Dysphagia Flashcards
What is dysphagia
Difficulty swallowing
The causes of dysphagia can be split into:
Inflammatory
Mechanical
Motility disorders
Inflammatory cause of dysphagia are:
Tonsilitis, pharyngitis
Oesophagitis: GORD, candida
Oral candidiasis
Aphthous ulcers
Mechanical causes of dysphagia
Luminal: FB, large food bolus
Mural –> Benign stricture: Web, oesophagitis, trauma e.g. OGD
–> Malignant stricture: pharynx, oesophageal, gastric
–>Pharyngeal pouch
Extra-mural: Lung Ca, rolling hiatus hernia, mediastinal lymph nodes e.g. in lymphoma, retrosternal goitre, thoracic aortic aneurysm
Motility disorder causes of dysphagia
Local: Achalasia, diffuse oesophageal spasm, nutcracker oesophagus, bulbar/pseudobulbar palsy (CVA/MND)
Systemic: systemic sclerosis/ CREST syndrome/ MG
Presentation
If swallowing both liquids and food is difficult at start: motility disorder
If food> liquids –> stricture
Difficulty making swallowing movement = bulbar palsy
Odonophagia: Cancer, oesophageal ulcer, spasm
Intermittent: oesophageal spasm
Constant and worsening: malignant stricture
Neck bulges or gargles on drinking: pharyngeal pouch
Signs associated with dysphagia
Cachexia Anaemia Virchow's node (+ve = Troisier's sign) Neurology Signs of systemic disease e.g. scleroderma
Investigations for dysphagia
Bloods: FBC, U&E CXR OGD Barium swallow +/- video fluoroscopy Oesophageal manometry
What is achalasia?
Degeneration of the myenteric plexus (Auerbach’s) causing reduced peristalsis and LOS fails to relax
What are the causes of achalasia
Primary = idiopathic = commonest Secondary = oesophageal Ca, Chaga's disease (T.cruzii)
Presentation of achalasia
Dysphagia: liquids and solids at the same time
Regurgitations
Substernal cramps
Weight loss
What is a complication of chronic achalasia
Chronic achalasia can progress to oesophageal SCC
Investigations for achalasia
Barium swallow - dilated tapering oesophagus - birds beak)
Manometry - failure of relaxation and reduced peristalsis
CXR: may show widened mediastinum
OGD: exclude malignancy
Management of achalasia
Medical: CCBs, nitrate
Int: endoscopic balloon dilatation, botulinum toxin injection
Surgical: Heller’s cardiomyotomy open or endo
What is a pharyngeal pouch/ Zenker’s diverticulum
outpouching of oesophagus between upper border of cricopharyngeus muscle and lower border of inferior constrictor of pharynx
weak area called: Killian’s dehiscence
Where does the pharyngeal pouch occur?
Defect usually occurs posteriorly but swelling usually bulges to the left side of the neck
What is the presentation of pharyngeal pouch?
Regurgitation
Neck bulge
Halitosis
Gurgling sounds on drinking
Pathology of pharyngeal pouch
Food debris –> pouch expansion –> oesophageal compression –> dysphagia
Management of pharyngeal pouch
Excision
Endoscopic stapling
What is diffuse oesophageal spasm?
Intermittent dysphagia +/- chest pain
Ba swallow shows corkscrew oesophagus
What is nutcracker oesophagus?
Increased contraction pressure with normal peristalsis
