FN: Dysphagia

Question 1

Causes

Answer 1

Inflammatory
Neuroogical/ Motility disorders
Mechanical Obstruction

Question 2

Inflammatory causes

Answer 2

tonsilitis pharyngitits
Oesphagitits: GORD, candida
Oral candiadiasis
Apthous ulcers

Question 3

Neurological/Motility disorders local

Answer 3

Achalasia
Diffuse oesophageal spasm
Nutcracker oesophagus
Bulbar/pseudoblbar palsy (CVA, MND)

Question 4

Neurological/Motility disorders systemic

Answer 4

Systemic sclerosis/CREST

Mg

Question 5

Mechanical Obstruction categories

Answer 5

Luminal
Mural
Extra-mural

Question 6

Luminal causes

Answer 6

FB

LArge food bolus

Question 7

Mural

Answer 7

Benign stricture
Malignant stricture
Pharyngeal pouch

Question 8

Benign stricture causes

Answer 8

Web (e.g. Plummer-Vinson)
Oesophagitits
Trauma e.g. OGD

Question 9

Malignant stricture

Answer 9

Pharynx, oesophagus, gastric

Question 10

Extra-Mural causes

Answer 10

Retrosternal goitre
Rolling hiatus hernia
Lung Ca
Mediastinal LNs (e.g. lymphoma)
Thoracic aortic aneurysm

Question 11

Investigations

Answer 11

Upper GI endoscopy
Ba swallow
Manometry

Question 12

Achalasia pathophysiology

Answer 12

• Degeneration of myenteric plexus (Auerbach’s)
  Reduced peristalsis
  LOS fails to relax

Question 13

Achalasia Cause

Answer 13

primary/idiopathic: commonest

Secondary: Chagas disease (T. cruzil)

Question 14

Achalasia PResentation

Answer 14

Dysphagia: liquids then solids
REgurgitation (esp @ night)
Sibsternal cramps
Wt. loss

Question 15

Achalasia Complications

Answer 15

Oesophageal SCC in 3-5%

Question 16

Achalasia investigations

Answer 16

BA swallow
Manometry
CXR
OGD

Question 17

Achalasia Ba swallow show

Answer 17

Dilated tapering oesophagus - bired beak

Question 18

Achalasia manometry

Answer 18

Failure of relaxation and reduced peristalsis

Question 19

Achalasia CXR

Answer 19

widened mediastinum, double RH border

Question 20

Achalasia OGD shows

Answer 20

Exlcude malignancy

Question 21

Achalasia Rx

Answer 21

Med: CBBs, nitrates
Int: botox injection endoscopic balloon dilation
Surg: Hellers cardiomyotomy (open or lap)

Question 22

Pharyngeal Pouch: Zenkers Diverticulum definition

Answer 22

Outpuching between crico- and thyro-pharyngeal components of the inf. pharyngeal constrictor - area of weakness = Killians dehiscence

Question 23

Pharyngeal Pouch: Zenkers Diverticulum defect occurs

Answer 23

usually posterioorly but swealling usually bulges to left side of he neck

Question 24

Pharyngeal Pouch: Zenkers Diverticulum why dysphagia

Answer 24

Food debris leads to pouch expansion and oesophageal compression that causes dysphagia

Question 25

Pharyngeal Pouch: Zenkers Diverticulum Presentation

Answer 25

Regurg, halitosis, gurgling sounds

Question 26

Pharyngeal Pouch: Zenkers Diverticulum Rx

Answer 26

Excision, endoscopic stapling

Question 27

Diffuse oesophageal spasm

Answer 27

Intermittant severe chest pain ± dysphagia

Ba swallow shows corkscren oesophagus

Question 28

Nutcracker Oesophagus

Answer 28

• Intermittant dysphagia ± chest pain

- Raised contraction pressure with normal peristalsis

Question 29

Plummer-Vinson Syndrome

Answer 29

Severe IDA - hyperkeratinisation of upper 3rd of oesophagus - web formation
Pre-malignant: 20% risk of SCC

Question 30

Oesophageal Rupture

Answer 30

• Iatrogenic (85-90%) : endoscopu, biopsy, dilatation
• Violent emesis: Boerhaves syndrome
• Carcinoma
• Caustic ingestion
• Trauma: surgical emphysema ± pneumothorax

Question 31

Oesophageal Rupture features

Answer 31

Odonphagia
Mediastinitis: tachypnoea, dyspnoea, fever, shock
Surgical emphysema

Question 32

Oesophageal Rupture Mx

Answer 32

Iatrogenic: PPI, NGT, Abx
Other: resus, PPI, Anxm antifungal, debridement + formation of oesophago-cutaneous fistula w/ T- tube