Clinical Lectures Flashcards
Dysphagia
- Difficulty swallowing
- Patient complains of:
- Food sticking in throat
- Difficulty swallowing
- Food sticking then may choke
Odynophagia
- Pain associated with swallowing
- May or may not accompany dysphagia
- Generally caused by painful lesions in mouth
Most common causes of odynophagia
Herpes simplex
Candida stomatitis
Globus sensation
The sensation of a lump in the throat
-Patient complains of sensation of something in the back of the throat “all of the time”
Globus sensation effect on swallowing
- Swallowing is normal
- Sense of the “lump” disappears transiently with swallowing
Primary cause of globus sensation
Tightening of upper esophageal sphincter
Achalasia
- Lower esophageal sphincter fails to relax
- Results in dilation of the upper esophagus
- True cause of dysphagia
Diffuse esophageal spasm
- Synchronous contraction of esophagus
- Lack of orderly peristalsis
- There may be normal periods of peristalsis
- May cause chest pain similar to angina (also relieved by nitro)
- True cause of dysphagia
Dysarthria
- Unclear articulation of speech
- Due to difficulty controlling or coordinating the muscles used in speech
Vomiting (emesis)
The voluntary or involuntary forceful emptying of the stomach contents
Regurgitation
The passive flow of material back up the esophagus
Dysphagia history
Step 1: Is dysphagia present?
Step 2: is this esophageal or oropharyngeal in location?
Step 3: is this a structural abnormality of a motor disorder?
What would be suggestive of a progressive lesion (i.e. carcinoma)?
Swallowing difficulty progresses over time
When would you suspect stricture?
Swallowing difficulty remains fixed with certain sized quantity of food
When would you suspect a motility disorder?
Dysphagia with both solids and liquids
What suggests problems in distal esophagus?
Dysphagia associated with hiccups
Oropharyngeal dysfunction
Difficulty initiating swallowing or repetitive swallowing
Esophageal dysfunction
Restrosternal “hanging up” sensation
Mechanical obstruction
Difficulty with solids not liquids
Esophageal dysmotility
Difficulty with both solids and liquids
Zenker diverticulum
Regurgitation of undigested food or halitosis
Blumberg test
Rebound tenderness; peritoneal irritation, appendicitis
Markle (heel jar) test
Patient stands, raises up on toes, allows heels to hit floor > sharp pain hits abdomen; peritoneal irritation
McBurney test
Sharp pain when McBurney point is palpated; appendicitis
Murphy test
Abrupt cessation of inspiration on palpation of gall bladder; cholecystitis
Rovsing test
RLQ pain intensified by LLQ palpation; peritoneal irritatoin, appendicitis
Iliopsoas muscle test
Patient lies supine, resist their hip flexion > worsened RLQ pain; appendicitis
Obturator muscle test
Right leg flexed at hip and knee, rotate leg internally and externally > worsened RLQ pain with internal; ruptured appendix or pelvic abscess
