Dysphagia

Question 1

What are some of the categories causes of dysphagia can be classified into?

Answer 1

Inflammatory
Neurological
Mechanical obstruction

Question 2

What are some of the inflammatory causes of dysphagia?

Answer 2

Tonsillitis
Pharyngitis
Oesophagitis - can be due to GORD

Question 3

What are some of the neurological causes of dysphagia?

Answer 3

Local - Bulbar palsy, Achalasia

Systemic - Systemic sclerosis (CREST), Myasthenia gravis

Question 4

What are some of the things that may cause mechanical obstruction leading to dysphagia?

Answer 4

Luminal - Foreign body, large food bolus
Mural - Oesophagitis, trauma, pharyngeal pouch, malignancy
Extra-mural - Goitre, Rolling hiatus hernia, Lung Ca, Mediastinal lymph nodes, Thoracic aortic aneurysm

Question 5

What investigations can be done in a patient with dysphagia?

Answer 5

Barium swallow

OGD

Question 6

What is Achalasia?

Answer 6

Degeneration of myenteric plexus causing dysfunctional contraction of the oesophagus. Reduced peristalsis and lower oesophageal sphincter fails to relax

Question 7

What causes Achalasia?

Answer 7

Mostly idiopathic

May be secondary to Chagas’ disease (Caused by bloodsucking bugs in South America, CNS/Heart effects)

Question 8

How do patients with Achalasia usually present?

Answer 8

Progressive dysphagia from liquids to solids
Regurgitation especially at night
Weight loss
Substernal cramps

Question 9

What are some of the complications of Achalasia?

Answer 9

If chronic, there is an increased risk of oesophageal SCC

Question 10

What investigations can be done in a patient with suspected Achalasia?

Answer 10

Barium swallow - Bird beak (Dilated tapering oesophagus)
CXR - Widened mediastinum
OGD to exclude malignancy

Question 11

What is the management of a patient with Achalasia?

Answer 11

Can give calcium channel blockers or nitrates
Can do endoscopic balloon dilatation
Surgery - Heller’s cardiomytotomy (Cut LOS to help relax muscle and allow food to pass through)

Question 12

What is Diffuse oesophageal spasm?

Answer 12

Intermittent severe chest pain +/- dysphagia
Barium swallow shows a corkscrew oesophagus
Calcium channel blockers or PPIs can be used to treat

Question 13

What is Nutcracker oesophagus?

Answer 13

Intermittent dysphagia +/- chest pain
Due to increased contraction pressure, but peristalsis is normal.
Give calcium channel blockers, PPIs, avoid triggers eg hot/cold drinks

Question 14

What is a pharyngeal pouch?

Answer 14

Outpouching between crico- and thyro-pharyngeal
components of the inferior pharyngeal constrictor
Usually occurs posteriorly, but presents as swelling in left side of the neck

Question 15

How does a pharyngeal pouch cause dysphagia?

Answer 15

Food debris trapped in pouch → pouch expansion → oesophageal compression → dysphagia

Question 16

How would a patient with a pharyngeal pouch present?

Answer 16

Halitosis

Regurgitation

Question 17

How would you treat a pharyngeal pouch?

Answer 17

Excision

Endoscopic stapling

Question 18

What causes oesophageal rupture?

Answer 18

Mainly iatrogenic eg endoscopy, biopsy
Violent emesis
Carcinoma
Trauma
Caustic ingestion (Chemicals that can corrode tissue)

Question 19

What are some of the features of oesophageal rupture?

Answer 19

Odonophagia
Tachypnoea
Dyspnoea
Fever
Shock

Question 20

How do you manage a patient with oesophageal rupture?

Answer 20

PPI
NGT
ABx (If needed)