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Year 3 > Dysphagia (oxford clin cases) > Flashcards

Dysphagia (oxford clin cases) Flashcards

1
Q

Define dysphagia

A

Difficulty swallowing

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2
Q

When a patient complains of dysphagia what is the first thing you should establish?

A

Where the dysphagia is/ when it is ie is it trouble initiating the swallow or pain higher up as they swallow or is it low dysphagia where they have a feeling of food getting stuck lower several seconds after the swallow

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3
Q

Define odynophagia?

A

Painful swallowing

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4
Q

What are the medical terms for difficulty swallowing vs painful swallowing?

A

Difficulty swallowing= dysphagia

Painful swallowing= odynophagia

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5
Q

Define globus?

A

The feeling of having a lump in the neck

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6
Q

What is high dysphagia likely due to?

A

Systemic or neuromuscular issues

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7
Q

What is low dysphagia likely due to?

A

Obstruction

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8
Q

Where anatomically is relevant when someone presents with dysphagia?

A

Anywhere from the mouth to the lower oesophageal sphincter

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9
Q

What are the 2 main types of dysphagia?

A

Structural or functional

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10
Q

What are common causes of functional high dysphgia?

A 
Stroke 
Parkinsons 
Myasthenia gravis 
MS
MND
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11
Q

What are common causes of structural high dysphagia?

A

Cancer

Pharyngeal pouch

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12
Q

What are common causes of functional low dysphagia?

A

Achalasia
Chaga’s disease
Diffuse oesophageal spasm
Oesophagitis

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13
Q

What are common causes of structural low dysphagia?

A

Cancer
Stricture
Schatzki ring

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14
Q

What type of dysphagia is carcinoma until proven otherwise?

A

New onset dysphagia in middle aged or older patients

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15
Q

What are some questions that would be useful to ask when someone presents with dysphagia? Why?

A

What is the duration?- if sudden then suggests a bolus thats stuck, if its for a long time then it may be more likely cancer
Is it progressive or intermittent- progressive suggests cancer/ stricture, intermittent suggests a mechanical disorder
Is it for solids or fluids- only fluids suggests mechanical obstruction

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16
Q

What does coughing straight after swallowing suggest?

A

Problems with coordination eg Parkinsons

17
Q

What does coughing a while after eating suggest?

A

Regurgitation of food eg from a pharyngeal pouch

18
Q

What does a nocturnal cough (when someone is not eating) alongside dysphagia indicate?

A

Achalasia

19
Q

What does gurgling alongside dysphagia indicate?

A

Pharyngeal pouch

20
Q

What does hoarseness of the voice alongside dysphagia suggest?

A

Involvement of the vocal chords and the recurrent laryngeal nerve (eg by a tumor)

21
Q

What nerve is involved if there is hoarseness of the voice?

A

Recurrent laryngeal nerve

22
Q

What does heartburn/ waterbrash alongside dysphagia suggest?

A

Reflux of some sort

23
Q

What is the main red flag symptom of oesophageal cancer?

A

Weight loss

24
Q

What symptom will all causes of dysphagia eventually lead to?

A

Weight loss

25
Q

What 2 conditions should you ask about in medical history when someone has dysphagia?

A

Peptic ulcer

GORD

26
Q

What drugs can exacerbate reflux symptoms?

A

CCB’s, nitrates etc which relax smooth muscle

27
Q

What drugs can predispose people to peptic ulcers?

A

NSAIDs, aspirin, steroids

28
Q

When may it be useful to do a barium swallow?

A

When you suspect a lesion that is high up

When there is risk of perforation eg higher cancer/pharyngeal pouch

29
Q

What is a barium swallow? What does it show

A

A patient is asked to swallow barium contrast and its passage from the upper to lower oesophageal sphincter is monitored

30
Q

What is the first line investigation for lower dysphagia?

A

Endoscopy

31
Q

What is manometry?

A

It is an investigation which involves measuring pressure of the lower oesophageal sphincter and the peristaltic waves from the oesophagus

32
Q

When is manometry used?

A

When a mechanical obstruction of the oesophagus is ruled out and to investigate motility issues eg achalasia and corkscrew oesophagus

33
Q

What happens to lower oesophageal cells in Barret’s oesophagus?

A

There is metaplasia from squamous into columnar epithelium

34
Q

What description is given to oesophageal squamous epithelium that has undergone metaplasia into columnar epithelium?

A

Velvety (on imaging eg endoscopy)

35
Q

Why does dysphagia arise in achalasia?

A

Due to lack of relaxation of the lower oesophageal sphincter

36
Q

Why does achalasia occur?

A

Loss of the ganglion cells of the myenteric plexus in the lower oesophagus

Year 3 (104 decks)

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