FN: Dysphagia Flashcards

1
Q

Definition

A

Difficulty swallowing

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2
Q

Causes

A

Inflammatory
Mechanical Block
Motility Disorders

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3
Q

Inflammatory causes

A

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

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4
Q

Mechanical Block

A

Luminal
Mural
Extra-Mural

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5
Q

Luminal causes

A

􏰁 FB

􏰁 Large food bolus

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6
Q

Mural

A
􏰁 Benign stricture
- 􏰃 Web (e.g. Plummer-Vinson)
- 􏰃 Oesophagitis
􏰃 - Trauma (e.g. OGD)
􏰁 Malignant stricture
- 􏰃 Pharynx, oesophagus, gastric
􏰁 - Pharyngeal pouch
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7
Q

Extra-mural causes

A

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

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8
Q

Local motility Disorders

A

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

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9
Q

systemic motility disorders

A

􏰁 Systemic sclerosis / CREST 􏰁 MG

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10
Q

Presentation

A

􏰀 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

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11
Q

Signs

A
􏰀 Cachexia
􏰀 Anaemia
􏰀 Virchow’s node (+ve = Troisier’s sign)
􏰀 Neurology
􏰀 Signs of systemic disease (e.g. scleroderma)
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12
Q

Ix

A
􏰀 Bloods: FBC, U+E
􏰀 CXR
􏰀 OGD
􏰀 Barium swallow ± video fluoroscopy
􏰀 Oesophageal manometrry
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13
Q

Achalasia pathophysiology

A

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

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14
Q

Achalasia cause

A

􏰁 1O / idiopathic: commonest

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

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15
Q

Achalasia presentation

A

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

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16
Q

Achalasia comps

A

Chronic achalasia → oesophageal SCC

17
Q

Achalasia Ix

A

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

18
Q

Achalasia Rx

A

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

19
Q

Pharyngeal Pouch: Zenkers Diverticulum

A

􏰀 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.

20
Q

Pharyngeal Pouch: Zenkers Diverticulum presentation

A

regurg
Halitosis
Gurgling sounds

21
Q

Pharyngeal Pouch: Zenkers Diverticulum Rx

A

Excision

Endoscopic Stapling

22
Q

Diffuse oesophageal Spasm

A

􏰀 Intermittent dysphagia ± chest pain

􏰀 Ba swallow shows corkscrew oesophagus

23
Q

Nutcracker Oesophagus

A

􏰀

↑ contraction pressure ̄c normal peristalsis