Dysphagia (oxford clin cases) Flashcards
Define dysphagia
Difficulty swallowing
When a patient complains of dysphagia what is the first thing you should establish?
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
Define odynophagia?
Painful swallowing
What are the medical terms for difficulty swallowing vs painful swallowing?
Difficulty swallowing= dysphagia
Painful swallowing= odynophagia
Define globus?
The feeling of having a lump in the neck
What is high dysphagia likely due to?
Systemic or neuromuscular issues
What is low dysphagia likely due to?
Obstruction
Where anatomically is relevant when someone presents with dysphagia?
Anywhere from the mouth to the lower oesophageal sphincter
What are the 2 main types of dysphagia?
Structural or functional
What are common causes of functional high dysphgia?
Stroke Parkinsons Myasthenia gravis MS MND
What are common causes of structural high dysphagia?
Cancer
Pharyngeal pouch
What are common causes of functional low dysphagia?
Achalasia
Chaga’s disease
Diffuse oesophageal spasm
Oesophagitis
What are common causes of structural low dysphagia?
Cancer
Stricture
Schatzki ring
What type of dysphagia is carcinoma until proven otherwise?
New onset dysphagia in middle aged or older patients
What are some questions that would be useful to ask when someone presents with dysphagia? Why?
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
What does coughing straight after swallowing suggest?
Problems with coordination eg Parkinsons
What does coughing a while after eating suggest?
Regurgitation of food eg from a pharyngeal pouch
What does a nocturnal cough (when someone is not eating) alongside dysphagia indicate?
Achalasia
What does gurgling alongside dysphagia indicate?
Pharyngeal pouch
What does hoarseness of the voice alongside dysphagia suggest?
Involvement of the vocal chords and the recurrent laryngeal nerve (eg by a tumor)
What nerve is involved if there is hoarseness of the voice?
Recurrent laryngeal nerve
What does heartburn/ waterbrash alongside dysphagia suggest?
Reflux of some sort
What is the main red flag symptom of oesophageal cancer?
Weight loss
What symptom will all causes of dysphagia eventually lead to?
Weight loss
What 2 conditions should you ask about in medical history when someone has dysphagia?
Peptic ulcer
GORD
What drugs can exacerbate reflux symptoms?
CCB’s, nitrates etc which relax smooth muscle
What drugs can predispose people to peptic ulcers?
NSAIDs, aspirin, steroids
When may it be useful to do a barium swallow?
When you suspect a lesion that is high up
When there is risk of perforation eg higher cancer/pharyngeal pouch
What is a barium swallow? What does it show
A patient is asked to swallow barium contrast and its passage from the upper to lower oesophageal sphincter is monitored
What is the first line investigation for lower dysphagia?
Endoscopy
What is manometry?
It is an investigation which involves measuring pressure of the lower oesophageal sphincter and the peristaltic waves from the oesophagus
When is manometry used?
When a mechanical obstruction of the oesophagus is ruled out and to investigate motility issues eg achalasia and corkscrew oesophagus
What happens to lower oesophageal cells in Barret’s oesophagus?
There is metaplasia from squamous into columnar epithelium
What description is given to oesophageal squamous epithelium that has undergone metaplasia into columnar epithelium?
Velvety (on imaging eg endoscopy)
Why does dysphagia arise in achalasia?
Due to lack of relaxation of the lower oesophageal sphincter
Why does achalasia occur?
Loss of the ganglion cells of the myenteric plexus in the lower oesophagus
