Dysphagia Flashcards by Katya Angoua

Definition Dysphagia

Difficulty in eating due to disruption in swallowing process

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Main symptom of oesophageal disease

Dysphagia

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Complications of Dysphagia

Aspiration pneumonia
Malnutrition
Weight loss
Dehydration
Airway obstruction

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Main dx of surgical importance leading to Dysphagia

Achalasia
Carcinoma
Corrosive Eosophageal stricture (accidental/suicidal)
Peptic oesophagitis
Esophageal atresia in neonates

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2 types of classification of Dysphagia etiology

Anatomical
Systemic

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Types of anatomical classification of causes of Dysphagia

Longitudinal
Transverse

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Types of longitudinal etiology of Dysphagia

Pre œsophageal
Esophageal
Post Esophageal

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Inflammatory pre eosophageal dx leading to Dysphagia

stomatitis
Tonsillitis
Pharyngitis
Ludwigs angina
Retropharyngeal abscess

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Tumors in pre eosophageal dx leading to Dysphagia

Cancer of the tongue
Cancer of buccal cavity
Cancer of pharynx

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Swellings in pre eosophageal dx leading to Dysphagia

Sublingual dermoid’
Lingual thyroid

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Pharyngeal weaknesses/paralysis in pre eosophageal dx leading to Dysphagia

Bulbar paralysis
Poliomyelitis
myasthenia gravis

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Congenital esophageal causes of Dysphagia

Atresia
Stenosis
Dysphagia lusoria

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Oesophageal anatomical transverse classification

Luminal
Mucosa
Muscle
Extrinsic

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Acquired intraluminal Oesophageal causes of Dysphagia

Foreign body
Food obstruction
Polyps

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Acquired mucosal Oesophageal causes of Dysphagia

NSAIDS
potassium chloride tablets
Antibiotics -doxycycline, clindamycin, tetracycline
Radiation
Infection ( HIV, candida, herpes )

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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

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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