Dysphagia Flashcards
Definition Dysphagia
Difficulty in eating due to disruption in swallowing process
Main symptom of oesophageal disease
Dysphagia
Complications of Dysphagia
Aspiration pneumonia
Malnutrition
Weight loss
Dehydration
Airway obstruction
Main dx of surgical importance leading to Dysphagia
Achalasia
Carcinoma
Corrosive Eosophageal stricture (accidental/suicidal)
Peptic oesophagitis
Esophageal atresia in neonates
2 types of classification of Dysphagia etiology
Anatomical
Systemic
Types of anatomical classification of causes of Dysphagia
Longitudinal
Transverse
Types of longitudinal etiology of Dysphagia
Pre œsophageal
Esophageal
Post Esophageal
Inflammatory pre eosophageal dx leading to Dysphagia
stomatitis
Tonsillitis
Pharyngitis
Ludwigs angina
Retropharyngeal abscess
Tumors in pre eosophageal dx leading to Dysphagia
Cancer of the tongue
Cancer of buccal cavity
Cancer of pharynx
Swellings in pre eosophageal dx leading to Dysphagia
Sublingual dermoid’
Lingual thyroid
Pharyngeal weaknesses/paralysis in pre eosophageal dx leading to Dysphagia
Bulbar paralysis
Poliomyelitis
myasthenia gravis
Congenital esophageal causes of Dysphagia
Atresia
Stenosis
Dysphagia lusoria
Oesophageal anatomical transverse classification
Luminal
Mucosa
Muscle
Extrinsic
Acquired intraluminal Oesophageal causes of Dysphagia
Foreign body
Food obstruction
Polyps
Acquired mucosal Oesophageal causes of Dysphagia
NSAIDS
potassium chloride tablets
Antibiotics -doxycycline, clindamycin, tetracycline
Radiation
Infection ( HIV, candida, herpes )
Acquired dx of wall Oesophageal causes of Dysphagia
Benign tumors
Carcinoma
Oesophagitis (corrosive, foreign body, reflux )
Neuromuscular dysfunction (Achalasia, diffuse spasm, spinal muscular atrophy, polymyositis, dematomyositis)
Perforation (foreign body, instrumentation )
Connective tissue dx (scleroderma)
Paterson Kelly syndrome
Diverticular dx
Barrett’s esophagus
Muscular dystrophies
Acquired extrinsic pressure Oesophageal causes of Dysphagia
Pharyngeal pouch
Intrathoracic goitre
Enlarged mediastinal lymph nodes
Mediastinal tumors
Aortic aneurysm
Systemic classification of disease causing Dysphagia
Surgical;
Central
Endocrine
Psychogenic
Pharmacologic
Motility disorders
Surgical causes of Dysphagia
laryngectomy
Pharyngectomy
Oesophagectomy
Head and neck surgery
Pharyngeal plexus in surgery
Tracheostomy
Central causes of Dysphagia
decreased range of motion of muscles of mastication and bolus propulsion
Decreased sensation
Delayed or absent pharyngeal swallowing
Reduced pharyngeal peristalsis
Delayed or absent laryngeal adduction and elevation
Effects of central Dysphagia
pocketing of food in mouth
Circumoral leakage
Early pharyngeal spill
Weak posterior tongue causin tongue thrusting
CNS lesions leading to Dysphagia
Alzheimer’s dx
Brain tumors
Guillain barre syndrome
Huntington dx
CNS infection
Stroke
Traumatic brain injury
Parkinson dx
Poliomyelitis
Cerebral palsy
Multiple sclerosis
Amyotrophic lateral sclerosis
Endocrine dx leading yo Dysphagia
Cushing syndrome
Hyperthyroidism
Hypothyroidism
Vitamin b12 deficient
Presentation of psychogenic Dysphagia
oral apraxia
Intact speech
Intact pharyngoesophageal and neurologic function
Drugs causing myopathies leading to Dysphagia
CNS depressants
Antipsychotics
Corticosteroids
lipid lowering agents
Colchicine
Aminoglycosides
Anticholinergic
Drugs affecting mucosa leading to Dysphagia
potassium chloride tablet
NSAIDs
Antibiotics (doxycycline, tetracycline, clindamycin, trimethoprim-sulfamethoxazole )
Motility disorder causing Dysphagia
diffuse esophageal spasm
Achalasia
Scleroderma
Cricopharyngeal dysfunction
Main post esophageal dx leading to Dysphagia
Gastric carcinoma
History key point
History of ingestion (accidental, suicidal, corrosive poisoning, foreign body, temporary dentures )
Duration of Dysphagia ( very short like inflammation /infection, long intermittent like in achalasia, long and progressive like in stricture, short and progressive like ion malignancy )
Pain for inflammation or trauma
Post prandial epigastric pain radiating retrosternally which worsens by bending in oesophagitis
Site of obstruction (mouth , throat, posteriorly to sternum , epigastric )
Fever in inflammation, perforation
Suppurative lung dx)
Weight loss
Solids but ot liquids - fixed obstruction or tight stricture
Liquids but not solid like in Achalasia
Point to note in neck exam for Dysphagia
Lymph nodes
Goitres
Pharyngeal pouch
Surgical emphysema
Points to note in general exam for Dysphagia
Weight loss
Dehydration
Manutrition
Oropharynx exam in Dysphagia findings
carcinoma
Inflammatory lesions
Swellings
abnormalities demonstrating Paterson Kelly syndrome (cheilosis, Spoon shaped nails ,Smooth tongue )
Chest exam findings in dysphagia
Sternum bulging with pulsation
Decreased breath sounds , rhonchi, wheeze in suppurative lung dx
Abdominal exam findings in dysphagia
epigastric mass -gastric ca
Hepatomegaly
Localized or generalized tenderness
Findings on hands suggesting scleroderma
Thickening and pigmentation/depigmentation
CNS exam findings in dysphagia
Diplopia, drooping of eyelids , difficulty speaking in myasthenia gravis
Imaging techniques required in case of dysphagia
Plain x ray
Barium swallow
Endoscopy
Findings on X ray
foreign body
Retrosternal thyroid
Mediastinal swelling
Mega esophagus containing fluid
Barium swallow findings
Diffuse irregularity in nutcracker oesophagus
Irregular filling defect - malignancy
Dilated oesophagus looking like birds beak in Achalasia
Strictures in corrosive injury
Role of endoscopy
Diagnosis and cure
Helps determine cause, location, biopsy
When is manometry useful
In neuromuscular disorder
Lab investigation
24h ph - if low reflux of gastric secretion
FBC for iron deficiency anemia in Plummer Vinson/Paterson-Kelly syndrome
Edrophonium test in myasthenia gravis
