Dysphagia Flashcards

1
Q

Causes

A
  1. Mechanical
  2. Motility
  3. Others
    Esophagitis
    Globus hystericus
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2
Q

Types of mechanical block

A
1. Malignant stricture
Esophageal cancer
Gastric cancer
Pharyngeal cancer
2. Benign strictures
Esophageal web
Peptic stricture
3. Extrinsic pressure
Lung cancer
Mediastinal nodes
Retrosternal goiter
AA
Left atrial enlargement
4. Pharyngeal pouch
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3
Q

Motility disorders

A
Achalasia
Diffuse esophageal spasm
Systemic sclerosis
Myasthenia gravis
Bulbar palsy
Pseudobulbar palsy
Syringonulnia
Bulbar poliomyelitis
Chagas
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4
Q

Key history questions

A
  1. Difficulty swallowing solids and liquids
    If both->motility
    If solids->liquids= stricture
  2. Difficulty making swallowing
    Bulbar palsy
  3. Painful
    Cancer, ulcer, spasm
  4. Intermittent, constant and getting worse
    Intermittent: suspect oesophageal spasm
    Constant and worsening: suspect malignant stricture
  5. Does the neck bulge or gurgle on drinking
    If yes, suspect pharyngeal pouch

Medication, radiation

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5
Q

What is achalasia

A

The lower esophageal sphincter fails to relax->dysphagia, regurgitation, substernal cramps, weight loss.

Treatment with with endoscopic balloon dilitation and PPI

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6
Q

Multidisciplinary team

A
  1. GP
  2. Otolaryngologists
  3. Speech and swallowing therapists
  4. Gastroenterologist
  5. Radiologists
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7
Q

Investigations

A
TFTs
CSF (MS)
Botulinum toxin assay
Liver enzymes
Ceruloplasmin, 24 hour copper
CK
ACHr Antibodies->MG
AntiDNA, ANA->scleroderma

Endoscopy->OGD
Barium swallow->structural when OGD fails to identify

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