Oropharyngeal Dysphagia

Question 1

What is Dysphagia?

Answer 1

Difficulty moving food/liquid through mouth, pharynx, esophagus

Question 2

What will a patient sense with Dysphagia?

Answer 2

Swallowed material sticking along the path

Question 3

When do Oropharyngeal Dysphagias occur?

Answer 3

At the beginning of swallowing

Question 4

General symptoms and location of food sticking with Oropharyngeal Dysphagias

Answer 4

• Trouble initiating swallowing
• ENT symptoms, nasal regurgitation, aspiration
• Food sticks at level of suprasternal notch

Question 5

3 common Oropharyngeal Dysphagias?

Answer 5

1. Zenker’s Diverticulum
2. Esophageal web
3. Sjogren Syndrome

Question 6

3 common Oropharyngeal Dysphagias?

Answer 6

1. Zenker’s Diverticulum
2. Esophageal web
3. Sjogren Syndrome

Question 7

What is Zenker’s Diverticulum?

Answer 7

False diverticula involving the mucosa/submucosa through the muscular layer of the posterior esophagus proximal to the cricopharyngeus (Killian’s triangle)

Question 8

Posterior false diverticula?

Answer 8

Zenker’s Diverticulum

Question 9

Zenker’s Diverticulum occurs at an area of weakness which is due to?

Answer 9

Loss of elasticity of upper esophageal sphincter

Question 10

Zenker’s Diverticulum is constant or progressive?

Answer 10

Progressive!

Question 11

Symptoms of Zenker’s Diverticulum

Answer 11

Coughing, throat discomfort
Halitosis and regurgitation
Choking, gurgling and palpable protrusion

Question 12

Coughing and throat discomfort

• > Halitosis and regurgitation
• > Choking and palpable protrusion

Answer 12

Zenker’s Diverticulum

Question 13

What test should you do and why for Zenker’s Diverticulum?

Answer 13

Barium Swallow BEFORE EGD due to risk of perforation

Question 14

What test should you do and why for Zenker’s Diverticulum?

Answer 14

Barium Swallow BEFORE EGD due to risk of perforation

Question 15

What are possible complications of Zenker’s Diverticulum?

Answer 15

Perforation (if EGD done before barium swallow)
Weight loss
Aspiration -> pneumonia and lung abscess

Question 16

What is an Esophageal Web?

Answer 16

Thin membranes of squamous mucosa affecting the proximal or mid esophagus

Question 17

Thin membranes of mucosa affecting the proximal or mid esophagus

Answer 17

Esophageal web

Question 18

Esophageal web is constant or progressive?

Answer 18

Constant!

Question 19

Symptoms of Esophageal web?

Answer 19

Intermittent dysphagia with solids

Question 20

Esophageal web can be acquired due to what 2 things?

Answer 20

Eosinophilic esophagitis

Plummer Vision Syndrome

Question 21

What is Plummer Vision Syndrome and what can it cause?

Answer 21

• Can cause an Esophageal web

= Iron deficient anemia, Koilonychia, glossitis and angular chelitis

Question 22

Test and treatment for Esophageal web?

Answer 22

Barium Swallow

Dilation

Question 23

What is Sjogren Syndrome?

Answer 23

Autoimmune disease - exocrine gland problem

Question 24

Who does Sjogren Syndrome primarily affect?

Answer 24

Post menopausal females

Question 25

Symptoms of Sjogren Syndrome?

Answer 25

Dry mouth (xerostomia) --> Oropharyngeal dysphagia
Enlargement of salivary glands
Dry eyes with sensation of foreign body

Question 26

Keratoconjuctivitis sicca

Answer 26

Dry eyes with sensation of foreign body in them

- Seen with Sjogren Syndrome

Question 27

Symptoms of Sjogren Syndrome?

Answer 27

Dry mouth (xerostomia) -> Oropharyngeal dysphagia
Enlargement of salivary glands
Dry eyes

Question 28

What tests should be ordered for Sjogren Syndrome?

Answer 28

Minor salivary gland biopsy

- Tear/saliva production

Question 29

What markers will be (+) with Sjogren Syndrome?

Answer 29

(+) Anti SSA/RO

(+) Anti SSB/LA

Question 30

What are those with Sjogren Syndrome at an increased risk for developing?

Answer 30

Oral infections - Dental caries

B-cell NHL