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Gastrointestinal > Dysphagia > Flashcards

Dysphagia Flashcards

1
Q

Describe normal motility of oesophagus.

A

Peristalsis moves food down to stomach

Two waves of peristalsis

When peristalsis reaches the lower oesophageal sphincter it opens and allows food into stomach

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2
Q

What is peristalsis?

A

Sequential, coordinated contraction waves that travels the entire length of the oesophagus, propelling intraluminal contents to the stomach.

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3
Q

Describe the two waves of peristalsis that occur?

A

Primary wave: triggered by swallowing centre

Secondary wave: triggered by food bolus distending the oesophagus

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4
Q

What are oesophageal motility disorders?

A

Problems with the oesophagus that restrict its movement, so causing difficulty swallowing and moving food down to the stomach

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5
Q

What two categories of oesophageal motility disorders are there?

A

Primary: problem with oesophagus directly

Systemic: systemic disease that causes problems with the oesophagus

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6
Q

Name an important primary oesophageal motility disorder?

A

Achalasia

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7
Q

What is achalasia?

A

Where the muscles in the lower part of the oesophagus fail to relax and open

Lack of peristalsis

Preventing food getting into the stomach

Diagnosed when you’ve ruled out other causes like cancer

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8
Q

Clinical features of achalasia?

A 
Dysphagia
Regurgitation
Chest pain
Weight loss + malnutrition
Aspiration of oesophagus contents into lungs
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9
Q

What causes achalasia?

A

Unknown!

Maybe autoimmune, hereditary

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10
Q

What do you need to rule out when you see a patient with suspected oesophageal motility disorder?

A

Essential to rule out:

  • GORD
  • Hiatus hernia
  • Psychosomatic disorders
  • Cancer
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11
Q

Investigations for achalasia?

A

Barium swallow: barium shows up clearly on fluoroscopy, you will see the blockage

Endoscopy: to rule out cancer

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12
Q

What might you see on an endoscopy in a patient with achalasia?

A

Normal looking oesophagus

Difficulty passing endoscope through LOS, food debris trapped above it

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13
Q

Treatment of achalasia?

A

Sublingual nifedipine: a Ca channel blocker

Lifestyle changes: eat slowly, chew well, drink plenty of water with food, raise head of bed while sleeping

Botox injection into LOS: to paralyse the muscles holding it shut

Pneumatic dilatation: use a balloon to stretch the muscles

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14
Q

Which systemic disease causes oesophageal motility disorders?

A

Systemic sclerosis: CREST syndrome

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15
Q

What is CREST syndrome?

A

A type of systemic sclerosis (AKA scleroderma)

A connective tissue disorder which has many features, one of which is oesophageal dysmotility

Calcinosis
Raynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia.
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16
Q

How does CREST cause oesophageal dysmotility?

A

CREST causes atrophy of the GI tract wall smooth muscle

So less peristalsis occurs, food can’t move down properly

17
Q

How does oesophageal dysmotility caused by CREST present?

A

Dysphagia
Sensation of food getting stuck
Atypical chest pain
Cough

The need to drink liquids in order to swallow food

You may see other features of CREST

18
Q

Investigations of oesophageal dysmotility caused by CREST?

A

Endoscopy
Barium swallow

Tests for CREST: serum antibodies

19
Q

Treatment of oesophageal dysmotility caused by CREST?

A

Treat CREST

Lifestyle: eat slowly, chew well, drink plenty of water with food, raise head of bed while sleeping

Oesophageal dilation

20
Q

What should you consider with a patient who has solid dysphagia?

A

Obstruction

Oesophageal cancer
Stricture

21
Q

What should you consider with a patient who has solid + liquid dysphagia?

A

Oesophageal motility disorder

  • Stroke
  • Myasthenia Gravis
  • CREST
  • Achalasia
22
Q

What are some causes of dysphagia?

A 
Stroke
Myasthenia Gravis
CREST
Achalasia
Tonsilitis
23
Q

How can you tell from the patient’s history whether their dysphagia is likely to be caused by an oesophageal motility disorder or an obstruction?

A

If they have had problems with liquid + solid swallowing from the beginning = Oesophageal motility disorder

If they started with solid dysphagia and have progressed to liquid dysphagia = obstruction

24
Q

What are the red flag symptoms of dysphagia?

A

Solid dysphagia progressing to liquid

Painful swallowing

Problem is constant and getting worse

Weight loss

25
Q

What tests should you perform on patients with dysphagia?

A

Bloods:

  • FBC to look for anaemia
  • U&E to check for dehydration / malnutrition
  • Serum antibodies to check for CREST

CXR: to look for aspiration

Endoscopy + biopsy: malignancy

Barium swallow

Gastrointestinal (20 decks)

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