Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Yr 3 Oxford Clinical Cases > Dysphagia > Flashcards

Dysphagia Flashcards

1
Q

Define dysphagia.

A

Difficulty swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the difference between low dysphagia and high dysphagia?

A

High Dysphagia – patients tend to have problems with initiating the swallow or immediately upon swallowing

Low Dysphagia – patients feel that food gets stuck a few seconds after swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is odynophagia?

A

Painful swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Broadly speaking, what are the two main causes of odynophagia?

A

Malignancy

Infection (more common)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is globus?

A

Common sensation of having a lump in one’s throat without true dysphagia

This is a benign condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Other than anatomically, how else is dysphagia classified?

A

Functional

Structural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List some differentials for high dysphagia:

A
  • FUNCTIONAL
    • Stroke
    • Parkinson’s Disease
    • Multiple Sclerosis
    • Myotonic Dystrophy
    • Motor Neurone Disease
    • Myasthenia Gravis
  • STRUCTURAL
    • Cancer
    • Pharyngeal Pouch
    • Cricopharyngeal Bar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List some differentials for low dysphagia:

A
  • FUNCTIONAL
    • Achalasia
    • Chagas Disease
    • Nutcracker Oesophagus
    • Limited Cutaneous Systemic Sclerosis
    • Diffuse Oesophageal Spasm
    • Infective and Eosinophilic Oesophagis
  • STRUCTURAL
    • Cancer
    • Stricture
    • Foreign Body, Plummer-Vinson Syndrome, Post-Fundoplication
    • Mediastinal Mass, Retrosternal Goitre, Bronchial Carcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List some important questions to ask about the history of presenting complaint to characterise the dysphagia

A
  1. How long has the dysphagia been around for?
  2. Has the dysphagia been progressive or persistent?
  3. Is the dysphagia to solid, liquids or both?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the duration of symptoms that is typically associated with oesophageal cancer.

A

Cancer is usually associated with a relatively short history (days/weeks) because the cancer will reach a size at which symptoms begin to appear rapidly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the likely causes of chronic dysphagia lasting months/years?

A

Motility disorders (e.g. achalasia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which cause does progressive dysphagia suggest?

A

Gradually growing stricture (could be malignant or benign)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What cause does intermittent dysphagia suggest?

A

Motility disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does dysphagia to solids but not liquids suggest?

A

Mechanical obstruction (e.g. stricture) NOTE: if this stricture becomes more severe it could cause dysphagia to fluids as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does dysphagia that is worse with fluids than solids suggest?

A

Motility disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does absolute dysphagia to solids, liquids and saliva suggest?

A

Foreign body obstruction (e.g. a bolus of food stuck in the oesophagus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

List some questions you could ask a dyphagic patient to elicit any associated symptoms

A
  1. Has there been any gurgling or dysphonia?
  2. Has the dysphagia been accompanied by a cough?
  3. Has there been any halitosis?
  4. Has there been any heartburn or waterbrash?
  5. Has there been any unintentional weight loss?
  6. Have there been any neurological symptoms?
  7. Have there been any rheumatological symptoms?
18
Q

What does coughing immediately after swallowing suggest?

A

Problem with coordinating the swallow (e.g. due to stroke or Parkinson’s disease)

19
Q

What does coughing some time after a meal suggest?

A

Regurgitation of food

20
Q

What does nocturnal cough when patients are lying flat and not eating suggest?

A

Achalasia

21
Q

What might halitosis in a patient with dysphagia suggest?

A

This occurs if food gets stuck in the oropharynx (e.g. in a pharyngeal pouch)

22
Q

What can cause a gurgling noise when patients attempt to speak soon after eating/drinking?

A

Food/liquid stuck in a pharyngeal pouch could cause a gurgling noise

23
Q

What can cause hoarseness of the voice in patients with dysphagia?

A

Vocal cord dysfunction due to involvement of the recurrent laryngeal nerve (e.g. compression by a pancoast lung tumour)

24
Q

Why is it important to ask whether the patient has experienced heartburn or water brash?

A

These symptoms are associated with GORD => oesophageal adenocarcinoma, strictures

Achalasia is also associated with retrosternal burning

25
Q

Why is it important to enquire about neurological symptoms?

A

Neurological signs may indicate that functional dysphagia (e.g. due to stroke, Parkinson’s disease etc) is more likely

26
Q

Why is it important to enquire about rheumatological symptoms?

A

Rheumatological signs may suggest that limited cutaneous systemic sclerosis is the cause of the dysphagia

27
Q

What are the five main features of limited cutaneous systemic sclerosis?

A

CREST

  • Calcinosis
  • Raynaud’s Phenomenon
  • Oesophageal Dysmotility
  • Sclerodactyly
  • Telangiectasia
28
Q

What are the two most important conditions to enquire about with regards to the patient’s past medical history? Explain why.

A
  • GORD-Predisposes to oesophageal cancer and non-malignant strictures , hiatus hernia- post fundoplication complication
  • Peptic Ulcer Disease- Can lead to scarring and strictures around the gastric cardia and lower oesophagus
29
Q

List some important features of the drug history that should be noted.

A

Drugs that relax smooth muscle (e.g. CCBs, nitrated) – exacerbate reflux symptoms Drugs that increase risk of PUD (e.g. NSAIDs, steroids, aspirin, bisphosphonates)

30
Q

Physical examination is rarely useful for dysphagia. However, there are five main features that are important to check for. What are they?

A
  1. Cranial nerve pathology
  2. Signs of GI malignancy (e.g. Troisier’s sign, cachexia)
  3. Neck mass (e.g. large pharyngeal pouch, retrosternal goitre, cervical lymphadenopathy => cancers)
  4. Features of CREST syndrome
  5. Koilonychia (Fe2+ def => Plummer-Vinson syndrome = Oesophageal webs)
31
Q

What would you do a barium swallow?

A

High Dysphagia

Achalasia

32
Q

What is the first-line investigation for low dysphagia?

A

OGD

33
Q

Name a type of modified barium swallow that is sometimes used to investigate patients with functional high dysphagia and describe the procedure

A

Videofluoroscopy- SALT modifies swallow technique throughout study

34
Q

Which important investigation is used to differentiate between different types of motility disorder?

A

Manometry – assesses the pressures in the lower oesophageal sphincter and the peristaltic wave

35
Q

List some imaging modalities that may be used to stage oesophageal cancer.

A
  • Spiral CT Chest/Abdomen
  • PET
  • Endoscopic Ultrasound
  • Laparoscopy
36
Q

What is the main treatment for oesophageal cancer?

A

Oesophagectomy

37
Q

What percentage of oesophageal cancer patients are UNsuitable for surgery?

A

60-70%

38
Q

Define achalasia.

A

1) Failure of relaxation of the lower oesophageal sphincter
2) Failure of normal oesophageal peristalsis

39
Q

Describe the typical history of a patient with achalasia.

A

Young patient, no loss of weight, a long history of mild dysphagia to both solids and liquids with no problems coordinating the swallow in the mouth but the food/drink feels like it gets stuck on the way down to the stomach

40
Q

First line investigation for Achalasia and key-feature seen?

A

Barium Swallow

Bird-beak oesophagus

41
Q

GORD + distal velvetty epithelium seen on endocsopy- what is the diagnosis?

A

Barrett’s or Adenocarcinoma

Metaplasia of the epithelium

Yr 3 Oxford Clinical Cases (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions