Dysphagia

Question 1

What is dysphagia?

Answer 1

difficulty in swallowing
endoscopy is essential

painful swallowing = odynophagia

Question 2

What are malignant causes of dysphagia ?

Answer 2

• Oesophageal cancer
• Pharyngeal cancer
• gastric cancer
• extrinsic pressure i.e. lung cancer / node enlargement

Question 3

What are neuro causes of dysphagia?

Answer 3

• Bulbar palsy
• lateral medullary syndrome
• mysasthenia gravis
• syringomyelia

Question 4

What are other causes of of dysphagia ?

Answer 4

• Benign strictures
• pharyngeal pouch
• achalasia
• systemic sclerosis
• oesophagitis
• iron deficiecy anaemi

Question 5

What to ask in hx of patient with dysphagia?

Answer 5

• dyspepsia ?
• weight loss?
• lumps?
• progressive dysphagia?

Question 6

What tests for dysphagia ?

Answer 6

Bloods:
* FBC, ESR

Imaging:
* CXR
* Barium swallow
* endoscopy + biopsy
* oesphageal motiliy studies

Question 7

Pt with dysphagia:
Ask: can fluid be drunk as fast as normal except if food is stuck.
What are you differentials if patients says yes or no

Answer 7

If pt says yes
* suspect a stricture (benign / malignant)

Pt says no:
* think of motility disorder (achalasia, neuro cause)

Question 8

Pt with dysphagia ask: is it difficult to make the swallowing movement ?

if pt says yes, what is differencial?

Answer 8

Yes:
* suspect bulbar palsy (especically if cough on wwallowing )

Question 9

Pt with dysphagia ask: is it difficult to make the swallowing movement?

if pt says yes, what is differencial?

Answer 9

Yes:
* suspect bulbar palsy (especically if cough on wwallowing )

Question 10

Pt with dysphagia ask: Is the dysphagia constant and painful?

Yes: what is differencial

Answer 10

Yes:
* think malignant stricture

Question 11

Pt with dysphagia ask: Does the neck bulge or gurgle on drinking?
if patient says yes what is your differential?

Answer 11

Yes:
* suspect a pharyngeal pouch
* also food may be regurgitated