Dysphagia Flashcards
Define dysphagia.
Difficulty swallowing
What is the difference between low dysphagia and high dysphagia?
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
What is odynophagia?
Painful swallowing
Broadly speaking, what are the two main causes of odynophagia?
Malignancy
Infection (more common)
What is globus?
Common sensation of having a lump in one’s throat without true dysphagia
This is a benign condition
Other than anatomically, how else is dysphagia classified?
Functional
Structural
List some differentials for high dysphagia:
- Functional Stroke Parkinson’s Disease Multiple Sclerosis Myotonic Dystrophy Motor Neurone Disease Myasthenia Gravis - Structural Cancer Pharyngeal Pouch Cricopharyngeal Bar
List some differentials for low dysphagia:
- 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
List some important questions to ask about the history of presenting complaint.
How long has the dysphagia been around for?
Has the dysphagia been progressive or persistent?
Has the dysphagia been accompanied by a cough?
Has there been any gurgling or dysphonia?
Is the dysphagia to solid, liquids or both?
Has there been any halitosis?
Has there been any heartburn or waterbrash?
Has there been any unintentional weight loss?
Have there been any neurological symptoms?
Have there been any rheumatological symptoms?
Describe the duration of symptoms that is typically associated with oesophageal cancer.
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
What are the likely causes of chronic dysphagia lasting months/years?
Motility disorders (e.g. achalasia)
Which cause does progressive dysphagia suggest?
Gradually growing stricture (could be malignant or benign)
What cause does intermittent dysphagia suggest?
Motility disorder
What does dysphagia to solids but not liquids suggest?
Mechanical obstruction (e.g. stricture) NOTE: if this stricture becomes more severe it could cause dysphagia to fluids as well
What does dysphagia that is worse with fluids than solids suggest?
Motility disorder