Dysphagia Flashcards
1
Q
Causes
A
- Mechanical
- Motility
- Others
Esophagitis
Globus hystericus
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
3
Q
Motility disorders
A
Achalasia Diffuse esophageal spasm Systemic sclerosis Myasthenia gravis Bulbar palsy Pseudobulbar palsy Syringonulnia Bulbar poliomyelitis Chagas
4
Q
Key history questions
A
- Difficulty swallowing solids and liquids
If both->motility
If solids->liquids= stricture - Difficulty making swallowing
Bulbar palsy - Painful
Cancer, ulcer, spasm - Intermittent, constant and getting worse
Intermittent: suspect oesophageal spasm
Constant and worsening: suspect malignant stricture - Does the neck bulge or gurgle on drinking
If yes, suspect pharyngeal pouch
Medication, radiation
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
6
Q
Multidisciplinary team
A
- GP
- Otolaryngologists
- Speech and swallowing therapists
- Gastroenterologist
- Radiologists
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