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M2 GI > tbl 1 clinical approach to dysphagia > Flashcards

tbl 1 clinical approach to dysphagia Flashcards

1
Q

What are common structural causes of oropharyngeal dysphagia in addition to osteophytes and skeletal abnormalities, congenital (cleft palate, diverticula, pouches etc)

A

Cricopharyngeal bar, Zenker’s diverticulum, Cervical webs

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2
Q

Myopathic causes of oropharyngeal dysphagia?

  1. _______
  2. ________
  3. ________
  4. Myotonic dystrophy
  5. Oculopharyngeal dystrophy
  6. Polymyositis
  7. Sarcoidisis
  8. Paraneoplastic syndromes
A

Connective tissue disease (overlap syndrome), dermatomyositis, myasthenia gravis

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3
Q

What are neurological causes of oropharyngeal dysphagia?

  1. _____
  2. ______
  3. ________
  4. cerebral palsy
  5. Guillain- Barre syndrome
  6. Huntington disease
  7. Multiple sclerosis
  8. Multiple sclerosis
  9. Polio
  10. Post polio syndrome
    11: Tardive dyskinesia
  11. Metabolic encephalopathies
  12. Amyotrophic lateral sclerosis
  13. . Parkinson disease
    15: dementia
A

brainstem tumours; head trauma; stroke

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4
Q

What are iatrogenic causes of oropharyngeal dysphagia?

  1. medication side effects (chemotherapy, ____ etc)
  2. postsurgical muscular or neurogenic
  3. radiation
  4. corrosive (pill injury, intentional)
A

neuroleptics

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5
Q

Infectious causes of oropharyngeal dysphasia?

  1. ____________
  2. Diptheria
  3. Botulism
  4. Lyme disease
  5. Syphillis
A

Muscositis (herpes, cytomegalovirus, Candida etc)

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6
Q

Metabolic causes of oropharyngeal dysphasia?

  1. _________
  2. Cushing’s syndrome
  3. Thyrotoxicosis
  4. Wilson disease
A

Amyloidosis

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7
Q

Common intrinsic causes of oesophageal dysphagia?

A

Benign tumours, caustic esophagitis/ stricture, diverticula, malignancy

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8
Q

Extrinsic causes of oesophageal dysphagia are often due to compression of aberrant nearby structures on the oesophagus. Examples include ________, cervical osteophytes, enlarged aorta, enlarged left atrium, mediastinal mass (lymphadenopathy, lung cancer etc), post surgery (laryngeal, spinal)

A

aberrant subclavian artery

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9
Q

What are the motility disorders that cause oesophageal dysphagia

A

Achalasia, Chagas disease, primary motility disorders, secondary motility disorders

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10
Q

what is the definition of functional dysphagia?

A

absence of structural or motility disorders

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11
Q

What does changes in speech (slurred, nasal speech, dysarthria, dysphonia) + oropharyngeal dysphagia suggests?

A

neuromuscular dysfunction

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12
Q

What does weak cough, hoarseness of voice + oropharyngeal dysphagia suggests?

A

vocal cord paralysis

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13
Q

What does oropharyngeal dysphagia developing late in a meal suggest?

A

myasthenia gravis

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14
Q

What does elderly age, blood in mouth, weight loss + oropharyngeal dysphagia suggests?

A

possible malignancy

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15
Q

What does otalgia (ear pain) + oropharyngeal dysphagia suggests?

A

hypopharyngeal lesion/ cancer

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16
Q

What does odynophagia + oropharyngeal dysphagia suggests?

A

inflammation, infection, or cancer

17
Q

What does dry mouth, dry eyes + oropharyngeal dysphagia suggests?

A
  • inadequate salivary production: sjogren’s syndrome
  • history of head and neck radiotherapy
  • medication e.g. anticholinergics, anti histamines
18
Q

Evaluation of oropharyngeal dysphagia
- Bedside swallowing test
- Physical examination – examination of the oral cavity, head and neck and supraclavicular region
o Neurological examination of the _____ nerves
- Laboratory and imaging – additional tests may be warranted to determine aetiology
o E.g. MRI brain/brainstem (stroke, multiple sclerosis), auto-antibodies against acetylcholine receptors (in _________)

Further evaluation:
- Nasopharyngeal laryngoscopy: rule out structural lesion in the _________________
- Fibreoptic endoscopic evaluation of swallowing (FEES) or Video fluoroscopy with modified barium swallow: Functional assessment of swallowing Assesses degree of dysfunction and risk/severity of aspiration
- Manometry of upper oesophageal sphincter (UES): To detect UES dysfunction
Identify those who may benefit from ______ – surgical procedure to sever the cricopharyngeal muscle:

A

cranial ; myasthenia gravis; oropharynx, hypopharynx and larynx; cricopharyngeal
myotomy

19
Q

Complications and management of oropharyngeal dysphagia
- Complications – aspiration, pneumonia, mortality
o A decrease in deglutition (swallowing) safety, leading to ________ which results in aspiration pneumonia and can lead to death
o Goal of management – improve food transfer and prevent aspiration.

