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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
Q

What would coughing some time after food suggest?

A

regurgiation of food in

  • pharyngeal pouch
  • achalasia
  • GORD
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26
Q

What would nocturnal cough suggest?

A

achalasia

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27
Q

What would suffering from halitosis suggest?

A

food remains lodged in oropharynx e.g. Pharyngeal Pouch

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28
Q

What would gurgling soon after eat or drink / visible bulge in neck suggest?

A

pharyngeal pouch

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29
Q

what would hoarseness suggest?

A

vocal cord dysfunction due to tumour affected reccurent laryngeal nerve

30
Q

What would heartburn and waterbrash suggest?

A

reflux disease with or without strictrue

31
Q

What can chronic dyspepsia predispose to?

A

oesophageal cancer

32
Q

What do 40% of people with achalasia complain of?

A

retrosternal burning

32
Q

What do 40% of people with achalasia complain of?

A

retrosternal burning

33
Q

Why do you ask about weight loss with dysphagia?

A

red flag for oesophageal cancer

34
Q

When do you ask about neurological symptoms with dysphagia?

A

symptoms of functional dysphagia

35
Q

What are functional dysphagia symptoms to look for?

A
  • difficulty swallowing
  • slow eating
  • extra effort required to eat/chew
  • tiredness after eating
  • early dysphagia for liquids
36
Q

When do you enquire about rheumatological symptoms in dysphagia?

A

limited cutanous scleroderma (CREST)

37
Q

What PMHx is important to check for in dysphagia?

A
  1. Gord
  2. Peptic Ulcers
  3. MS or Parkinsons
38
Q

What does gord predispose to?

A
  • oesophageal adenocarcinoma

- non-malignant strictures of oesophagus

39
Q

Why should you check if patient has had fundoplication for GORD?

A

post-operative dysphagia complication

40
Q

Why do you ask about peptic ulcers with dysphagia?

A

can lead to scarring and strictures around gastric cardia and lower oesophagus

41
Q

What do you check if patient has no firm diagnosis of GORD or peptic ulcer but you suspect?

A

may complain of dyspepsia and/or waterbrash

42
Q

What DHx is important to check in dysphagia?

A
  1. CCB and nitrates

2. NSAIDs, aspirin, steroids and bisphosphonate

43
Q

Why do you check CCBs and nitrates?

A

can exacerbate reflux symptoms by decreasing oesophageal tone

44
Q

Why do you check about NSAIDs, aspirin, steroids and bisphosphonates?

A

predispose to peptic ulceration

45
Q

What are the five important examinations for a patient with dysphagia?

A
  1. Cranial nerve pathology
  2. Signs of GI malignancy
  3. Neck Mass
  4. Features of CREST
  5. Koilonychia
46
Q

Why do you examine cranial nerve pathology?

A

important if history suggests functional dysphagia e.g. patient may have bulbar palsy

47
Q

What could suggest oesophageal cancer on examination?

A
  • cachetic

- palpable Virchow’s node

48
Q

When could a GI malignancy be palpable?

A
  1. If extends to cardia of stomach may be palpable in thin patients
  2. Can metastasise to liver to check for hepatomegaly
49
Q

What can you palpate in the neck with dysphagia?

A
  1. large pharyngeal pouch in thin patients (may gurgle on palpatation)
  2. Goitre
50
Q

What can head and neck cancers cause?

A

-cervical lymphadenopathy -upper (oropharyngeal) dysphagia

51
Q

What are the features of CREST syndrome?

A
  • Calcinosis
  • Raynauds
  • Oesophageal dysmotlity
  • Sclerodactyly
  • Telangiectasia
52
Q

What does koilonychia suggest and what is it associated with dysphagia?

A
  1. severe iron deficiency anaemia

2. assoicated with Plummer-vinson syndrome

53
Q

What are the investigations for dysphagia?

A
  1. Barium swallow
  2. Endoscopy
  3. Videofluroscopy
  4. Monometery
54
Q

What is barium swallow? What is sometimes given?

A
  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
Q

When is barium swallow useful?

A

high lesion (as can’t do endoscopy and if pharyngeal pouch or oesophgeal cancer risk perforation)

56
Q

When is barium swallow indicated?

A

achalasia

57
Q

What does endoscopy allow visulisation of?

A

luminal and mural lesion

58
Q

What can you do during endoscopy?

A
  • can biopsy
  • treat lesions
  • carry out procedures
59
Q

Why is endoscopy better than barium swallow?

A

more sensitive and specific than double contrast barium swallow

60
Q

When is endoscopy the first line investigation?

A

low dysphagia

61
Q

What is videofluroscopy?

A

modified barium swallow as barium in liquid form and speech therapist runs

62
Q

When is videofluroscopy suitable?

A

functional high dysphagia

63
Q

What does manometry do?

A

assess pressure in lower oesophageal sphincter and peristaltic wave in the rest of oesphagus

64
Q

What is manometry used to diagnose?

A

motility disorder and distinguishing which one

65
Q

When is manometry indicated?

A

when barium swallow and/or endoscopy are unremarkable suggesting a cause other than mechanical obstruction

66
Q

What would a velvety epithelium in distal oesphagus suggest?

A

Barrett’s oesophagus

67
Q

What tests do you do for staging of adenocarcinoma?

A
  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
Q

What happens if the tumour is suitable for radical treatment?

A

aneasthatist perform fit assesment test

69
Q

What is prognosis of oesophageal cancer like?

A
  • 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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