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Z Year3 Clinical Presentations > Dysphagia > Flashcards

Dysphagia Flashcards

1
Q

What is dysphagia?

A

difficulty swallowing

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2
Q

Where is high dysphagia and when does food get stuck?

A
  1. oropharyngeal and upper oesophageal

2. difficulty in initiating swallow or immediately upon swallowing

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3
Q

Where is low dysphagia and when does food get stuck?

A
  1. lower oesophageal

2. feels the food gets stuck a few seconds after swallowing

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4
Q

What is odynophagia?

A

painful swallowing

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5
Q

When can you get odynophagia?

A
  1. Malignancy

2. Candidiasis

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6
Q

What is globus?

A

common sensation of having lump in throat without true dysphagia

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7
Q

What are the functional causes of high dysphagia?

A
  1. Stroke
  2. Parkinson’s disease
  3. Myasthenia gravis
  4. MS
  5. Myotonic dystrophy
  6. Inadequate saliva production
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8
Q

What are the functional causes of low dysphagia?

A
  1. Achalasia
  2. Chagas disease
  3. Nutcracker oesophagus
  4. Diffuse oesophagial spasm
  5. Limited cutaneous scleroderma (CREST)
  6. Infective oesophagitis
  7. Eosinophilic oesopahgitis
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9
Q

What are the luminal (structural) causes of low dysphagia?

A

foreign body

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10
Q

What are the mural (structural) causes of high dysphagia?

A
  1. Cancer
  2. Pharyngeal Pouch
  3. Cricopharyngeal bar
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11
Q

What are the mural (structural) causes of low dysphagia?

A
  1. Cancer
  2. Stricture (caustic or inflammatory)
  3. Pulmmer-Vinson syndrome
  4. Schatzki ring
  5. Congenital atresia
  6. Post-fundoplication
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12
Q

What are the extrinsic (structural) causes of low dysphagia?

A
  1. Mediastinal mass
  2. Retrosternal goitre
  3. Bronchial carcinoma
  4. Thoracic aortic aneurysm
  5. Pericardial effusion
  6. Ortner’s syndrome
  7. Dysphagia Lusoria
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13
Q

What must you think new onset dysphagia in middle-aged to elderly patients?

A

carcinoma until proven otherwise

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14
Q

What questions fo you need to ask a patient with dysphagia related to swallowing?

A
  1. Duration of symptoms
  2. Is the dysphagia progressive or intermittent?
  3. Is the dysphagia to solids, fluids or both?
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15
Q

What would present immediately during a meal?

A

food bolus stuck in oesophagus

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16
Q

What does dysphagia of a short history of days to week suggest?

A

cancer

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17
Q

What does dysphagia lasting months to years suggest

A

chronic motility disorders e.g. achalasia

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18
Q

What would progressive dysphagia suggest?

A

stricture (benign or malignant)

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19
Q

What would intermittent dysphagia suggest?

A

motility disorder

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20
Q

If the patient is able to swallow fluid as normal but has difficulty with solid food (sticking) what does this suggest?

A

mechanical obstruction e.g. stricture

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21
Q

If dysphagia initially more pronounced for fluids than solids what would it suggest?

A

motility disorder e.g. achalasia or neuromuscular condition

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22
Q

What would absolute dysphagia to to solids, liquids, saliva suggest?

A
  • food bolus stuck due to malignancy or stricture

- poorly chewed

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23
Q

What associated questions do you ask about in dysphagia?

A
  1. Any coughing and if so related to eating
  2. Suffer from halitosis
  3. Any gurgling or dysphonia
  4. Heartburn or water brash
  5. Weight loss
  6. Neurological symptoms
  7. Rheumatological symptoms
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24
Q

What would choking (coughing straight after swallowing) suggest?

