Dysphagia Flashcards
mechanical dysphagia is
oesophageal dysphasia
an oesophageal stricture is
a narrowing of the oesophagus
reasons someone might have an oesophageal stricture
- prolonged GORD
- previous surgery
radiation therapy - swallowing a substance that harms the oesophagus eg. button battery
- cancer
- chron’s disease
- scleroderma
- eosinophilic oesophagitis
what are the symptoms of an oesophageal stricture
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
tests for oesophageal stricture
barium swallow
endoscopy
barium swallow
x rays used to see if the barium gets stuck or slowed down on the way through your oesophagus
endoscopy
a thin tube (endoscope) down the throat and into stomach
has a light and tiny camera on the end
two general categories of stricture cause
inflammatory (peptic/GORD)
malignant (cancer)
define dysphagia
difficulty swallowing
define odynophagia
pain on swallowing
two categories of dysphagia
- oropharyngeal (following stroke or neuromuscular disorder)
- oesophageal (either mechanical or neuromuscular)
typical presentation/history of an oropharyngeal dysphagia
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
typical causes of oropharyngeal dysphagia
stroke (pseudo-bulbar palsy)
bulbar palsy (motor neurone disease)
multiple sclerosis
brain injury
pharyngeal diverticulum
neuromuscular causes of oesophageal dysphagia
scleroderma (esp. with CREST)
chaga’s disease (trypanosomiasis)
achalasia (aganglionosis)
oesophageal spasm/presbyoesophagus
what is scleroderma with CREST
Calcinosis
Raynaud’s phenomenon
oEsophageal dysfunction
Sclerodactyly
Telangiectasia
mechanical causes of oesophageal dysphagia
swallowed foreign body
stricture (inflammatory or neoplastic)
extrinsic pressure
abnormalities of the wall
schatski’s rings
extrinsic pressure as a mechanical cause of oesophageal dysphagia
thyroid swellings
pharyngeal pouch
thoracic aortic aneurysm
mediastinal tumours
paraoesophagheal (rolling) hiatal hernias
abnormal aortic arch
shcatski’s rings
narrowed ring og mucosal tissue
an alarm symptom on dysphagia history
weight loss
some less obvious symptoms that may show up on history
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
key exam findings
supraclavicular nodes/neck mass
regular hepatomegaly
angular stomatitis
glossitis
tongue fasciculation
oral ulceration
temp
vocal cord paralysis
complications of long term GORD
oesophagitis
ulceration
stricture
barrett’s
cancer
asthma
pneumonia
pulmonary fibrosi
hoarseness
dental caries
halitosis
what is achalasia
hypertrophy of circular muscle layer
degeneration of Auerbach’s plexus
affects nitrinergic nerves
clinically
- dysphagia
- regurgitation
- aspiration pneumonia
- carcinoma
- malnutrition
treatment of achalasia
endoscopic
- balloon dilatation
- botulinum toxin
- POEM (per-endoscopic myotomy)
surgical
- laparoscopic cardiomyotomy (lowest recurrence)
two main types of oesophageal carcinoma
squamous cell carcinoma
adenocarcinoma (rapid increase in incidence in recent decades)
risk factors for squamous cell carcinoma of oesophagus
achalasia
plummer-vinson
corrosives
head and neck SCC
scleroderma
smoking
soils
hot drinks
alcohol
risk factors for adenocarcinoma of oesophagus
reflux or barrett’s
obesity
diagnosis of oesophageal cancer
endoscopy with biopsy
barium swallow (rarely used)
staging: endoscopic USS, CT scan, laparoscopy, PET scan
PET advantages
disease staging
prevents futile surgery
allows monitoring response to therapy
non-invasive
less radiation
PET disadvantages
misses small volume of disease
patient has to lie still for up to an hour and a half
claustrophobic
expensive
treatment of oesophageal cancer
often too late: palpation, chemo, XRT
resection if: fit, local disease (short segment, no invasion), local nodes only
EMR
endoscopic mucosal resection
for barrettes and mucosal disease only
palliation for oesophageal cancer
stent
alcohol
laser
photodynamic therapy
argon plasma coagulation
carcinoma of cardia
is an oesophageal/gastric cancer affecting cardia of the stomach
requires surgery - oesophagogastrectomy
dysphagia prominent
incidence increasing
stomach cancer
unlike cardia cancer, incidence is decreasing
indolent (causes no pain)
diagnosis on endoscopy
role of helicobacter possible
requires surgery
MALT-oma
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
symptoms of oesophageal rupture
pain, difficulty swallowing, SOB
causes of oesophageal rupture
tumour, GORD with ulceration, previous surgery, swallowing a substance, injury, violent vomiting
another name for oesophageal rupture
boerhaave’s syndorme
what’s the difference between mallory-weirs tear and boerhaave syndrome
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)
prognosis for oesophageal rupture/boerhaave syndrome
death unless dramatic intervention
