Dysphagia Flashcards
What is dysphagia?
Difficulty in swallowing
Painful swallowing is odynophagia
What are causes of dysphagia?
Malignant: Oeseophageal cancer Pharyngeal cancer Gatric cancer Extrinsic pressure from lung cancer or lymph node
Neurological: Bulbar palsy Lateral medullary syndrome Myasthenia gravia Syringomyelia
Other causes: Benign strictures Pharyngeal pouch Achalasia Systemic sclerosis Oesophagitis
What should you ask about in hx of dysphagia?
Dyspepsia Weight loss Lumps Progressive dysphagia? Can fluid be drunk as fast as usual? Difficult to make swallowing movement? Dysphagia constant and painful? Neck bulge/gurgle on drinking?
What do you think if fluid can be drunk as fast as usual except if food is stuck? No (fluid hard to swallow?
Yes - suspect a stricture (benign/malignant)
No - motility disorders (achalasia, neurological)
What do you suspect if it is difficult to make swallowing movement?
Yes: suspect bulbar palsy especially if cough on swallowing
What do you suspect if dysphagia is constant and painful?
Ulceration - Suspect a malignant stricture
What do you suspect if there is neck bulge or gurgle on drinking?
Suspect a pharyngeal pouch - food may be regurgitated
What investigations in dysphagia?
FBC ESR CXR BArium swallow Endoscopy with biopsy Oesophageal motility studies
Who should you involve in dysphagia management?
Dietician
Nutritional support may be needed pre and post treatment via percutaneous endoscopic gastrostomy (PEG)
What is associated with oesophageal carcinoma?
Achalasia, alcohol, smoking, Barrett’s oesophagus
What are symptoms of oesophageal carcinoma? Manamgent?
Dysphagia, weight loss, hoarseness, cough
Surgery ± chemo/radiotherapy
What causes benign oesophageal stricture? What is treatment?
Oesophageal reflux, swallowing corrosives, foreign body, trauma
Dilatation (endoscopic under GA)
What is achalasia
Coordinated peristalsis is lost and lower oesophageal sphincter fails to relax (due to degeneration of the myenteric plexus)
Causing dysphagia, regurgitation and weight loss
Dilated tapering oesophagus on contrast study
Endoscopic balloon dilation and then PPI
What is pharyngeal pouch? Signs?
Pharyngeal mucosa herniates through an area of weakness known as Killian’s dehiscence possible due to incoordination of swallowing and increased pressure above the closed upper oesophageal sphincter.
Signs: Dysphagia with gurgling and regurgitation of udigested food Halitosis Lump in the neck Aspiration pneumonia
Elderly men
What is investigation and management of pharyngeal pouch?
Barium swallow
Endoscopy to exclude malignancy
Endoscopic stapling of the wall that divides the pouch from the oesophagus
