Dysphagia Flashcards
What are the two important things you need to know about dysphagia?
Oral, pharyngeal, oesophageal?
Mechanical, motility?
Which 5 key questions do we ask to figure out where and which kind of dysphagia this is?
1) Is there difficulty swallowing both liquids and solids?
YES: motility disorder
NO: suspect stricture
2) Is it hard to initiate the swallowing movement?
YES: suspect bulbar palsy especially if cough on swallowing
3) Is swallowing painful (odynophagia)?
YES: suspect ulceration or spasm
4) Is the dysphagia intermittent or remain and worsening?
INT: suspect oesophageal spasm
NO: suspect stricture
WORSE: suspect malignant stricture
5) Does the neck bulge or gurgle on drinking?
YES: suspect pharyngeal pouch
What are the different motility disorders?
Achalasia
CNS
Pharyngeal causes
What can cause ulceration of the oesophagus?
Malignancy Oesophagitis Viral Candida in the immunocompromised Poor steroid technique
What examination do we do?
Examine mouth, say ahh
Supraclavicular nodes
Look for systemic disease signs
What are the tests that we would do for dysphagia?
FBC (anaemia)
UE (dehydration)
Upper GI endoscopy and biopsy
Contrast swallow if suspicious of pharyngeal pouch Oesophageal manometry (dysmotility) Video fluoroscopy (neurogenic)
What are the differentials for dysphagia?
Oesophagitis Oesophageal spasm GORD Achalasia Extrinsic compression Benign oeso stricture Oesophageal cancer CNS causes
What are some CNS causes of dysphagia?
Muscular - muscle dystrophy, myasthenia gravis
Neurological - stroke, parkinsons, MS
Weakened muscles/impaired coordination - in the elderly - this commonly affects the first two phases of swallowing
How might GORD affect dysphagia?
Scars from acid damage can obstruct the oesophagus
What are some complications of dysphagia?
Choking
Pulmonary aspiration
Malnutrition
How can we treat dysphagia?
Muscle exercises Change head/neck position Soft food and thick drinks Surgery PEG/RIG
WHAT DO YOU ALWAYS FUCKING ASK IN GI SYMPTOMS?
NSAIDS