A

coordination issue: stroke + Parkinsons

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25
What would coughing some time after food suggest?
regurgiation of food in - pharyngeal pouch - achalasia - GORD
26
What would nocturnal cough suggest?
achalasia
27
What would suffering from halitosis suggest?
food remains lodged in oropharynx e.g. Pharyngeal Pouch
28
What would gurgling soon after eat or drink / visible bulge in neck suggest?
pharyngeal pouch
29
what would hoarseness suggest?
vocal cord dysfunction due to tumour affected reccurent laryngeal nerve
30
What would heartburn and waterbrash suggest?
reflux disease with or without strictrue
31
What can chronic dyspepsia predispose to?
oesophageal cancer
32
What do 40% of people with achalasia complain of?
retrosternal burning
32
What do 40% of people with achalasia complain of?
retrosternal burning
33
Why do you ask about weight loss with dysphagia?
red flag for oesophageal cancer
34
When do you ask about neurological symptoms with dysphagia?
symptoms of functional dysphagia
35
What are functional dysphagia symptoms to look for?
- difficulty swallowing - slow eating - extra effort required to eat/chew - tiredness after eating - early dysphagia for liquids
36
When do you enquire about rheumatological symptoms in dysphagia?
limited cutanous scleroderma (CREST)
37
What PMHx is important to check for in dysphagia?
1. Gord 2. Peptic Ulcers 3. MS or Parkinsons
38
What does gord predispose to?
- oesophageal adenocarcinoma | - non-malignant strictures of oesophagus
39
Why should you check if patient has had fundoplication for GORD?
post-operative dysphagia complication
40
Why do you ask about peptic ulcers with dysphagia?
can lead to scarring and strictures around gastric cardia and lower oesophagus
41
What do you check if patient has no firm diagnosis of GORD or peptic ulcer but you suspect?
may complain of dyspepsia and/or waterbrash
42
What DHx is important to check in dysphagia?
1. CCB and nitrates | 2. NSAIDs, aspirin, steroids and bisphosphonate
43
Why do you check CCBs and nitrates?
can exacerbate reflux symptoms by decreasing oesophageal tone
44
Why do you check about NSAIDs, aspirin, steroids and bisphosphonates?
predispose to peptic ulceration
45
What are the five important examinations for a patient with dysphagia?
1. Cranial nerve pathology 2. Signs of GI malignancy 3. Neck Mass 4. Features of CREST 5. Koilonychia
46
Why do you examine cranial nerve pathology?
important if history suggests functional dysphagia e.g. patient may have bulbar palsy
47
What could suggest oesophageal cancer on examination?
- cachetic | - palpable Virchow's node
48
When could a GI malignancy be palpable?
1. If extends to cardia of stomach may be palpable in thin patients 2. Can metastasise to liver to check for hepatomegaly
49
What can you palpate in the neck with dysphagia?
1. large pharyngeal pouch in thin patients (may gurgle on palpatation) 2. Goitre
50
What can head and neck cancers cause?
-cervical lymphadenopathy -upper (oropharyngeal) dysphagia
51
What are the features of CREST syndrome?
- Calcinosis - Raynauds - Oesophageal dysmotlity - Sclerodactyly - Telangiectasia
52
What does koilonychia suggest and what is it associated with dysphagia?
1. severe iron deficiency anaemia | 2. assoicated with Plummer-vinson syndrome
53
What are the investigations for dysphagia?
1. Barium swallow 2. Endoscopy 3. Videofluroscopy 4. Monometery
54
What is barium swallow? What is sometimes given?
1. Cineradiographic study in supine patient from upper to lower oesophageal sphincter 2. sometimes effervesent agent to produce double contrast study that is better at seeing mucosal lesions
55
When is barium swallow useful?
high lesion (as can't do endoscopy and if pharyngeal pouch or oesophgeal cancer risk perforation)
56
When is barium swallow indicated?
achalasia
57
What does endoscopy allow visulisation of?
luminal and mural lesion
58
What can you do during endoscopy?
- can biopsy - treat lesions - carry out procedures
59
Why is endoscopy better than barium swallow?
more sensitive and specific than double contrast barium swallow
60
When is endoscopy the first line investigation?
low dysphagia
61
What is videofluroscopy?
modified barium swallow as barium in liquid form and speech therapist runs
62
When is videofluroscopy suitable?
functional high dysphagia
63
What does manometry do?
assess pressure in lower oesophageal sphincter and peristaltic wave in the rest of oesphagus
64
What is manometry used to diagnose?
motility disorder and distinguishing which one
65
When is manometry indicated?
when barium swallow and/or endoscopy are unremarkable suggesting a cause other than mechanical obstruction
66
What would a velvety epithelium in distal oesphagus suggest?
Barrett's oesophagus
67
What tests do you do for staging of adenocarcinoma?
1. Spiral CT Chest/abdomen 2. PET scan 3. Endoscopic US (no evidence of metastatic disease on CT/PET) 4. Laparoscopy (no evidence of metastatic disease on CT/PET)
68
What happens if the tumour is suitable for radical treatment?
aneasthatist perform fit assesment test
69
What is prognosis of oesophageal cancer like?
- Prognosis depends on stage - Stage 1 - 5year survival 80% - 70% of patients present with lymph node involvement where 5 year survival 15%

Z Year3 Clinical Presentations (37 decks)

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