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Year 3 - Met3a > Dysphagia > Flashcards

Dysphagia Flashcards

1
Q

Name oesophageal symptoms

A
  • Dysphagia
  • Odynophagia
  • Heartburn
  • Regurgitation
  • Waterbrash
  • Chest pain
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2
Q

Define dysphagia

A

difficulty swallowing

- things might be stuck in the throat

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3
Q

define odynophagia

A

pain on swallowing

- something is painful

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4
Q

What is heartburn

A
  • reflux in the chest
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5
Q

describe how oropharyngeal swallowing works

A
  • when you swallow
  • tongue presses up to the roof of your mouth
  • soft palate blocks the nasal cavity
  • epiglottis blocks the trachea entrance
  • opens passageway to the oesophagus
  • then the nasal cavity and trachea opens up again
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6
Q

How does oesophageal swallowing works

A
  • Gravity pushes it down
  • orientated contraction of muscles that helps push the food down
  • propels food down into the stomach
  • has to go through the LOS
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7
Q

What does the LOS do

A

prevents gastric contents from refluxing back into the oesophagus but allows food in

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8
Q

What happens when oesophageal swallowing fails

A
  • feel food that sticks in your chest
  • things move down slowly
  • drink a lot of water to push it through
  • or induce vomiting when things dont go through
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9
Q

What are the two types of causes of dysphagia

A
  • Obstructive

- Non obstructive

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10
Q

What are the types of obstructive dysphagia

A

Intraluminal
- foreign body

Within walls

  • cancer
  • strictures
  • rings
  • webs

Extraluminal

  • lymphadenopathy
  • compression from heart and aorta - anuerysms
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11
Q

What are non obstructive causes of dysphagia

A

Oesophageal

  • motility problems
  • neuromuscular problems
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12
Q

What should you take in a history with dysphagia

A
  • sudden v gradual
  • duration
  • lipids v solids
  • other oesophageal symptoms
  • red flags
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13
Q

What are the red flags of dysphagia

A
  • weight loss
  • anaemia
  • family history
  • smoking
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14
Q

What are the causes of oesophageal stricture

A
  • Untreated GORD (10-20% risk)
  • Radiotherapy
  • Caustic injury - e.g. bleach

Drugs

  • Bisphosphanates
  • NSIADS
  • tetracyclines
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15
Q

What drugs can cause oesophageal strictures

A
  • Bisphosphanates
  • NSIADS
  • tetracyclines
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16
Q

what are the two types of cancer effect the oesophagus

A
  • adenocarcinoma

- squamous cell carcinoma

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17
Q

what is the more common cancer that effects the oesophagus

A

adenocarcinoma

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18
Q

where do the two types of cancer that affect the oesophagus arise from and what part of the oesophagus are they in

A
  • adenocarcinoma = from columnar glandular epithelium in the lower 1/3 of the oesophagus
  • squamous cell carcinoma = from squamous epithelium in the top 2/3rds
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19
Q

What are the risk factors for squamous cell carcinoma

A
  • Smoking
  • alcohol
  • chewing betel nut
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20
Q

What can squamous cell oesophageal cancer effect around it

A
  • usually very aggressive
  • can invade the trachea, causing fistuale
  • effect the laryngeal nerve causing hoarseness and dysphonia
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21
Q

Where does squamous cell oesophageal cancer metastasise to

A
  • bone
  • brain
  • liver
  • lungs
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22
Q

How do you treat squamous cell oesophageal cancer

A
  • radiotherpy

- +/- chemotherapy

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23
Q

What are the risk factors for adenocarcinoma

A
  • GORD

- beretts oesophagus

24
Q

how aggressive is adenocarcinoma oesophageal cancer

A

less aggressive than squamous cell carcinoma

25
Q

Where does adenocarcinoma oesophageal cancer metastasise

A

Liver

Lymph nodes

26
Q

What is the treatment for adenocarcinoma oesophageal cancer

A
  • Surgery - resect a lot of the oesophagus

- +/- chemotherapy

27
Q

What are the complications after adenocarcinoma oesophageal cancer surgery

A
  • vagal damage
  • reflux - due to loss of gastro oesophageal junction (LOS).
  • feel full quickly
  • nausea
28
Q

What happens in surgery of adenocarcinoma oesophageal cancer

A
  • oesophagus is shortened
  • stomach sits in the chest
  • loss of LOS
29
Q

What can you use to help symptoms in non curative oesophageal cancer

A
  • place stents in the oesophagus - pushes the walls open to keep it open
30
Q

How does a hiatus hernia cause reflux

A
  • Hernia can occur due to weakness in the muscles
  • sliding hiatus hernia - when it slide up you loose LOS
  • things are more likely to reflux up into the chest
31
Q

How do you know it is a sliding hiatus hernia

A

= see two restrictions

- LOS and diaphragm

32
Q

how do you manage a stricture

A
  • dilatation - balloon dilatation
  • balloon is completely deflated
  • with X ray guidance you inflate the balloon - and stretch open the stricture
  • end up with the lumen that is bigger than before
33
Q

