FN: Dysphagia

Question 1

Definition

Answer 1

Difficulty swallowing

Question 2

Causes

Answer 2

Inflammatory
Mechanical Block
Motility Disorders

Question 3

Inflammatory causes

Answer 3

􏰀 Tonsillitis, pharyngitis
􏰀 Oesophagitis: GORD, candida
􏰀 Oral candidiasis
􏰀 Aphthous ulcers

Question 4

Mechanical Block

Answer 4

Luminal
Mural
Extra-Mural

Question 5

Luminal causes

Answer 5

􏰁 FB

􏰁 Large food bolus

Question 6

Mural

Answer 6

􏰁 Benign stricture
- 􏰃 Web (e.g. Plummer-Vinson)
- 􏰃 Oesophagitis
􏰃 - Trauma (e.g. OGD)
􏰁 Malignant stricture
- 􏰃 Pharynx, oesophagus, gastric
􏰁 - Pharyngeal pouch

Question 7

Extra-mural causes

Answer 7

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

Question 8

Local motility Disorders

Answer 8

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

Question 9

systemic motility disorders

Answer 9

􏰁 Systemic sclerosis / CREST 􏰁 MG

Question 10

Presentation

Answer 10

􏰀 Dysphagia for liquids and solids at start 􏰁 Yes: motility disorder
􏰁 No, solids > liquids: stricture
􏰀 Difficulty making swallowing movement: bulbar palsy
􏰀 Odonophagia: Ca, oesophageal ulcer, spasm
􏰀 Intermittent: oesophageal spasm
􏰀 Constant and worsening: malignant stricture
􏰀 Neck bulges or gurgles on drinking: pharyngeal pouch

Question 11

Signs

Answer 11

􏰀 Cachexia
􏰀 Anaemia
􏰀 Virchow’s node (+ve = Troisier’s sign)
􏰀 Neurology
􏰀 Signs of systemic disease (e.g. scleroderma)

Question 12

Ix

Answer 12

􏰀 Bloods: FBC, U+E
􏰀 CXR
􏰀 OGD
􏰀 Barium swallow ± video fluoroscopy
􏰀 Oesophageal manometrry

Question 13

Achalasia pathophysiology

Answer 13

􏰁 Degeneration of myenteric plexus (Auerbach’s) 􏰁 ↓ peristalsis
􏰁 LOS fails to relax

Question 14

Achalasia cause

Answer 14

􏰁 1O / idiopathic: commonest

􏰁 2O: oesophageal Ca, Chagas’ disease (T. cruzii)

Question 15

Achalasia presentation

Answer 15

􏰁 Dysphagia: liquids and solids at same time 􏰁 Regurgitation
􏰁 Substernal cramps
􏰁 Wt. loss

Question 16

Achalasia comps

Answer 16

Chronic achalasia → oesophageal SCC

Question 17

Achalasia Ix

Answer 17

􏰁 Ba swallow: dilated tapering oesophagus (Bird’s beak)
􏰁 Manometry: failure of relaxation + ↓ peristalsis
􏰁 CXR: may show widended mediastinum
􏰁 OGD: exclude malignancy

Question 18

Achalasia Rx

Answer 18

􏰁 Med: CCBs, nitrates
􏰁 Int: endoscopic balloon dilatation, botulinum toxin injection
􏰁 Surg: Heller’s cardiomyotomy (open or endo)

Question 19

Pharyngeal Pouch: Zenkers Diverticulum

Answer 19

􏰀 Outpouching of oesophagus between upper boarder of cricopharyngeus muscle and lower boarder of inferior constrictor of pharynx
􏰁 Weak area called Killian’s dehiscence.
􏰀 Defect usually occurs posteriorly but swelling usually
bulges to left side of neck.
􏰀 Food debris → pouch expansion → oesophageal
compression → dysphagia.

Question 20

Pharyngeal Pouch: Zenkers Diverticulum presentation

Answer 20

regurg
Halitosis
Gurgling sounds

Question 21

Pharyngeal Pouch: Zenkers Diverticulum Rx

Answer 21

Excision

Endoscopic Stapling

Question 22

Diffuse oesophageal Spasm

Answer 22

􏰀 Intermittent dysphagia ± chest pain

􏰀 Ba swallow shows corkscrew oesophagus

Question 23

Nutcracker Oesophagus

Answer 23

􏰀

↑ contraction pressure ̄c normal peristalsis