Dysphagia

Question 0

Odynophagia

Answer 0

Pain on swallowing

Question 1

Dysphagia

Answer 1

Difficulty swallowing

May be due to obstruction, weakness or paralysis

Question 2

Control of swallowing

Answer 2

A brain stem reflex controlled in the tracts spliturus
Suspends respiratory drive and coordinates activity
Motor –> trigeminal, facial, hypoglossal
Sensory –> trigeminal, glossopharyngeal, vagus

Question 3

Stages of swallowing

Answer 3

Oral stage - voluntary, tongue pushes food bolus to oropharynx
Pharyngeal stage - involuntary, sensory input to glossopharyngeal raises palate to close nose,larynx closes & food –> oesophagus
Oesophageal stage - reflex relaxation of cricopharyngeus and peristaltic wave carries food to stomach at 4cm/s

Question 4

Causes of dysphagia

Answer 4

Congenital or acquired, if acquired can be
Pre-oesophageal
Oesophageal
Central CNS

Question 5

Congential causes of dysphagia

Answer 5

Tracheo-oesophageal fistula
aberrant subclavian artery
Congenital stricture
Tracheal atresia

Question 6

Pre-oesophageal causes of dysphagia

Answer 6

Inflammatory –> tonsillitis, pharyngitis, abscesses, Ludwig’s angina (angina ludovici)
Neoplastic –> SCC of the mouth, tonsils or tongue

Question 7

Ludwig’s angina

Answer 7

Also known as angina ludovici
A life threatening cellulitis of the floor of the mouth which occurs in adults with long standing dental infections
Can give a strangling sensation and often needs surgical treatment

Question 8

Oesophageal causes of dysphagia

Answer 8

Luminal –> Foreign body, tumour
Mural –> candidiasis, tumour, varices,
External compression –> goitre, Lung cancer, lymphadenopathy, aortic aneurysm

Question 9

Central CNS causes of dysphagia

Answer 9

Stroke
multiple sclerosis, myasthenia gravis, motor neuron disease (bulbar), Parkinson’s disease
Anxiety (globus hystericus)

Question 10

Red flag symptoms in dysphagia

Answer 10

Otalgia–> referred from oral cavity, oropharynx or tongue base
Hoarseness –> indicates recurrent or direct laryngeal nerve involvement
Weight loss and/or progressive dysphagia may indicate cancer
Neck lumps –> investigate with panendoscopy

Question 11

Signs and symptoms of pharyngeal pouch

Answer 11

Recurrent chest infections & cough
Possible dysphagia
Neck lump (reducible)
Regurgitation and halitosis