B5-062 Dysphagia Flashcards
- inability to swallow solids/liquids including secretions
- suggest foreign body impactior or inflammation in esophagus
acute dysphagia
most common offending agent of acute dsyphagia
meat
greater incidence in males over 70
painful swallowing
odynophagia
causes of odynophagia
- pharyngitis
- infections
- pill/corrosive agent
- ulcer/abrasion
- difficulty initiating swallowing
- often neuromuscular dysfunction
oropharyngeal or esophageal
oropharyngeal
- difficulty swallowing several seconds after swallow intiation
- sensation that food/liquid is stuck in passage
oropharyngeal or esophageal
esophageal
may arise from body of esophagus, LES, or cardia
esophageal dysphagia
most common causes of esophageal dysphagia
2 (general)
GERD/esophagitis
functional esophageal disorders
difficulty intiating a swallow associated with coughing, choking, or nasal regurgitation
oropharyngeal dysphagia
what specialties would be involved in management of oropharyngeal dysphagia?
ENT, speech therapy
what specialty would be involved in management of esophageal dysphagia?
GI
- used to view, biopsy, and manipulate/grab
- can be utilized to biopsy, remove foreign body, stop bleeding, inject air or fluid, dilate, surgery, and laser
EGD
when would a pre-endoscopy barium esophagram be used as the intial test?
- proximal esophageal lesion suspected
- known stricture
when is a post endoscopy barium esophagram used?
after negative EGD when obstruction still suspected
what test is done if motility disorder is suspected/EGD is negative for structural issues
esophageal manometry
- measures the rhythmic contractions when swallowing
- measures coordination and force extered on muscles
esophageal manometry
- loss of peristalsis in distal esophagus
- incomplete relaxation of LES with swallowing
achalasia
see a dilated esophagus with “bird beak” narrowing on barium esophagram
achalasia
use esophageal manometry to confirm dx
- progressively worsening dysphagia of solids/liquids
- regurgitation and aspiration
achalasia
group of conditions linked by presence of sclerotic lesions
Calcinosis
Raynauds
Esophageal dysfunction
Sclerodactyly
Telangiectasias
- manometry: absent peristalsis, low/absent LES pressure
- EGD may show erosive esophagitis or peptic stricture
systemic sclerosis
may be related to recurrent esophagitis or Barrett’s esophagitis
esophageal stricture
iron deficiency anemia, dysphagia, esophageal web
Plummer-Vinson syndrome
narrow mucosal ring often associated with hiatal hernia
Schatzki ring
most common esophageal ring
patients younger than 50 with no other worrisome symptoms should be treated with
four week trial of acid suppression
recommended for initial assessment of patients with esophageal dysphagia
EGD
accurate diagnosis of eosinophilic esophagitis should include a
biopsy
characterized by decreased lacrimal and salivary gland function
Sjogrens Syndrome
defective peristalsis
xerostomia
dry eyes
Sjogrens
pharyngoesophageal false diverticulum
Zenker’s
oropharyngeal dysphagia
halitosis
obstruction
regurgitation
aspiration
zenker’s diverticulum
sensation of solid/liquid sticking or passing abnormally through esophagus without evidence of other diseases
functional dysphagia
diagnosed using Rome criteria
stacked circular rings
proximal strictures
whitish papules
on endoscopy
eosinophilic esophagitis
rapidly progressive dyphagia
chest pain
odynophagia
anemia
anorexia
significant weight loss
esophageal carcinoma
esopheageal carcinoma in the upper and middle of esophagus is
cell type
squamous cell
esopheageal carcinoma in the lower 1/3 of esophagus is
cell type
adenocarcinoma
difficulty generating speech
dysphasia
sensation of lump, retained food bolus, or tighness in throat not due to underlying disorder
globus sensation
painful swallowing
odynophagia
“bird-beak” sign on barium esophagram
achalasia
“corkscrew” sign on barium esophagram
distal esophageal spasm
stacked circular rings
eosinophilic esophagitis
plummer vinson triad
iron deficiency anemia
dysphagia
esophageal webs
treatment of Plummer Vinson
increased iron intake
dilation of esophageal rings
metaplastic columnar epithelium replaces the squamous epithelium of the distal esophagus as a result of chronic irritation
Barrett’s esophagus
chronic multisystem disease of progressive fibrosis of the skin and internal organs and widespread vascular dysfunction
systemic sclerosis
dysphagia
heartburn
episodic pseudo-obstruction
systemic sclerosis
most prevalent esophageal cancer worldwide
squamous cell carcinoma
cancer in middle and upper portion of esophagus is
squamous cell carcinoma
GERD and Barretts often precipitate what kind of cancer?
adenocarcinoma
false posterior diverticula of the esophagus at junction of pharynx and esophagus
zenker’s diverticulum
progressive degeneration of ganglion cells in myenteric plexus of the esophageal wall which leads to failure of relaxation of the LES and loss of peristalsis in distal esophagus
achalasia
begins in the mucus secreting glands of the distal esophagus often after chronic irritation from GERD/Barrett’s
esophageal adenocarcinoma
results from direct esophageal mucosal injury from abrasion or caustic effects of medication
pill esophagitis
stacked concentric circular rings
eosinophilic esophagitis
opportunistic infection that can cause odynophagia and dysphagia, as well as oral and esophageal thrush
oral candidiasis
cause intermittent dysphagia
esophageal webs
thin mucosal folds that protrude into esophageal lumen
esophageal webs