Management
o Treatment of underlying disorder
o Swallowing rehabilitation
o Dietary modification e.g. thickened fluids/feeds
o Cricopharyngeal myotomy or ______ (rare) – if there is cricopharyngeal dysfunction
o Enteral feeding e.g. nasogastric tube, percutaneous gastrostomy tube – if assessed to be at high risk of aspiration and not safe for oral feeding

A

tracheobronchial aspiration; botulinum toxin injection

20
Q

Functional dysphagia – when all tests are normal
- Functional dysphagia (Rome IV diagnostic criteria) is defined as:
o A sense of solid and/or liquid food lodging or passing abnormally through the oesophagus
o No oesophageal mucosal or structural pathology
o No GERD or ________
o No major esophageal motility disorder
o All criteria must be fulfilled for the past 3/12 with symptom onset at least 6/12 prior to the diagnosis
o Avoid precipitating factors and chew well
- If there are severe symptoms – use _______, cholinergic agent, antidepressant, anxiolytic, or smooth-muscle relaxant

A

eosinophilic esophagitis (EoE); calcium channel blocker

21
Q

oesophageal dysphagia + heartburn suggests ?

A

peptic sticture

22
Q

oesophageal dysphagia + caustic ingestions, radiation therapy suggests?

A

benign stricture

23
Q

oesophageal dysphagia + anaemia, lost of appetite, loss of weight suggests?

A

malignant strictures

24
Q

oesophagial dysphagia + odynophagia suggests?

A

ulceration/ inflammation

25
Q

infectious oesophagitis can be caused by which viruses (2)?

A

HSV, CMV

26
Q

What medication can induce oesophagitis?

A

tetracycline, doxycycline, bisphosphonates

27
Q

Diagnostic tests – evaluation of oesophageal dysphagia
- __________ : direct visualisation of oesophageal mucosa to rule out obstructive luminal lesions, obtain biopsies, and to determine the underlying cause
- When OGD is unrevealing and mechanical obstruction is suspected – OGD may not be sensitive enough to pick up early oesophageal compression
o Barium swallow – can demonstrate ______ or extrinsic oesophageal compression that can be missed by an OGD
o Computed tomography (CT) thorax – can
demonstrate ______________ e.g. aberrant subclavian artery (dysphagia lusoria), mediastinal mass, lymph nodes
- When OGD is unrevealing and motility disorder is
suspected – oesophageal manometry can be used

A

Oesophagogastroduodenoscopy (OGD); oesophageal web/rings; extrinsic compression on oesophagus

28
Q

Acute onset of oesophageal dysphagia, occurring soon after ingesting meat

A

food bolus retention

29
Q

Non acute onset of oesophageal dysphagia, Both solids and liquids from the onset of symptoms (motility disorder), progressive

A

Achalasia

30
Q

Non acute onset of oesophageal dysphagia, Both solids and liquids from the onset of symptoms (motility disorder), intermittent/ non progressive

A

Oesophageal motility disorders

31
Q

Non acute onset of oesophageal dysphagia, Solids only (mechanical obstruction), progressive from solids to liquids

A
  • Peptic stricture (slowly progressive)

- Malignant stricture (more rapid)

32
Q

Non acute onset of oesophageal dysphagia, Solids only (mechanical obstruction), intermittent/ non progressive

A

oesophageal rings, eosinophilic oesophagitis, extrinsic compression from vascular anomalies (e.g. aberrant vessels)

33
Q

What are disorders of gastroesophageal junction (GEJ)?

A

Achalasia

GEJ outflow obstruction

34
Q

What are major disorders of peristalsis?

A

Distal oesophageal spasms
Hypercontractile (Jackhammer) oesophagus
Absent contractility

35
Q

What are minor disorders of peristalsis?

A

Ineffective oesophageal motility

Fragmented peristalsis

M2 GI (39 decks)

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