Dysphagia Flashcards
Types of dysphagia.
Can be divided into oral, pharyngeal and oesophageal dysphagia.
Can also be divided into mechanical or motility related dysphagia.
Differential of dysphagia.
Odynophagia
Patient might say they have difficulties swallowing but in reality they have painful swallowing
Causes of mechanical dysphagia.
Malignant stricure like pharyngeal, oesophageal or gastric cancer.
Benign strictures like oesophageal web or ring and peptic strictures.
Extrinsic pressure lik lung cancer, mediastinal lymph nodes, retrosternal goitre, aortic aneurysm or left atrial enlargement
Pharyngeal pouch
Motility causes of dysphagia.
Achalasia
Diffuse oesophageal spasm
Systemic sclerosis
Neurological bulbar palsy
Five key questions to ask in dysphagia.
Was there difficulty swallowing solids and liquids from the start?
Yes = motility
No = solids then liquids = suspect a stricture
Is it difficult to initate a swallowing movement?
Yes = bulbar palsy
Is swallowing painful?
Yes = suspect ulceration or spasm
Is the dysphagia intermittent or is it constant and getting worse?
Yes = malignant stricture
Does the neck bulge or gurgle on drinking?
Yes = pharyngeal pouch
Oesophageal dysphagia causes.
Physical obstruction or neuromuscular problem.
Obs = tumour, stricture or inflammation from oesophagitis.
Neuro = achalasia, dysmotility, presbyoesophagus
Causes of oro-pharyngeal dysphagia.
Usually due to problems coordinating the muscles that move the food bolus to the back of the mouth like in a stroke.
Important to examine the patient’s cranial nerves.
Signs of dysphagia.
Possible cachexia and anaemia.
Examine mouth and check for supraclavicular nodes.
Looks for signs of systemic disease like systemic sclerosis and CNS disease.
Investigations in dysphagia.
Bloods- FBC and U&Es.
Upper GI endoscopy +/- biopsy
If sus pharyngeal pouch then consider contrast swallow.
Video fluoroscopy for neurogenic
Oesophageal manometry for dysmotility.
Investigations of oesophageal dysphagia.
OGD to exclude obstructive cause.
Barium swallow or oesophageal manometry for neuromuscular problems.
Investigations of oro-pharyngeal dysphagia.
Cranial nerve assessment
Video-fluoroscopy can be helpful
Treatment of oesophageal dysphagia.
Depends on cause.
Dilation for benign strictures
Surgery and stenting for cancers.
Treatment of oro-pharyngeal dysphagia.
Try thickening foods if that helps.
If it still remains unsafe to eat consider enteral feeding.
What is achalasia?
Loss of coordinated peristalsis. The lower oesophageal sphincter fails to relax leading to dysphagia and regurgitations.
It is usually investigaed with manometry or constrast swallow.
Treatment of achalasia.
Endoscopic balloon dilation or Heller’s cardiomyotomy and then PPis.
Botox
CCB and nitrates may als relax the sphincter.
