Dysphagia Flashcards

1
Q

What is Dysphagia?

A

Difficulty swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Odynophagia?

A

Pain upon swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the common causes of Dysphagia?

A
Diseases of mouth/tongue
Neuromuscular disorders
Oesophageal motility disorders
Extrinsic pressure
Intrinsic lesion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the two main types of Dysphagia?

A

Oropharyngeal

Oesophageal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the features of Oropharyngeal Dysphagia?

A

Difficulty initiating swallow +/- choking/aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the causes of Oropharyngeal Dysphagia?

A

Neurological disease (bulbar palsy/MG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the appropriate investigations in suspected Oropharyngeal Dysphagia?

A

Neurological examination

Videofluoroscopic swallowing assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the features of Oesophageal Dysphagia?

A

Food sticks after swallowing +/- regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the causes of Oesophageal Dysphagia?

A

Dysmotility
Stricture
Oesophagitis
Pharyngeal pouch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the appropriate investigations in suspected Oesophageal Dysphagia?

A

Barium swallow
Endoscopy (OGD)
Biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What features suggest a malignant background?

A

Short hx of progressive dysphagia
Severe wt loss
Elderly pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What features suggest a dysmotility (Achalasia) background?

A

Long hx of non-progressive dysphagia
No wt loss
Young pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is Plummer-Vinson syndrome?

A
Pre-malignant condition due to hyperkeratinisation of oesophagus (causing oesophageal web)
Triad of sx
   -dysphagia
   -koilonychia
   -glossitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the management of Plummer-Vinson syndrome?

A

Iron

Dilation of web via OGD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the sx of an oesophageal malignancy?

A
>60yrs
Progressive dysphagia (solids --> liquids --> saliva)
Wt loss/anorexia
Retrosternal chest pain
Coughing/aspiration
Lymphadenopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the main types of oesophageal malignancy?

A

Mostly in lower 1/3

Mainly adenocarcinomas, some SCCs

17
Q

What are the features of oesophageal adenocarcinomas?

A

Risk factors related to GORD (Barratt’s)

Metastasise earlier than SCC (lymphatic spread)

18
Q

What are the features of oesophageal SCCs?

A

Occur in heavy smoking/drinking males
Present late due to lumen compromise (dysphagia)
Regional lymph node spread early/common

19
Q

What is the prognosis for oesophageal malignancy?

A

Poor (<10% 5yr survival)

  • SCC slightly better (responsive to radiotherapy)
  • mets common at diagnosis (25%)
20
Q

Where are the common sites of metastasis for oesophageal malignancy?

A

Liver
Lungs
Bones

21
Q

What are the appropriate investigations for suspected oesophageal malignancy?

A

OGD w/ transoesophgeal USS/biopsy
CT thorax/abdo
PET
Laparoscopy

22
Q

What are the management options for oesophageal malignancy?

A

Radical curative oesophagectomy for T1/T2 localised disease
Pre-op chemo
Chemo/radio combinations (if surgery not indicated)
Oesophageal stenting (palliative, restores swallow)

23
Q

What is Achalasia?

A

Dysmotility problem due to lack of coordinated muscle contraction/relaxation at the lower end of the oesophagus
-leads to retention of food bolus

24
Q

What are the presenting sx of Achalasia?

A
Dysphagia
Regurgitation
Substernal cramps
Nocturnal cough
Wt loss
20-30yrs
25
Q

What are the appropriate investigations in suspected Achalasia?

A

Barium swallows
OGD (dilated oesophagus, stagnant food/fluid)
Oesophageal manometry (increased lower sphincter pressure)

26
Q

What is the main complication of Achalasia?

A

Predisposes to development of oesophageal carcinoma

27
Q

What are the management options for Achalasia?

A

Conservative/lifestyle (chew food well, eat upright, drink lots w/ meals)
Botox injection
Endoscopic balloon dilation (risk of rupture)
Heller’s cardiomyotomy