Clinical- Dysphagia

Question 1

Define “dysphagia”

Answer 1

difficulty swallowing due to malfunctioning oropharyngeal or esophageal transport of food

Question 2

What are the 3 main causes of dysphagia?

Answer 2

1. oropharyngeal- bad transfer of a food bolus from the oropharynx to the esophagus
2. mechanical- anatomically compromised esophageal lumen
3. motor- motility disorder

Question 3

Why might solid food cause dysphagia but liquid food not cause dysphagia?

Answer 3

mechanical obstruction

Question 4

What might be the cause if there is dysphagia with both solid and liquid food?

Answer 4

Neuromuscular disorder

Question 5

This is the first test that should be done in the evaluation of dysphagia.

Answer 5

Esophagogastrodueodenoscopy (EGD)

Question 6

This is the faulty transfer of a food bolus from the oropharynx into the esophagus.

Answer 6

Oropharyngeal dysphagia

Question 7

Amyloidosis, dermatomyositis, hyper/othryroidism, MG, and myopathies are classified as what causitive type of oropharyngeal dysphagia?

Answer 7

structural abnormalities

Question 8

ALS, CVA’s, Huntingtons, MS, parkinsons and tetanus are classified as what causitive type of oropharyngeal dysphagia?

Answer 8

Neurological disorders

Question 9

Cervical osteophytes, cricopharyngeal dysfxn, goiters, lymphadenopathy and zenker diverticulum are classified as what causitive type of oropharyngeal dysphagia?

Answer 9

Muscular disorders

Question 10

This is the failure of the esophagus to relax due to degeneration of the Auerback ganglion cells in the LES.

Answer 10

Achalasia

Question 11

What is the clinical presenstation of achalasia?

Answer 11

years of dysphagia to both solids and liquids, may vomit upundigested food, NO HEARTBURN cuz LES is always contracted

Question 12

What shows on CXR for achalasia?

Answer 12

air-fluid level within the esophagus in advanced cases

Question 13

What shows on barium esophagography for achalasia?

Answer 13

dilated esophagus with a beak-like tapering at the LES

Question 14

What is the triad of conditions in achalasia?

Answer 14

1. incomplete relaxation of the LES
2. hypterensive LES
3. aperistalsis in the esophageal body

Question 15

Why must u do a EGD to rule out cancer in achalasia?

Answer 15

Cuz cancer could be infiltrating near the esphogaastric jxn and look the same way on radiographs

Question 16

What is the bug that produces a neurotoxin that destroys the myenteric plexus, and produces achalasia?

Answer 16

Trypanosoma cruzi (Chagas)

Question 17

This autoimmune condition has secondary involvement with the esophagus, and presents as dysphagia with both solids and liquids and heartburn.

Answer 17

Scleroderma

Question 18

Break down the CREST acronym for scleroderma

Answer 18

Calcinosis
Raynauds
Esophageal dysfunction
Sclerodactyly
Telangiectasias

Question 19

What will a barium study show for sclerodermal involvement of the esophagus?

Answer 19

rigid esophagus with widely patent LES, aperistalsis of the esophagus and decreased tone of the LES

Question 20

This condition presents as chest pain, intermittent dysphagia with solids or liquids, and can be aggravated by stress. Barium swallow shows a corkscrew esophagus.

Answer 20

Diffuse esophageal spasm

Question 21

This is the condition when the mere is mechanical compromise of the esophageal lumen to a diameter <12mm

Answer 21

Mechanical dysphagia

Question 22

What is the cause of peptic strictures?

Answer 22

prolonged GERD

Question 23

Where is the most common site of peptic strictures?

Answer 23

it’s a short narrowing of the distal esophagus immediately at or above the esophogastric jxn

Question 24

What are the 2 main causes of alkaline strictures?

Answer 24

1. post-gastrectomy

2. Inducing vomiting after lye ingestion

Question 25

Lye-induced strictures are associated with an increased incidence of what type of cancer of the esophagus?

Answer 25

Squamous cell cancer

Question 26

This condition is in females with iron-deficiency anemias, and presents as glossitis with proximal esophageal webs/rings.

Answer 26

Plummer-vinson syndrome

Question 27

This is the most common benign tumor of the esophagus.

Answer 27

Leiomyoma

Question 28

How do leiomyomas appear on radiographs?

Answer 28

smooth, noncircumfrential filling defect with normal overlying mucosa located in the wall of the esophagus

Question 29

Achalasia, lye-induced strictures, plummer-vinson syndrome, HPV, tylosis, and smoking/drinking can predispose you to what type of cancer?

Answer 29

Squamous cell carcinomas

Question 30

What is the most common risk factor for adenocarciomas for the esophagus?

Answer 30

Barretts esophagus

Question 31

How do patients with esophageal carcinomas typically present?

Answer 31

Progressive dysphagia accompanied by weight loss

Question 32

So how do you treat esophageal cancers?

Answer 32

Surgical resection if early, chemo if advanced

Question 33

This term is for painful swallowing

Answer 33

Odynophagia

Question 34

What are the 2 most common causes of odynophagia?

Answer 34

inflammation or spasm

Question 35

What is the most common fungal infection to cause odynophagia?

Answer 35

candida albicans