Dysphagia Flashcards
Neuromuscular, mechanical/obstructive, and infective. Oral, pharyngeal, and oesophageal.
What are the two main pathological mechanisms in persistent dysphagia?
Mechanical/obstructive and neuromuscular (CNS or localised, neurogenic or auto-inflammatory)
What are acute causes of dysphagia?
- Trauma/foreign body
- Acute throat infection
- Acute oesophagitis - infectious or allergic e.g. eosinophillic
- Stroke
What are the different onset of dysphagia? What is an important characteristic to determine?
Acute, chronic/gradual, intermittent.
Important to ask whether it is food and fluid from the start - if no and progresssive, suspect malignancy or growing obstructive problem.
Describe the anatomy and physiology of swallowing.
Swallowing involves the coordinated action of the mouth, pharynx, and esophagus.
It has three phases: oral (voluntary), pharyngeal (involuntary), and esophageal (involuntary). The process is controlled by the swallowing center in the brainstem.
What are common symptoms associated with dysphagia?
- Regurgitation of food or drink,
- coughing or choking during eating,
- bubbling or gurgling or bad breath
- pain on swallowing (odynophagia), and
- weight loss/anorexia
What are benign and acute causes of dysphagia? What is the predominant symptoms?
Infection e.g. tonsillitis
Often with pain/ sore throat
What are three secondary problems associated with dysphagia that may be life-threatening?
- Aspiration
- Malnutrition/dehydration
- Difficulty taking medication
How can you classify obstructive pathologies of dysphagia?
- Intrinsic: oesophageal tumour or stricture, pouch
- Extrinsic: mediastinal mass
List important associated features of dysphagia to ask about.
- Difficulty initiating or coordinating - CNS
- Coughing/choking - aspiration
- Pain - wall damage
- Regurgitation - obstructive
- Voice changes
- Neck lump
What are some oropharyngeal causes of dysphagia? How might you differentiate it from an oesophageal cause?
- neurological problems (e.g., stroke, Parkinson’s disease) - poor coordiation, inability to chew
- Dementia - loss of voluntary action of swallowing
- Myasthenia gravis
- infections (e.g., poor dentition, severe tonsillitis, candidiasis, epiglottitis)
- Oropharyngeal tumors,
- pharyngeal pouch,
Differentiated by difficulty initiating a swallow, symptoms of aspiration e.g. choking and coughing
What are some oesophageal causes of dysphagia?
How might you differentiate it from an oropharyngeal cause - list 3 symptoms?
- oesophagitis/eosinophilic,
- oesophageal cancer or mediastinal tumour
- Benign strictures,
- oesophageal webs and rings,
- achalasia - degenerative condition
- Systemic sclerosis - oesophageal dysmotility
Difficulty passing food - sensation of food sticking in chest or throat, regurgitation
A person with a neurologcial condition presents with dysphagia. What could it be? List 5 conditions (CNS and PNS)
- Stroke/ cellebellar disease
- Facial nerve palsy
- Parkinson’s disease,
- multiple sclerosis,
- Motor neurone disease
- Myasthenia gravis
Coordination, aspiration
What is a pharyngeal pouch also called?
Zenker’s diverticulum.
What is odynophagia caused by? Is it a red flag?
Damage to the oesophagus or forceful contractions.
* Oesophagitis (infection, auto-immune due to medication, acid reflux)
* Ulceration (acid reflux, malignancy)
* Oesophageal spasms
Red flag for malignancy. Oesophageal cancer may first present with odynophagia.
A patient with GORD presents with dysphagia. Why is this?
Lower oesophageal stricture
A woman with heavy menstrual bleeding complains of tiredness and food being stuck in the chest. What is the likely cause of her dysphagia?
Oesophageal web - can happen in iron-deficiency anaemia
Which medical history is relevant in a patient with dysphagia?
- Damage or radiation to the mouth, throat, or oesophagus
- GORD- chronic acid reflux
- Neurological conditions
Other: medication, cancer RFs
What about odynophagia should you ask about?
- Site/location (mouth, throat, chest)
- Progression - intermittent or progressive/constant
Chest - may suggest oesophageal problem
How might you determine the location of pathology in dysphagia?
Open question of the characteristic of dysphagia - e.g. how does it feel like?
Initation of swallow and food moving down
Why is it important to ask about progression of dysphagia? e.g. food or fluid first affected
Suspect malignancy if progressive.
Benign causes include new strictures.
What pathological mechanism does regurgitation suggest?
e.g. A patient reports progressive difficulty swallowing solid foods over the past six months, with occasional regurgitation of undigested food.
Obstruction e.g. stricture, tumour, achalasia (inc. LOS tone)
What are the key components of a physical examination for a patient with dysphagia?
Assessing the oral cavity, neck, neurological function and respiratory exam.
If possible, observe the patient swallowing different consistencies of food and liquids
Describe the diagnostic tests used to evaluate dysphagia (e.g., barium swallow, endoscopy, manometry)
Barium Swallow: X-ray imaging to visualize the swallowing process and detect structural abnormalities.
Endoscopy: Direct visualization of the esophagus and stomach to identify inflammation, strictures, or tumors.
Manometry: Measures the pressure and coordination of esophageal muscles during swallowing.
Videofluoroscopy: Dynamic X-ray study to assess the oral and pharyngeal phases of swallowing.
General management for dysphagia
- Dietary modications or nutritional supplementation
- Swallowing therapy
- Treatement of underlying cause - medical or surgical
A 70-year-old patient presents with progressive difficulty swallowing solids and liquids, weight loss, and regurgitation. What is your differential diagnosis?
Differential diagnosis includes esophageal cancer, achalasia, esophageal stricture/ severe GERD.
What is a quick imaging test for dysphagia? Especially if suspecting chest involvement or foreign body?
CXR
