Regurgitation
Hallitosis
Gurgling sounds
How is a pharyngeal pouch managed?
Excision
Endoscopic stapling
How does diffuse oesophageal spasm present?
Intermittent severe chest pain, with or without dysphagia
What does barium swallow show in diffuse oesophageal spasm?
Corkscrew oesophagus
How does nutcracker oesophagus present?
Intermittent dysphagia, with or without chest pain
What happens in nutcracker oesophagus?
There is an increase in contraction pressure of the oesophagus, with normal peristalsis
What is Plummer-Vinson syndrome?
When severe iron deficiency anaemia leads to hyperkeratinisation of the upper 3rd of the oesophagus, leading to web formation
Why is Plummer-Vision syndrome significant?
It is a pre-malignant condition q
What is the risk that Plummer-Vision syndrome will develop into SCC?
20%
What are the causes of oesophageal rupture?
Iatrogenic Violent emesis Carcinoma Caustic ingestion Trauma
What % of cases of oesophageal rupture are iatrogenic?
85-90%
What are the iatrogenic causes of oesophageal rupture?
Endoscopy
Biopsy
Dilatation
What is it called when the oesophagus ruptures due to emesis?
Boerhaave’s syndrome
What are the clinical features of oesophageal rupture?
Odonophagia
Mediastinitis
Surgical emphysema
What are the symptoms of mediastinitis?
Tachypnoea
Dyspnoea
Fever
Shock
How is iatrogenic oesophageal rupture managed?
PPI
NGT
Abx
How is oesophageal rupture managed when it the cause is not iatrogenic?
Resus PPI ABx Antifungals Debridement and formation of an oesophago-cutaneous fistula
