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GIR Test 3 > B5.062 Dysphagia > Flashcards

B5.062 Dysphagia Flashcards

1
Q

is dysphagia a disease?

A

no

its an alarm symptom that warrants a prompt evaluation to investigate the cause and initiate therpay

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2
Q

reasons for dysphagia

A

may be due to a structural or motility abnormality in the passage of solid and/or liquids from the oral cavity to the stomach

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3
Q

range of patient complaints regarding dysphagia

A

inability to initiate swallow

sensation of items stuck in esophagus

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4
Q

definition of dysphagia

A

subjective sensation of difficulty or abnormality of swallowing

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5
Q

classification systems related to dysphagia

A 
acute vs nonacute
oropharyngeal vs esophageal
solids, liquids, or both
progressive vs intermittent
structural/mechanical vs motor/motility vs others
associated symptoms
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6
Q

acute dysphagia

A

inability to swallow solids and/or liquids, including secretions, suggests impaction of a foreign body in the esophagus
requires immediate attention

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7
Q

epidemiology of acute dysphagia

A

males > females
increased with age (esp after 70)
meat most common offending agent

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8
Q

odynophagia

A

painful swallowing

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9
Q

possible causes of odynophagia not related to impaction

A

pharyngitis
infectious cold/candida/HSV
pill induced ulcer/abrasion

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10
Q

globus sensation

A

lump in throat feeling
no actual lump
non painful
no dysphagia
typically worse swallowing saliva than food/liquid
not due to structural or motility disorder

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11
Q

questions to ask pts with dysphagia?

A 
initiation or getting stuck?
coughing/choking?
solids, liquids, both?
how long?
location?
other symptoms?
medical problems? surgery? radiation? medications?
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12
Q

symptoms of oropharyngeal dysphagia

A 
difficulty initiating a swallow
coughing
choking
aspiration
regurgitation
drooling, food spillage. sialorrhea, dysarthria
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13
Q

common causes of oropharyngeal dysphagia

A

often neuromuscular dysfunction

  • vagus nerve
  • MS
  • cerebrovascular accident
  • transverse myelitis
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14
Q

oral dysfunctions resulting in dysphagia

A

mastication (cranial nerve involvement)

decreased saliva production

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15
Q

pharyngeal dysfunctions resulting in dysphagia

A

neuromuscular
UES, decreased relaxation
Zenkers

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16
Q

common complaints with esophageal dysphagia

A

difficulty swallowing several seconds after initiation of the swallow
sensation that foods and/or liquids are obstructed/stuck in the passage from upper esophagus to the stomach

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17
Q

classes of mechanical lesions causing esophageal dysphagia

A

intrinsic: occurring within esophagus
extrinsic: outside esophagus but affecting function

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18
Q

solids + liquids dysphagia

A

motor disorder

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19
Q

just solid dysphagia

A

mechanical obstruction

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20
Q

intermittent motor disorder etiologies

A

primary and secondary esophageal motility disorders

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21
Q

progressive motor disorder etiologies

A

scleroderma (chronic heartburn)

achalasia

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22
Q

nonprogressive mechanical obstruction etiologies

A

esophageal ring/ eosinophilic esophagitis

foreign body

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23
Q

progressive mechanical obstruction etiologies

A 
peptic stricture (chronic heartburn)
esophageal/ cardia cancer
24
Q

why would you do a barium swallow instead of an EGD

A

if youre worried about damaging the esophagus

history of prior radiation, caustic injury, surgery for cancer, complex stricture

25
Q

what additional testing is used for dysphagia if motility disorder is suspected

A

esophageal manometry

26
Q

purpose of EGD

A

diagnostic and therapeutic

can view, biopsy, and manipulate/grab

27
Q

when do you do a pre-endoscopy barium esophagram

A

suspect proximal esophageal lesion

known complex stricture

28
Q

when do you do a post-endoscopy barium esophagram

A

after negative EGD if mechanical obstruction is still suspected
lower esophageal rings or extrinsic esophageal compression can be missed on upper endoscopy

29
Q

what is achalasia

A

loss of peristalsis in distal esophagus

incomplete relaxation of LES with swallowing

30
Q

epidemiology of achalasia

A

any age (usually 25-60)
women and men equal frequency
progressively worsening dysphagia of solids and liquids

