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GI > Dysphagia > Flashcards

Dysphagia Flashcards

1
Q

What imaging/tests should you consider with oropharyngeal dysphagia?

A

Esophagram

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2
Q

What imaging/test should you consider with esophageal dysphagia?

A

Endoscopy

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3
Q

If someone is having difficulty swallowing solids and/or liquids, what does that indicate?

A

Motor disorder

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4
Q

If someone is having difficulty swallowing just solids, what does that indicate?

A

Mechanical obstruction

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5
Q

Medications that cause dysphagia

A

Potassium chloride, vitamin C, tetracycline, NSAIDs, bisphosphonates, ferrous sulfate, aspirin

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6
Q

Risk factors for dysphagia

A
  • Children (hereditary/congenital)
  • Adults (esophageal cancer > neurologic disorders)
  • Smoking
  • Long hx of GERD
  • Meds
  • Neurologic events or diseases (CVA, NM disease, Parkinson)
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7
Q

History taking for oropharyngeal dysphagia

A
  • Do you have problems with initiating a swallow?
  • Do you cough or choke or is food coming through your nose after swallowing?
  • Could you point to where the food gets stuck? (localizing source of dysphagia is unreliable, but better with oropharyngeal)
  • Do you have chronic medical problems?
  • Any surgeries on your larynx, esophagus, stomach, or spine?
  • Any radiation therapy?
  • Are you taking any medications/herbs/OTCs?
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8
Q

History taking for esophageal dysphagia

A
  • Do you feel food getting stuck after swallowing?
  • Do you have a problem swallowing solids, liquids, or both?
  • How long have you had problems swallowing? (if rapidly progressive, there is a concern for malignancy)
  • Do you have chronic medical problems?
  • Any surgeries on your larynx, esophagus, stomach, or spine?
  • Any radiation therapy?
  • Are you taking any medications/herbs/OTCs?
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9
Q

Targeted physical exam for oropharyngeal dysphagia

A
  • Choking with swallowing
  • Coughing, drooling, food spillage with swallowing
  • Nasal speech
  • Aspiration pneumonia
  • Weight loss
  • Dysarthria (unclear articulation of speech)
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10
Q

Targeted physical exam for esophageal dysphagia

A
  • Pressure sensation in mid-chest, below suprasternal notch—solids? Liquids? Both?
  • Aspiration pneumonia
  • Weight loss
  • GERD symptoms
  • Neck and oral cavity for lesions, masses, goiter
  • Signs of collagen vascular disease
  • Cranial nerve testing (gag test)
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11
Q

Zenker Diverticulum

A

Outpouching of the mucosa and submucosa (false diverticulum) through Killian triangle, an area of muscular weakness between the cricopharyngeus and the lower inferior constrictor

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12
Q

Possible causes of Zenker

A
  • Abnormal esophageal motility
  • Tightness of cricopharyngeus muscle, which is supposed to relax during swallowing
  • Esophageal shortening
  • Abnormalities in function of the Upper Esophageal Sphincter (UES)
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13
Q

Complications of Zenker

A
  • Aspiration pneumonia

- Squamous cell carcinoma in diverticulum

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14
Q

Zenker presentation

A
  • Mass in neck
  • Gurgling
  • foul breath
  • geriatric patients
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15
Q

Amytrophic lateral sclerosis

A

ALS is a progressive, incurable neurodegenerative disorder that causes muscle weakness, disability, and death

  • muscle wasting > mostly tongue compared to other oropharyngeal mm.
  • 25% present with dysphagia as initial complaint
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16
Q

Xerostomia symptoms

A
  • Difficulty with swallowing or speech
  • Dry, uncomfortable mucosal tissues
  • Thick, ropy saliva
  • Frequent oral candidiasis
  • Atrophic glossitis (lack of papilla) on the tongue
  • Atypical dental caries at the gingival margin
17
Q

Work up and tx for Xerostomia

A
  • Sialogram

- Pilocarpine tx

18
Q

Globus pharyngeus symptoms

A
  • Persistent or intermittent non-painful sensation of a lump or foreign body in the throat
  • Occurrence of the sensation between meals
  • Absence of dysphagia and odynophagia *
  • Absence of evidence that GERD is the cause of symptoms
  • Occurs over the past 3 months with symptom onset at least 6 months prior to diagnosis
19
Q

Esophageal spasm

A

Intermittent mechanical obstruction sometimes causing intermittent dysphagia and chest pain
-Corkscrew appearance

20
Q

Limited Scleroderma

A
  • Progressive motor disorder
  • Excessive collagen deposits throughout the body
  • Rigidity of facial skin and tongue causing impaired chewing and swallowing
  • Vascular (Raynaud’s) and immunological disorders
  • Coughing, aspiration, nasal regurgitation, oral Leakage
  • GERD, heartburn, dysphagia to solids and liquids
  • Hypomotility in LES
21
Q

Achalasia

A
  • Progressive motor disorder
  • Difficulty swallowing, sensation of swallowed material getting stuck in chest
  • Chest pain, regurg (rarely causes aspiration pneumonia), heartburn, hiccups, weight loss
  • Tx: balloon dilation or myotomy
  • Bird’s beak on barium swallow
22
Q

Achalasia etiology

A

Nerve cells of myenteric plexus in the esophagus degenerate for unknown reasons causing 2 problems:

  • Esophageal muscles do not contract normally—food is does not move through esophagus and stomach properly
  • LES (lower esophageal sphincter) does not function correctly
23
Q

Diabetic gastroparesis work up

A

Scintigraphy/radio isotope emptying scan is gold standard

24
Q

What does fiber do in diabetic gastroparesis?

A

Slows the rate of gastric emptying FURTHER and can lead to bezoars

25
Q

Bezoars

A

Solid masses of partially digested food that can cause blockage

26
Q

Imaging for progressive dysphagia in diabetes

A
  • Barium XR: 12 hour fast, then drink liquid barium, which is then viewed under XR. If food is remaining in the stomach, gastroparesis is likely
  • Barium Beefsteak meal: eat a meal that contains barium, which allows the doctor to observe the patient’s stomach digesting the meal
  • Scintigraphy/Radio-isotope gastric emptying scan: nuclear medicine study that shows how quickly food leaves the stomach. Gastroparesis is diagnosed if more than half the food remains after 2 hours
  • Gastric manometry: measures muscular and electrical activity of the stomach as it digests liquid and solid food
27
Q

Peptic stricture

A

Progressive mechanical obstruction

28
Q

Esophageal carcinoma

A
  • Geriatric patients
  • Dysphagia (first solids > liquids) is progressive and most common presenting symptom followed by weight loss
  • Barium esophagography is sensitive for mucosal irregularities
  • Suspicion high > endoscopy essential
29
Q

Drug-Induced esophagitis causes

A
  • Tetracyclines

- Bisphosphonates, iron, vitamin C, NSAIDs, aspirin, potassium chloride

30
Q

Drug-induced esophagitis presentation

A
  • Odynophagia w/ or w/o dysphagia
  • can be mistaken for GERD or cardiac etiology
  • patients may describe a foreign-body sensation in esophagus
31
Q

Drug-induced esophagitis dx

A

Upper endoscopy with mucosal biopsies gold standard

32
Q

Drug-induced esophagitis tx

A
  • STOP MED

- symptomatic relief from: H2 blockers, PPIs, or coating agents

GI (8 decks)

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