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Surgery > Dysphagia > Flashcards

Dysphagia Flashcards

1
Q

mechanical dysphagia is

A

oesophageal dysphasia

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2
Q

an oesophageal stricture is

A

a narrowing of the oesophagus

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3
Q

reasons someone might have an oesophageal stricture

A
  • prolonged GORD
  • previous surgery
    radiation therapy
  • swallowing a substance that harms the oesophagus eg. button battery
  • cancer
  • chron’s disease
  • scleroderma
  • eosinophilic oesophagitis
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4
Q

what are the symptoms of an oesophageal stricture

A

trouble swallowing and solid foods getting stuck in the throat
trouble swallowing liquids also (only in very severe condition)
heartburn
burning in throat
raspy voice or sore throat
cough for no reason

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5
Q

tests for oesophageal stricture

A

barium swallow
endoscopy

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6
Q

barium swallow

A

x rays used to see if the barium gets stuck or slowed down on the way through your oesophagus

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7
Q

endoscopy

A

a thin tube (endoscope) down the throat and into stomach
has a light and tiny camera on the end

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8
Q

two general categories of stricture cause

A

inflammatory (peptic/GORD)
malignant (cancer)

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9
Q

define dysphagia

A

difficulty swallowing

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10
Q

define odynophagia

A

pain on swallowing

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11
Q

two categories of dysphagia

A
  1. oropharyngeal (following stroke or neuromuscular disorder)
  2. oesophageal (either mechanical or neuromuscular)
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12
Q

typical presentation/history of an oropharyngeal dysphagia

A

uncoordinated initiation of swallow
may feature drooling, choking, coughing, pocketing of food between teeth and cheek, poor voice quality, inability to suck from straw, nasal regurgitation, aspiration with respiratory infection, malnutrition

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13
Q

typical causes of oropharyngeal dysphagia

A

stroke (pseudo-bulbar palsy)
bulbar palsy (motor neurone disease)
multiple sclerosis
brain injury
pharyngeal diverticulum

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14
Q

neuromuscular causes of oesophageal dysphagia

A

scleroderma (esp. with CREST)
chaga’s disease (trypanosomiasis)
achalasia (aganglionosis)
oesophageal spasm/presbyoesophagus

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15
Q

what is scleroderma with CREST

A

Calcinosis
Raynaud’s phenomenon
oEsophageal dysfunction
Sclerodactyly
Telangiectasia

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16
Q

mechanical causes of oesophageal dysphagia

A

swallowed foreign body
stricture (inflammatory or neoplastic)
extrinsic pressure
abnormalities of the wall
schatski’s rings

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17
Q

extrinsic pressure as a mechanical cause of oesophageal dysphagia

A

thyroid swellings
pharyngeal pouch
thoracic aortic aneurysm
mediastinal tumours
paraoesophagheal (rolling) hiatal hernias
abnormal aortic arch

18
Q

shcatski’s rings

A

narrowed ring og mucosal tissue

19
Q

an alarm symptom on dysphagia history

A

weight loss

20
Q

some less obvious symptoms that may show up on history

A

social changes in eating
frequent throat clearing
food avoidance
prolonged mealtimes
recurrent chest infectons
change in respiratory pattern after swelling
atypical chest pain
wet voice quality

21
Q

key exam findings

A

supraclavicular nodes/neck mass
regular hepatomegaly
angular stomatitis
glossitis
tongue fasciculation
oral ulceration
temp
vocal cord paralysis

22
Q

complications of long term GORD

A

oesophagitis
ulceration
stricture
barrett’s
cancer
asthma
pneumonia
pulmonary fibrosi
hoarseness
dental caries
halitosis

23
Q

what is achalasia

A

hypertrophy of circular muscle layer
degeneration of Auerbach’s plexus
affects nitrinergic nerves
clinically
- dysphagia
- regurgitation
- aspiration pneumonia
- carcinoma
- malnutrition

24
Q

treatment of achalasia

A

endoscopic
- balloon dilatation
- botulinum toxin
- POEM (per-endoscopic myotomy)
surgical
- laparoscopic cardiomyotomy (lowest recurrence)

25
Q

two main types of oesophageal carcinoma

A

squamous cell carcinoma
adenocarcinoma (rapid increase in incidence in recent decades)

26
Q

risk factors for squamous cell carcinoma of oesophagus

A

achalasia
plummer-vinson
corrosives
head and neck SCC
scleroderma
smoking
soils
hot drinks
alcohol

27
Q

risk factors for adenocarcinoma of oesophagus

A

reflux or barrett’s
obesity

28
Q

diagnosis of oesophageal cancer

A

endoscopy with biopsy
barium swallow (rarely used)
staging: endoscopic USS, CT scan, laparoscopy, PET scan

29
Q

PET advantages

A

disease staging
prevents futile surgery
allows monitoring response to therapy
non-invasive
less radiation

30
Q

PET disadvantages

A

misses small volume of disease
patient has to lie still for up to an hour and a half
claustrophobic
expensive

31
Q

treatment of oesophageal cancer

A

often too late: palpation, chemo, XRT
resection if: fit, local disease (short segment, no invasion), local nodes only

32
Q

EMR

A

endoscopic mucosal resection
for barrettes and mucosal disease only

33
Q

palliation for oesophageal cancer

A

stent
alcohol
laser
photodynamic therapy
argon plasma coagulation

34
Q

carcinoma of cardia

A

is an oesophageal/gastric cancer affecting cardia of the stomach
requires surgery - oesophagogastrectomy
dysphagia prominent
incidence increasing

35
Q

stomach cancer

A

unlike cardia cancer, incidence is decreasing
indolent (causes no pain)
diagnosis on endoscopy
role of helicobacter possible
requires surgery

36
Q

MALT-oma

A

Mucosa Associated Lymphoid Tissue
lymphoid tissue is not normally in the stomach
this is a response to a chronic stimulus eg. H pylori
may lead to non-hodgkins lymphoma
management

37
Q

symptoms of oesophageal rupture

A

pain, difficulty swallowing, SOB

38
Q

causes of oesophageal rupture

A

tumour, GORD with ulceration, previous surgery, swallowing a substance, injury, violent vomiting

39
Q

another name for oesophageal rupture

A

boerhaave’s syndorme

40
Q

what’s the difference between mallory-weirs tear and boerhaave syndrome

A

mallory weiss tear causes vomiting of blood but doesn’t tear all the way through the wall of the oesophagus
boerhaave syndrome ruptures the full thickness of the oesophageal wall (transmural tear)

41
Q

prognosis for oesophageal rupture/boerhaave syndrome

A

death unless dramatic intervention

Surgery (18 decks)

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