Dysphagia Flashcards
First thing to ask with dysphagia
If difficulty initiating- neuro
If feel get stuck- gastro causes
What is word for painful swallowing
Odynophagia
What normally causes odynophagia
Candidiasis
Cancer
What is globus
The feeling of having lump in throat without true dysphagia
Functional causes of high dysphagia
Stroke Parkinsons MG MS MND Inadequate saliva
What could result in inadequate saliva production
Sjogrens
Anticholinergics
Structural causes of high dysphagia
Cancer
Pharyngeal pouch
Lower causes of functional dysphagia
Achalasia
CREST syndrome
Oesophagitis
Luminal cause of low dysphagia
Foreign body
Mural causes of low dysphagia
Cancer
Stricture
Oesophageal webs
Extrinsic causes of low dysphagia
Mediastinal mass Retrosternal goitre Pancoast tumour Aortic aneurysm Pericardial effusion
What are progressive vs intermittent dysphagia symptoms indicative of
Progressive- cancer
Intermittent- functional
What does new onset dysphagia suggest
Structural
What does chronic dysphagia suggest
Functional
What does dysphagia progression from solids to liquid suggest
Stricture
What does dysphagia progression from liquid to solids suggest
Functional
Absolute dysphagia
To everything including saliva
Foreign body
Stricture
Repeated absolute dysphagia
Cancer
What does choking right after eating suggest
Functional cause
What does a nocturnal cough suggest
Achalasia- when lying down
What does a cough some time after eating suggest
Either a pharyngeal pouch
Food that was stuck at sphincter junction and has now aspirated- achalasia
GORD
What does halitosis suggest
Zenckers diverticulum( pharyngeal pouch)
What is other word for pharyngeal pouch
Zenckers diverticulum
What does gurgling after eating when trying to speak suggest
Zenckers diverticulum- could see bulge in neck
What does dysphonia with dysphagia suggest
Recurrent laryngeal involvement- extrinsic tumour
What is dysphonia
Abnormal voice
What does chest burn suggest
GORD predisposes to oesophageal cancer
40% achalasia patients present with this
What does slow eating suggest about dysphagia
Functional
What does tiredness after eating suggest
Functional
What does extra effort needed to swallow suggest
Functional
Why ask about rheum symptoms in dysphagia
CREST syndrome
CREST syndrome sx
Calcinosis Raynauds phenomena Eosophageal immobility Sclerodactyly Telengectasia
Why is telengectasia important in abdo exam
CREST -> dysphagia
Medical conditions to ask about in history dysphagia and why
Peptic ulcer- lead to scarring and strictures at junction
GORD- predisposes to oesophageal cancer, could have had due to hiatus hernia which would mean had fundoplication of lower oesophageal sphincter leading to post op dysphagia as stitches too tight
MS and parkinsons may lead to it
Drugs to ask about in dysphagia history
NSAIDS, steroids and bisphosphonates may lead to ulcers
CCB and nitrates can relax muscle of oesophagus
What is name for oesophageal webs
Plummer vinson syndrome
Cranial nerve pathology in dysphagia exam
Functional cause
Virchows node in dysphagia exam
Cancer
Hepatomegaly in dysphagia exam
Met to liver
Neck mass in dysphagia exam
Goitre-> external compression
Pharyngeal pouch
Koilonychia in dysphagia exam
Plummer vinson syndrome
4 main investigations for dysphagia
Barium swallow
Endoscopy
Videofluoroscopy
Manometry
Difference between barium swallow and barium meal
Swallow from upper to lower sphincter
Meal watches in stomach and duodenum too
Indications of barium swallow
Suspected high lesion as in OGD this area gets intubated and also is risk of perf here
Achalasia
When is endoscopy indicated
Lower lesion suspected
Much more sensitive
When is videofluroscopy indicated
Functional high dysphagia
Difference between videofluoroscopy and barium swallow
Videofluoroscopy given barium in liquid or semi solid form and therapist adjest swallowing technique
When is manometry indicated
Other imaging inconclusive
Used to differentiate between functional causes
How does achalasia appear on barium swallow
Birds beak
On endoscopy how is barretts oesophagus described
Velvety epithelium
What elective operation has highest mortality rate
Oesophagectomy
2/3 candidates deemed unfit due to advanced disease stage
What investigations are used to stage oesophageal cancer
CT
PET
Endoscopic US
Laparascopy
What happens to oesophagus in achalasia
Becomes dilated
What is nutcracker dysphagia
Strong spasms when trying to eat- from hypertensive crises
What is manometry used to differentiate achalasia from
Nut cracker syndrome
Dysphagia with SOB
Tumour compressing oesophagus
2 most common oesophagus cancers
Adenocarcinoma
Squamous cell carcinoma
Risk factors for squamous cell carcninoma of the oesophagus
Alcohol Smoking Achalasia Plummer vinson Coeliac
Risk factors for adenocarcinoma
Barretts oesophagus
Smoking and alcohol
What is plummer vinson syndrome
Dysphagia due to keratonised webs in the oesophagus associated with IDA
What is danger of plummer vinson syndrome
Premalignant to cricopharyngeal cancer
Risk factors for oesophageal cancer
Middle aged to elderly women
What is aetiology of achalasia
Absence of ganglion cells within the myenteric plexus of oesophagus leading to failure of lower oesophageal sphincter and lower oesophagus
Charcteristics of left recurrent laryngeal damage
Bovine cough
Hoarse voice
How can the recurrent left laryngeal nerve be damaged in dysphagic patients
Infiltration from oesophageal malignancy
Mediastinal malignancy
Ortners syndrome
What is Ortner syndrome
When the recurrent laryngeal nerve is compressed by the CVS system normally by left atria enlarged due to mitral stenosis
How can oesophageal cancer present
Dysphagia Weight loss GI reflux Odynophagia Dyspnoea
