Dysphagia Flashcards
What are 5 key questions to ask in the case of dysphagia?
- Difficulty swallowing solids and liquids from the start?
Yes: Motility disorder (achalasia, CNS, pharyngeal causes)
No: Stricture (benign/malignant) - Is it difficult to initiate a swallowing movement?
Yes: Bulbar palsy, esp if cough on swallowing - Is there pain on swallowing (odynophagia)?
Yes: Ulceration (oesophagitis, malignancy, viral infection) - Is the dysphagia intermittent or constant and getting worse?
Intermittent: Oesophageal spasm
Constant + worsening: Malignancy - Does the neck bulge/gurgle on drinking?
Yes: Pharyngeal pouch
What can suggest intra-abdominal malignancy?
Virchow’s Nodes (supraclavicular nodes)
What tests can be performed to investigate dysphagia?
- FBC (anaemia) + U&Es (dehydration)
- Upper GI endoscopy + biopsy
- If suspicious of pharyngeal pouch, consider contrast swallow
- Video fluoroscopy to identify neurogenic causes
- Oesophageal manometry for dismotility
How would diffuse oesophageal spasm present and how would one investigate it?
Intermittent dysphagia and chest pain.
Contrast swallow/manometry can show abnormal contractions.
What is achalasia and what causes it?
Loss of coordinated peristalsis and a failure of the lower sphincter to relax due to degeneration of myenteric plexus causing dysphagia, regurgitation and weight loss.
Manometry/contrast swallow will show dilated tapering oesophagus.
How is achalasia treated?
Endosocopic balloon dilatation or Heller’s cardiotomy followed by PPIs.
If non-invasive procedure needed, Botulinum toxin can be injected every few months.
Calcium channel blockers and nitrates can also relax lower sphincter.
What is a benign oesophageal stricture caused by?
GORD, corrosives, surgery or radiotherapy
How is a benign oesophageal stricture treated?
Endoscopic balloon dilatation