31
Q

symptoms of achalasia

A

regurgitation and aspiration

chest pain, heartburn, and difficulty belching

32
Q

barium findings in achalasia

A

dilated esophagus terminating in a ‘bird-beak” narrowing
aperistalsis
poor emptying of barium from esophagus

33
Q

what is systemic sclerosis (scleroderma)

A

group of conditions linked by presence of thickened, sclerotic lesions
esophageal involvement in up to 90% of patients

34
Q

esophageal manifestation of scleroderma

A

involves smooth muscle layer, resulting in atrophy and sclerosis of distal 2/3 of esophagus (proximal, striated muscle is normal)

35
Q

symptoms of scleroderma

A

heartburn and progressive dysphagia

secondary to motility abnormality and/or peptic stricture

36
Q

manometry findings in scleroderma

A

absent peristalsis and low/absent LES pressure

37
Q

EGD findings in scleroderma

A

may show erosive esophagitis or peptic stricture from chronic acid reflux

38
Q

causes of esophageal strictures

A

acid reflux, radiation, eosinophilic esophagitis, caustic ingestions, surgical adhesions

39
Q

goal for stricture treatment

A

relief of dysphagia and prevention recurrence

dilation + acid suppression

40
Q

treatment for stricture secondary to acid reflux

A

EGD and dilation performed together

41
Q

treatment of complex stricture

A

barium studies first

if these raise suspicion, diagnostic endoscopy may be required prior to dilation

42
Q

what are esophageal webs/rings

A

thin structures that partially occlude the esophageal lumen
most are asymptomatic but can present with intermittent dysphagia to solids
usually mucosal, rarely musclar

43
Q

how are esophageal webs/rings diagnosed

A

barium or EGD (less sensitive)
webs often rupture during EGD and can be dilated
rings should be biopsied before dilation

44
Q

plummer vinson syndrome

A

triad: iron deficiency anemia, dysphagia, esophageal web

45
Q

Schatzki ring

A

most common esophageal ring

narrow mucosal ring often associated with hiatal hernia

46
Q

esophageal carcinoma

A

presents with rapidly progressive dysphagia (solids only initially)
an achalasia like syndrome (pseudoachalasia) has been described in patients with adenocarcinoma of the cardia due to microscopic infiltration of the myenteric plexus or vagus nerve

47
Q

symptoms of esophageal carcinoma

A 
chest pain
odynophagia
anemia
anorexia
significant weight loss
48
Q

risk factors for esophageal carcinoma

A

alcohol, achalasia, Barrett’s esophagus, cigarettes, diverticula, esophageal web, esophagitis, familial

49
Q

what is eosinophilic esophagitis

A

allergic reaction to food or allergens

all ages

50
Q

symptoms of eosinophilic esophagitis

A 
dysphagia
food impaction
regurg/vomiting
chest/upper abdominal pain
refractory heartburn
51
Q

endoscopic findings in eosinophilic esophagitis

A

stacked circular rings
proximal strictures
whitish papules
increased eosinophils on biopsy

52
Q

treatment for eosinophilic esophagitis

A

elimination diet
steroid
acid suppression

53
Q

functional dysphagia

A

sensation of a solid and/or liquid food sticking or passing abnormally through esophagus
no evidence of mucosal or structural abnormality
no evidence of GERD or eosinophilic esophagitis
no evidence of esophageal motor disorder

54
Q

sjogrens syndrome

A

chronic autoimmune inflammatory disorder
characterized by: decreased lacrimal and salivary gland function
results in dry eyes and mouth

55
Q

how is Sjogrens related to dysphagia

A

3/4 of patients have associated dysphagia
defective peristalsis has been demonstrated in 1/3 of patients with primary Sjogrens
dry mouth exacerbates swallowing discomfort but does not appear to correlate with dysphagia

56
Q

Zenker’s diverticulum

A

false diverticulum

herniation of mucosal tissue at the junction of the pharynx esophagus because of a defect in the muscular wall

57
Q

symptoms of Zenkers

A 
oropharyngeal dysphagia
halitosis
obstruction
regurgitation
aspiration

GIR Test 3 (19 decks)

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