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
