Dysphagia & Achalasia Flashcards
1
Q
what is dysphagia?
A
difficulty swallowing
2
Q
DDx?
A
just some…
- pharyngitis
- pharyngeal pouch
- oesophageal candidiasis
- Diffuse oesophageal spasm
- GORD
- hiatus hernia
- stroke
3
Q
what may be in the history of diffuse oesophageal spasm?
A
- dyspahgia intermittent and non-progressive
- chest pain indistinguishable from cardiac chest pain, relieved by nitroglycerin & assoc w meals
4
Q
what may be in the history of oesophageal candidiasis?
A
- may be history of corticosteroid, abx, inhaler use or immunocompromised
- creamy white / yellow plaques seen in oropharynx or hypopharynx
5
Q
cause if dysphagia for BOTH solids and liquids at start: yes and no
A
yes–> motility disorder
no–> solids>liquids: stricture
6
Q
cause if difficulty making swallowing movements?
A
bulbar palsy
7
Q
cause if constant and worsening?
A
malignant stricture
8
Q
cause if odynophagia?
A
cancer, ulcer or spasm
9
Q
pathophysiology of achalasia?
A
- degeneration of myenteric plexus
- loss of oesophageal peristalsis and failure of LOS to relax in response to swallowing
- = food stagnates in lower part of oesophagus & regurgitates
10
Q
aetiology of achalasia?
A
- idiopathic - commonest
- oesophageal cancer
11
Q
presentation of achalasia?
A
- intermittent dysphagia (both solids and liquids)
- regurgitation
- retrosternal chest pain
12
Q
Ix for achalasia?
A
- endoscopy (exclude malignancy)
- barium swallow
- oesophageal manometry
13
Q
what is manometry?
A
investigation to measure function of LOS
14
Q
outline what may be seen in barium swallow and manometry in achalasia
A
- barium swallow
- dilated oesophagus w tapered beak-like narrowing
- manometry
- incomplete relaxation of LOS + aperistalsis + higher pressure at GOJ
15
Q
Mx of achalasia?
A
if symptomatic…
- medical: nitrate / CCB
- botulinum toxin
- surgical: endoscopic dilatation (POEM) / Heller’s myotomy
