Dyspepsia Flashcards
Oropharyngeal dysphagia is usually
related to _______
neuromuscular dysfunction and is
commonly caused by stroke
______ is usually due to motor disorders, such as achalasia or diffuse oesophageal spasm, and to peptic oesophageal
strictures often secondary to reflux
Oesophageal dysphagia
A _______ usually causes regurgitation
of undigested food and gurgling may be audible over the side of the neck
pharyngeal pouch
GORD tends to exclude ______
achalasia
Red flag pointers for dysphagia
- Age >50 years
- Recent or sudden onset
- Unexplained weight loss
- Painful swallowing
- Progressive dysphagia
- Dysphagia for solids
- Hiccoughs
- Hoarseness
- Neurological symptoms/signs
Gastroenterologists claim that the big three
common causes referred to them are_______
benign
peptic stricture, cancer and achalasia
Intermittent dysphagia for both liquids and
solids is characteristic of a motility disorder such
as oesophageal achalasia
≈__________ is usually
evident when there is a short history of rapidly progressive dysphagia and significant weight loss.
Malignant oesophageal obstruction i
What is a special esophageal obstruction test?
— hand the patient a glass of water and place a stethoscope over the left upper quadrant of abdomen
— measure time between swallowing and
murmur produced by bolus passing the cardia (normal: 7–10 seconds)
The primary investigation in suspected
_______ is a video barium swallow
while endoscopy is generally the first investigation in cases of suspected _________
pharyngeal dysphagia
oesophageal dysphagia
What is the dx?
- Fibrous stricture of lower third oesophagus (can be higher)
- Follows years of reflux oesophagitis
- Usually older patients
Benign peptic stricture
Benign peptic stricture
- Dysphagia with ______
- Diagnosis confirmed by ____ and ____
solid food
endoscopy and barium
swallow
Benign peptic stricture Tx
- Dilate the stricture
* Treat reflux vigorously
Association with esophageal CA
GORD, tobacco, Barrett oesophagus
MC esophageal CA
SCC (commonest) and adenocarcinoma
________ associated with Barrett mucosa
Adenocarcinoma
What is the dx?
• A disorder of oesophageal motility
• Widely dilated oesophagus
• Empties poorly through a smoothly tapered
lower end
Achalasia
Achalasia
________is the only way to diagnose with
certainty
Manometry
Conservative tx of achalasia
Conservative in the elderly (e.g. nifedipine/or
endoscopic botulinum toxin injection into the
sphincter
Surgical Mx of achalasia
Pneumatic dilatation of lower oesophageal
sphincter or surgical myotomy
______have no place in treatment of achalasia
Prokinetic drugs
_______, can cause
painful esophageal ulceration in all age groups
Tetracycline, especially doxycycline
Also referred to as ‘_________’ or ‘lump in the throat’, it is the subjective sensation of a lump in the throat.
globus hystericus
Cause of globus hystericus
Suppression of sadness is most often implicated. No specific aetiology or physiological mechanism has
been established
___________is increasingly beingrecognised as a cause of dysphagia, gastro-oesophagealreflux and acute food bolus obstruction in both children (particularly) and adults.
Eosinophilic oesophagitis
Associations of Eosinophilic oesophagitis
It is associated with allergic disorders such as hay fever,
cow’s milk allergy and asthma
Ab associated with Eosinophilic oesophagitis
IgE
Gastroscopy findings in Eosinophilic oesophagitis
eosinophilic
infiltrates in the oesophagus on mucosal biopsies
Mx of Eosinophilic oesophagitis
A six-food elimination diet (cow’s milk protein, wheat, soy, eggs, seafood
and peanuts) has been shown to reduce symptoms in up to 90%
Tx of acute attach of Eosinophilic oesophagitis
Treatment of the acute attack includes
IM buscopan and a swallowed topical corticosteroid aerosol e.g. fluticasone twice daily for 8 weeks.
Mechanical dysphagia represents _____ until
proved otherwise
cancer
Cancer-induced achalasia occurs with tumours at the _____ usually due to
______ of the stomach
gastro-oesophageal junction
adenocarcinoma
A prominent hard lymph node in the left
supraclavicular fossa_______ is suggestive of cancer of the stomach
(Troisier sign)
Dysphagia can be caused by a_____ and can be diagnosed by manometry or barium
swallow.
tight fundoplication
