Dysphagia

Question 1

Typical cause of oropharyngeal dysphagia

Oral cavity

Tongue

Pharyngeal

UES

CN innervation and function

Answer 1

NM dysfunction/obstruction

5, 7- mastication

12, propulsion of food to hypopharynx

9, 10- elevate soft palate
close epiglottis, propulsion of food to esophagus

Open/close sphincter

Question 2

Zenker’s diverticulum disrupts muslces creating

Answer 2

ineffective peristalsis in distal pharynx, leading to inc tone of UES

Question 3

Oropharyngeal dysphagia NM disorders

Myopathic
Neurologic
Structural

Look for symptoms such as

Answer 3

M= MG, polymyositis, CT do

N- stroke, head trauma, PD, ALS, MS, Cerebral palsy

S- zenkers, tumors

Ptosis, dysarthria, tongue atrophy, CN dysfunction

Question 4

Food impaction

Esophageal web/ring

Raditation injury

Pill esophagitis

Obstruction of esophageal lumen

Answer 4

Partial/complete lumen obstruction- acute pain after eating meat

Infants/young children, developmental anomaly occludes lumen

Radiation therapy of H/N, acute/chronic dysphagia as a result of ischemia/fibrosis/esophagitis

Ineffective swallowing, pill directly contacts mucosa resulting in an ulcer- CP, odynophagia/dysphagia to solids

Question 5

Diffuse esophageal spasm cause

Pt with scleroderma is at high risk for

Answer 5

Impaired NO synthesis

peptic stricture, so look for skin thickening

Question 6

Tx dysphagia first step

Obstruction tx

Infection tx

NM do tx

Answer 6

Rule out malignancy

Balloon dilation

Ab, treating immunosuppresion

treat underlyin cause, improve swallowing mechanics/posture/manuevers
feed with thick liquids