Dysphagia Flashcards
what are some important questions to ask a patient presenting with “dysphagia”
solids and liquids or solids > liquids?
intermittent or constant?
pain associated?
duration- ant obvious event at onset?
difficulty making the swallowing movement?
does the neck bulge or gurgle on swallowing liquids?
what GI specific investigations would you do in a patient presenting with dysphagia?
OGD
barium swallow +/- video fluoroscopy
oesophageal manometry
Name some functional causes of dysphagia?
Stroke, Parkinson’s disease, Myasthenia graves, oesophageal dysmotility in CREST, MS, myotonic dystrophy, MND, achalasia
Name some structural causes of dysphagia
oesophageal cancer, stricture, foreign body, compression from mass in mediastinum, retrosternal goitre etc tonsillitis, pharyngitis, oral candidiasis, GORD etc
what is the cause of achalasia?
degeneration of the myenteric plexus leading to decreased peristalsis and failure of the lower oesophageal sphincter to relax
how does achalasia present?
dysphagia, regurgitation, substernal cramps, wt loss
can chronic achalasia lead to oesophageal SCC?
yes
name 4 GI specific investigations useful in achalasia
OGD- to exclude malignancy
barium swallow- may see dilated tapering oesophagus in achalasia (birds beak)
manometry- may show failure of relaxation and decreased peristalsis
CXR- may show widened mediastinum
what parasite cause chagas disease?
Trypanosoma cruzi ( faecal oral transmission)
how do you manage achalasia?
there is no effective management to restore peristaltic function.
Meds: CCBs nd nitrates can cause muscle relaxation
intervention radiology: endoscopic balloon dilatation, Botox injections
surgical: hellers cardiomyotomy
what condition causes a corkscrew oesophagus on barium swallow?
diffuse oesophageal spasm
where would a swallowed foreign body most likely lodge? (3 places)
left main bronchus
cricopharyngeus
diaphragmatic hiatus hernia
what does chagas disease cause in the oesophagus?
failure of the lower oesophageal sphincter to relax
