Dysphagia

Question 1

1. Was there difficulty swallowing solids and liquids from the start?

Yes?

No - solids then liquids?

Answer 1

Yes: motility disorder: achalasia

no: stricture - benign or malignant

Question 2

Is swallowing painful (odynophagia)?

Answer 2

Ulceration (oesophagitis or malignancy)

Question 3

4. Is the dysphagia intermittent or constant or getting worse?

Answer 3

Intermittent - spasm

constant and worsening - malignant stricture

Question 4

Does the neck bulge or gurgle on drinking?

Answer 4

Yes: pharyngeal pouch

Question 5

common in old men 
midline lump in neck 
dysphagia 
chronic cough 
aspiration

Answer 5

pharyngal pouch

Question 6

intermittent dysphagia and chest pain

Answer 6

oesophageal spasm

Question 7

odynophagia
no weight loss
Hx of heart burn

often caused by prolonged reflux in GORD

Answer 7

oesophagitis

Question 8

hx of barrett’s oesophagus, smoking, alcohol
dysphagia
vomiting while eating
weight loss

Answer 8

oesophageal cancer

Question 9

dysphagia of both solids and liquids
heartburn
regurgitation - risk of aspiration pneumonia

Answer 9

achalasia

Question 10

what is cause of achalasia?

leads to?

Answer 10

abnormal PSNS innervation

lack of oesophageal sphincter relaxation and lack of coordinated peristalsis