What does a rolling hiatus hernia cause

A

rolling hernia can cause pain but doesnt tend to cause reflux

34
Q

What is the most common hiatus hernia

A

Sliding hernia

35
Q

What does achalasia look like in a barium swallowing

A
  • birds beak
36
Q

What is achalasia

A

Oesophageal motility disorder

  • happens when the LOS fails to relax - tight and gone into spasm
  • problem with the neurones
37
Q

What is achalasia associated with

A
  • Regurgitation
  • food stasis
  • oesophageal dilatation
38
Q

What is achalasia associated with

A

aperistalsis - absence of peristalsis

39
Q

What is aperistalsis

A

absence of peristalsis

40
Q

what do you have an increased risk of when you have achalasia

A
  • increased risk of squamous cell carcinoma
41
Q

why can you digest solids more easily in achalasia

A
  • solids have more weight so they push open the LOS

- liquids will just sit on top

42
Q

What is the management of achalasia

A
  • Surgical - cut open the muscle
  • Endoscopic - can use botox into the LOS which will paralyse the muscle and cause it to relax also can use a balloon to widen the LOS
43
Q

What is it called when you get rings in the oesophagus

A
  • oesophageal trachealisation
44
Q

What can cause oesophageal trachealisation

A

eosinophilic oesophagitis

45
Q

How does eosinophilic oesophagitis present

A
  • dysphagia and food impaction
  • leads to dysmotility
  • associated with atopy
46
Q

What is the treatment of eosinophilic oesophagitis

A
  • Dietary elimination
  • Medication (steroids) - topical steroids
  • Endoscopic for strictures
47
Q

does eosinophilic oesophagitis present in men or women more

A

men

48
Q

What questions in dysphagia history do you ask

A

History:

  • Onset: Sudden vs gradual
  • Duration
  • Liquids vs solids
  • Red flags: Weight loss, anaemia, family history, smoking

Systems enquiry:
- Heartburn, odynophagia, regurgitation , cough

Past Medical History
- GORD, atopy, cancer

Medications:
- Bisphosphanates, radiation

Social history:
- Smoking, alcohol

49
Q

How do you classify dysphagia

A
  • is it pharyngeal or oesophageal
  • is it obstructive or non-obstructive

Obstructive

  • problems with lumen
  • problems in walls of lumen
  • problems outside lumen
50
Q

What questions help you narrow what the cause of dysphagia is

A
  • onset
  • duration
  • difficulty swallowing solids or liquids
  • associated symptoms and signs and pathology
51
Q

What is the
- onset
- duration
- difficulty swallowing solids or liquids
- associated symptoms and signs and pathology
of cancer

A
  • onset = gradual
  • duration = short
  • difficulty swallowing solids or liquids = solids
  • associated symptoms and signs and pathology = weight loss, cachexia, anaemia
52
Q

What is the
- onset
- duration
- difficulty swallowing solids or liquids
- associated symptoms and signs and pathology
of strictures

A
  • onset = gradual
  • duration = short
  • difficulty swallowing solids or liquids = solids
  • associated symptoms and signs and pathology = reflux
53
Q

What is the
- onset
- duration
- difficulty swallowing solids or liquids
- associated symptoms and signs and pathology
of achalasia

A
  • onset = gradual
  • duration = long
  • difficulty swallowing solids or liquids = liquids
  • associated symptoms and signs and pathology = cough, regurgitation, weight loss
54
Q

What is the
- onset
- duration
- difficulty swallowing solids or liquids
- associated symptoms and signs and pathology
of eosinophillic oesphagitis and food bolus

A
  • onset = gradual
  • duration = long
  • difficulty swallowing solids or liquids = solids
  • associated symptoms and signs and pathology = rashes, allergy, atopy
55
Q

What are the key questions to ask for dysphagia

A

Key questions to ask

  1. Was there difficulty swallowing solids and liquids from the start
    - If yes then motility disorder such as CNS, achalasia
    - If no and only solids then stricture benign or malignant
  2. Is it difficult to initiate a swallowing movement?
    - If yes bulbar palsy
  3. Is it painful to swallow?
    - If yes – viral infection, candida, malignancy, oesophagitis, suspected ulceration
  4. Is the dysphagia intermittent or is it constant and getting worse?
    - Intermittent – suspected oesophageal spasm
    - Constant and getting worse – oesophageal malignancy
  5. Does the neck bulge on drinking?
    - Yes pharyngeal pouch
56
Q

What is the difference between a sliding and paraoespheageal hiatal hernias

A

Sliding
- Gastrooephageal junction slides up into the chest

Paraesophageal
- Gastrooesophageal junction remains in the abdomen but a bulge in the stomach goes up into the chest

57
Q

How do you treat a hiatus hernia

A

Imaging
- Upper GI requires endoscopy

Treatment

  • Loose weight
  • Treat GORD

Year 3 - Met3a (43 decks)

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