GI Quiz 1 - Dysphagia

Question 1

What is dysphagia?

Answer 1

difficulty swallowing (not lump in throat)

Question 2

What are 2 types of dysphagia?

Answer 2

Oropharyngeal: oropharynx -> esophagus
Esophageal: passing down esophagus

Question 3

What are 2 types of etiologies for oropharyngeal and esophageal dysphagia?

Answer 3

Oro: neurologic or muscular
Eso: motility disorders vs. mechanical obstruction

Question 4

What are some examples of neurologic and muscular causes of oro dysphagia?

Answer 4

Neuro: stroke, parkinson’s, MS, motor neuron disorders, bulbar poliomyelitis

Muscular: Myasthenia gravis, dermatomyositis, muscular dystrophy, cricophayngeal incoordination

Question 5

What are some examples of motility disorders & mechanical causes of eso dysphagia?

Answer 5

Motility: achalasia, diffuse eso spasm, systemtic sclerosis, eosinophillic esophagitis

Mechanical: peptic stricture, eso CA, LE rings, Caustic ingestions, Extrinsic compression (i.e. aortic aneurysm, enlarged L atrium, etc)

Question 6

What are SSx of oro vs eso dysphagia?

Answer 6

Oro: diff. initiating swallowing, food sticking in throat, nasal regurg., cough/choke w/swallowing, voice change

Eso: sensation of food sticking in throat/chest, oral regurg.

Both: drooling, wt loss (unexplained), recurrent pneumonia

Question 7

What is the PE for Dysphagia?

Answer 7

Nutritional status (weight)
Neuro exam: resting tremor, CN, muscle strength, gait, balance
Skin: rashes, thickening
Muscles: wasting, fasiculations, tenderness
Neck: thyromegaly/masses

Question 8

If you find a tremor, ataxia, balance disturbance w/dysphagia, what could the possible cause be?

Answer 8

Parkinson’s Dz

Question 9

If you find focal easy fatigability (facial mm) w/dysphagia, what could the possible cause be?

Answer 9

Myasthenia gravis

Question 10

If you find muscle fasciculation, wasting, weakness w/dysphagia, what could the possible cause be?

Answer 10

Motor neuron dz vs. neuropathy

Question 11

If you find rapidly progressive/constant dysphagia w/o neuro findings, what could the possible cause be?

Answer 11

Eso. obstruction vs. probable CA

Question 12

If you find a GI reflux SSx w/dysphagia, what could the possible cause be?

Answer 12

Peptic stricture

Question 13

If you find intermittent dysphagia, what could the possible cause be?

Answer 13

LE ring vs. diffuse eso spasm

Question 14

If you find slow progression (months -> yrs) dysphagia to solids/liquids w/nocturnal regurg., what could the possible cause be?

Answer 14

Achalasia

Question 15

If you find a neck mass/thyromegaly w/dysphagia, what could the possible cause be?

Answer 15

Extrinsic compression

Question 16

If you find Raynaud’s, arthralgias, skin tightening/contractures of fingers w/dysphagia, what could the possible cause be?

Answer 16

Systemic sclerosis

Question 17

If you find cough/dyspnea/lung congestion w/dysphagia, what could the possible cause be?

Answer 17

Pulmonary aspiration

Question 18

What is the typical work-up for dysphagia include?

Answer 18

ALL = endoscopy to r/o CA
M/b = barium swallow (w/solid bolus) -> obstruction 
M/b = Motility Study (if barium swallow neg./suggestive of motility disorder)

Question 19

What are RED FLAGS for dysphagia?

Answer 19

SSx of complete obstruction (drooling, inability to swallow anything)
Wt loss
New focal neuro deficit (objective weakness)