APPROACH TO DYSPHAGIA Flashcards
Common causes of dysphagia
Benign- peptic stricters
Motility disorders (achalasia)
Diverticulae (e.g Zenkers)
Malignant- oesophageal cancer
Extrinsic compression (thyroid/ other neck masses)
Types of oesophageal cancer
Squamous cell carcinoma
Adenocarcinoma
11 SCC risk factors
Alcohol
Smoking
Achalasia
Tylosis
Caustic injury
Radiation
Poor oral health
Low socioeconomic conditions
Poor diet
Plummer- Vinson syndrome
Prev head/neck SCC
8 Adenocarcinoma risk factors
Obesity
GORD
Males
Family history
Diet: low in fruit and veg
Radiation
Smoking
Increased age
- CXR findings in dysphagia
Bulky superior mediastinal silhouette (may see air fluid level if oesophagus dilated)
Pleural collection
Pulmonary nodules (metastases)
Pulmonary infiltrates/ opacification (aspiration/TOF)
Barium swallow in dysphagia 5
Mucosal irregularity
Irregular stricture with proximal dilatation of the oesophagus
Shouldering / Obvious mass lesions
Presence of TOF
Look for features of irresectability(advanced disease)
Features of irresectability(advanced disease) in dysphagia
Length> 8cm
Angulation > 30 degrees
Axis deviation > 2cm
Fistulae
Sinuses / Fissuring
4 Investigations in dysphagia
CXR
Barium swallow
Flexible endoscopy + biopsy
Endoscopic ultrasound
2 Endoscopic ultrasound indications
For T-stage evaluation (Depth of invasion through oesophageal wall)
May also be used to sample suspicious lymphadenopathy
SCC
Proximal 2/3 of oesophagus
Lymphatic spread to cervical, mediastinal and abdominal nodes
Spreads in linear fashion (submucosal)
Adenocarcinoma
Distal 1/3 and gastric cardia involved
Associated with GERD, Barrett’s
Spread transversely through the wall
Palliation for advanced oesophageal cancer
- Endoscopic -dilation, stent
- RadioXT- Intraluminal/ Brachy/ Selectron/ ext beam radiation
3.Operative- stent, surgical bypass
- Analgesia
- Dietary modification
Peptic stricture Ix
Barium swallow (to check extent of stricture)
Endoscopy and biopsy (to exclude malignancy)
Peptic stricture Mx
Manage reflux with PPIs
Progressive dilation
Oesophagectomy only in pts with failed dilation
Achalasia Ix
CXR
Ba swallow
Endoscopy
Manometry
Achalasia treatment modalities (5)
1.Medical Treatment
2.Endoscopic Botox Injection
3.Pneumatic (Balloon) Dilatation
4.Surgical Myotomy
5.Peoral Endoscopic Myotomy (POEM)
7 NEUROMUSCULAR causes of dysphagia
CVA
Parkinson’s
Brain stem tumours
Multiple sclerosis
Huntington’s
Post infectious - polio, syphilis
Myasthenia gravis
Myopathies - muscular dystrophy, myositis
7 STRUCTURAL ABNORMALITIES that cause Oreo pharyngeal dysphagia
Oropharyngeal neoplasms
Extrinsic compression - thyroid disease, cervical osteophytes, neck/mediastinal masses
Inflammatory masses
Trauma
Zenkers diverticulum
Oesophageal webs
Foreign body
2 intraluminal causes of dysphagia
Foreign body
Polypoid tumour
10 Intramural causes of oesophageal dysphagia
Benign stricture - GORD, caustic, radiotherapy
Malignant stricture
Tumour
Oesophagitis
Oesophageal spasm
Scleroderma
Oesophageal diverticula
Webs - Plummer-Vinson
Schatzki ring
Achalasia and other motility elisorders
5 extramural causes of oesophageal dysphagia
Mediastinal lymph nodes
Rolling hiatus hernia
Retrosternal goitre
Bronchial carcinoma
Vascular compression- Thoracic aortic aneurysm, Enlarged left atrium, aberrant vessels (dysphagia lusoria - aberrant right subclavian)
