Dysphagia Flashcards
Sequence of events
Open q- tell me more
Timing- when did it start? Solids or liquids first? is it there all the time or does it come and go?
Progression- has it worsened over time
Associated Sx
Dysphagia;
Does food get stuck in throat? Any pain? Is there a lump when you swallow? Bad smelling breath? Gurgling or a wet voice after swallowing? Vomited any blood? Cough?\
Systems review;
FWARJNL
GI- change in bowel habit? Any blood in stool or darker than usual?
Neurological systems review- weakness anywhere, problems walking or talking? Change in vision or other senses eg. Double vision
MSK- cold hands that change colour? Dry eyes or mouth? Skin changes? Change in appearance?
Extra questions
Accidentally or otherwise drank corrosives such as bleach
ALARMS symptoms
Anaemia (unexplained) Loss of weight (unintentional) Anorexia Recent onset of progressive symptoms Malaena or haematemesis Swallowing difficulty Over 55
Stroke
Acute onset of speech impairment and limbs weakness
Gurgling voice after drinking
Risks for CVD
Myasthenia Gravis
Autoimmune neuromuscular disorder characterised by muscle fatigability
Difficulty in initiating the swallow and subsequent coughing due to aspiration
Weakness, ptosis, dysarthria, SOB, Waddling gait
MND
Age usually between 50-70
Progressive illness associated with upper and lower motor signs
Quiet hoarse voice, difficulties swallowing can be first Sx in progressive bulbar palsy
Benign oesophageal stricture
Associated with chronic GORD
Intermittent dysphagia for solids which gradually worsens over time
History of radiation or explore to trauma
Oesophageal carcinoma
Progressively worsening dysphagia, initially for solids and then liquids
ALARMS Sx may be present
Risk factors- age, make sex, smoking, alcohol, chronic GORD (Barrett’s)
Oesophageal web
Associated with odynophagia
Congenital or Plummer Vinson syndrome (chronic iron deficiency anaemia with a web)
Pharyngeal pouch
Sensation of lump in throat and halitosis
Achalasia
Impaired relaxation of the LOS
Long history of intermittent dysphagia for solids more than liquids
Retrosternal chest pain after meals and heartburn
Oesophageal spasm
One off event
Intermittent chest pain often misdiagnosed as ACS
Globus pharyngeus
Somatisation disorder with the sensation of a lump in the throat, anxiety may coexist
People who may need to be involved
2 week wait if ALARMS symptoms
Dietician referral
SALT assessment
