Dysphagia Flashcards
What does dysphagia mean?
Dysphagia simply means difficulty with swallowing.
Unless associated with a sore through it is a serious symptom that warrants swift investigation.
What is the term given to painful swallowing?
Painful swallowing is termed odynophagia
What causes dysphagia?
Malignant – oesophageal, pharyngeal, gastric cancer or extrinsic pressure from lung, or nodal cancer.
Neurological – bulbar palsy, lateral medullary syndrome, myasthenia gravis or syringomyelia
Other – benign structures, pharyngeal pouch, achalasia, systemic sclerosis or iron deficiency anaemia
What questions should you ask in the history of someone with dysphagia?
Dyspepsia, weight loss, lumps or progressive?
Is it solids or both fluids and solids – if both this suggests motility disorders, if just solids this suggests a stricture
Is making the swallowing movement difficult – suggests bulbar palsy
Is it painful – suspect malignant stricture or ulceration secondary to an infection
Is it constant or intermittent – constant and worsening suggests malignancy, intermittent suggests spasm
Does the neck bulge or gurgle – pharyngeal pouch
What investigations should be done in a patient with dysphagia?
FBC Upper GI Endoscopy and biopsy CXR Barium swallow Important to assess nutrition as it could be causing malnutrition
What causes benign oesophageal strictures?
Causes – reflux, swallowing corrosives, foreign body and trauma
How are benign oesophageal strictures managed?
Treatment – dilation via endoscopy under GA
What is achalasia and how does it present?
Problems with coordinated peristalsis and failure of LOS to relax.
Symptoms – dysphagia or both solids and liquids, variable severity, heartburn, regurgitation – leading to cough and aspiration.
How is achalasia managed?
Treatment – botulinum toxin injection, endoscopic balloon dilation or heller’s cardiomyotomy, followed by PPI
What is a pharyngeal pouch?
Herniation of pharyngeal mucosa through Kilian’s dehiscence (triangle between the thyropharyngeus and cricopharyngeus muscles possibly due to incoordination of swallowing
What are the symptoms of a pharayngeal pouch?
Symptoms – dysphagia, regurgitation, halitosis, aspiration pneumonia, gurgling when eating and a lump in the neck.
How should a pharyngeal pouch be investigated?
Investigate with barium swallow and endoscopy to exclude malignancy within pouch
What is the management of a pharyngeal pouch?
Treatment – endoscopic surgery
What does globus pharyngeus mean?
Term used to describe the sensation of a lump in the throat when swallowing. Unclear why it occurs although could be related to muscle tension.
Treatment is simply reassurance and advice to try and ignore it/think about it less.
