Dysphagia Flashcards
Dysphagia definition
Difficulty with the act of swallowing
Globus definition
Non‑painful lump or feeling of fullness in the throat
Globus is alleviated by _______
Eating or drinking
Globus most noticeable with _________
Swallowing saliva
Odynophagia definition
Pain in swallowing
Causes of odynophagia
Infections e.g., candida, HSV, CMV
Chemical e.g., drug induced, radiation, Crohn disease, dermatological causes, severe reflux
Xerostomia – check medication causes, Sjögren syndrome
Pharyngeal or oesophageal malignancy
Signs/sx of oral dysphagia
Difficulty controlling food, liquid or saliva in the mouth
Drooling
Food getting stuck in the mouth
May report taking a long time to chew food and avoiding certain foods
Signs/sx of pharyngeal dysphagia
Delayed or difficulty initiating swallowing and may be associated with coughing, choking or nasal regurgitation
Unexplained chest infections
Swallow repetitively to clear hypopharynx
May feel that food gets stuck at neck level
May have wet or gurgly voice
Signs/sx of oesophageal dysphagia
Discomfort or obstructive symptoms a few seconds after swallowing
Oral or pharyngeal causes of dysphagia
Often have a neurological basis e.g., Parkinson’s, MS, previous stroke, MND
Local tumour in the pharynx
Consider muscular dystrophies as a cause of dysphagia if associated with what other sx
Hoarseness
Dysphonia
Nasal speech
Dysphagia
Oesophageal causes of dysphagia
Motility disorders e.g., achalasia, spasm, scleroderma
Oesophageal cancer
Strictures, or rings, or webs
Eosinophilic oesophagitis
Features which might point towards oesophageal cancer as a cause for dysphagia
Wt loss
Smoking
Alcohol
Rapidly progressive dysphagia
Features which might point towards strictures/rings/webs as a cause for dysphagia
Slower onset, or reflux
Features which might point towards eosinophilic oesophagitis as a cause for dysphagia
Associated with atopy, or asthma in young adults
If oseophageal dysphagia consider whether ______ or _______ disease
Structural or motor
If structural cause, progressive dysphagia is usually caused by ___________. Intermittent symptoms are more likely to be due to an __________.
Progressive - cancer or a stricture
Intermittent - oesophageal ring
If motility cause, progressive dysphagia is seen with _________. Intermittent symptoms are more likely to be due to ________.
Progressive - achalasia and scleroderma
Intermittent - spasm or other motility disorders
Examination for dysphagia
Examine the head and neck, including looking in the mouth and checking for lymphadenopathy.
Cranial nerve exam +/- full neuro depending on suspected cause
Check swallowing.
Examine the hands and skin, looking for Raynaud phenomenon, scleroderma, dermatomyositis.
