Dysphagia Flashcards
What is Dysphagia?
Difficulty swallowing
What is Odynophagia?
Pain upon swallowing
What are the common causes of Dysphagia?
Diseases of mouth/tongue Neuromuscular disorders Oesophageal motility disorders Extrinsic pressure Intrinsic lesion
What are the two main types of Dysphagia?
Oropharyngeal
Oesophageal
What are the features of Oropharyngeal Dysphagia?
Difficulty initiating swallow +/- choking/aspiration
What are the causes of Oropharyngeal Dysphagia?
Neurological disease (bulbar palsy/MG)
What are the appropriate investigations in suspected Oropharyngeal Dysphagia?
Neurological examination
Videofluoroscopic swallowing assessment
What are the features of Oesophageal Dysphagia?
Food sticks after swallowing +/- regurgitation
What are the causes of Oesophageal Dysphagia?
Dysmotility
Stricture
Oesophagitis
Pharyngeal pouch
What are the appropriate investigations in suspected Oesophageal Dysphagia?
Barium swallow
Endoscopy (OGD)
Biopsy
What features suggest a malignant background?
Short hx of progressive dysphagia
Severe wt loss
Elderly pts
What features suggest a dysmotility (Achalasia) background?
Long hx of non-progressive dysphagia
No wt loss
Young pts
What is Plummer-Vinson syndrome?
Pre-malignant condition due to hyperkeratinisation of oesophagus (causing oesophageal web) and IDA Triad of sx -dysphagia -koilonychia -glossitis
What is the management of Plummer-Vinson syndrome?
Iron
Dilation of web via OGD
What are the sx of an oesophageal malignancy?
>60yrs Progressive dysphagia (solids --> liquids --> saliva) Wt loss/anorexia Retrosternal chest pain Coughing/aspiration Lymphadenopathy
What are the main types of oesophageal malignancy?
Mostly in lower 1/3
Mainly adenocarcinomas, some SCCs
What are the features of oesophageal adenocarcinomas?
Risk factors related to GORD (Barratt’s)
Metastasise earlier than SCC (lymphatic spread)
What are the features of oesophageal SCCs?
Occur in heavy smoking/drinking males
Present late due to lumen compromise (dysphagia)
Regional lymph node spread early/common
What is the prognosis for oesophageal malignancy?
Poor (<10% 5yr survival)
- SCC slightly better (responsive to radiotherapy)
- mets common at diagnosis (25%)
Where are the common sites of metastasis for oesophageal malignancy?
Liver
Lungs
Bones
What are the appropriate investigations for suspected oesophageal malignancy?
OGD w/ transoesophgeal USS/biopsy
CT thorax/abdo
PET
Laparoscopy
What are the management options for oesophageal malignancy?
Radical curative oesophagectomy for T1/T2 localised disease
Pre-op chemo
Chemo/radio combinations (if surgery not indicated)
Oesophageal stenting (palliative, restores swallow)
What is Achalasia?
Dysmotility problem due to lack of coordinated muscle contraction/relaxation at the lower end of the oesophagus
-leads to retention of food bolus
What are the presenting sx of Achalasia?
Dysphagia Regurgitation Substernal cramps Nocturnal cough Wt loss 20-30yrs
