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ANKI GI > [9] Dysphagia > Flashcards

[9] Dysphagia Flashcards

1
Q

How long is the oesophagus?

A

25cm

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2
Q

How long is the distance from the oesophageal junction to the lips?

A

40cm

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3
Q

Where does the oesophagus start?

A

At the level of the cricoid cartilage (C6)

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4
Q

Where does the oesophagus lie in the neck?

A

In the visceral column

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5
Q

Where does the oesophagus run after the neck?

A

In the posterior mediastinum

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6
Q

Where does the oesophagus pass through the diaphragm?

A

At the right crus of the diaphragm, at T10

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7
Q

How long does the oesophagus continue in the abdomen before entering the cardia?

A

2-3 cm

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8
Q

Where are the locations of narrowing of the oesophagus?

A

Level of cricoid
Posterior to left main bronchus and aortic arch
Lower oesophageal sphincter

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9
Q

What is the oesophagus divided into?

A

3rd

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10
Q

What do the divisions of the oesophagus represent?

A

Change in musculature, from striated, to mixed, to smooth

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11
Q

What is the oesophagus lined by?

A

Non-keratinising squamous epithelium

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12
Q

What is the Z-line?

A

Transition from squamous epithelium to gastric columnar

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13
Q

What are the categories of causes of dysphagia?

A

Inflammatory
Neurological/motility disorders
Mechanical obstruction

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14
Q

What are the inflammatory causes of dysphagia?

A

Tonsillitis or pharyngitis
Oesophagitis
Oral candidiasis
Apthous ulcers

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15
Q

Give two examples of causes of oesophagitis

A

GORD

Candida

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16
Q

What are the local neurological/motility causes of dysphagia?

A

Achalasia
Diffuse oesophageal spasm
Nutcracker oesopahgus
Bulbar/pseudobulbar palsy

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17
Q

What can cause a bulbar/pseudobulbar palsy?

A

CVA

Motor neurone disease

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18
Q

What are the systemic neurological causes of dysphagia?

A

Systemic sclerosis

Myasthenia gravis

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19
Q

What are the categories of mechanical oesophagus obstruction?

A

Luminal
Mural
Extra-mural

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20
Q

What can cause luminal obstruction of the oesophagus?

A

Foreign body

Large food bolus

21
Q

What can cause mural obstruction of the oesophagus?

A

Benign strictures
Malignant strictures
Pharyngeal pouch

22
Q

What can cause benign oesophageal strictures?

A

Web, e.g. Plummer Vinson
Oesophagitis
Trauma, e.g. OGD

23
Q

Where can malignant strictures occur causing dysphagia?

A

Pharynx
Oesophagus
Stomach

24
Q

What are the extra-mural causes of oesophageal obstruction?

A 
Retrosternal goitre
Rolling hiatus hernia
Lung cancer
Enlarged mediastinal lymph nodes
Thoracic aortic aneurysm
25
Q

Give an example of something that can cause enlarged mediastinal lymph nodes

A

Lymphoma

26
Q

How is dysphagia investigated?

A

Upper GI endoscopy
Ba swallow
Manometry

27
Q

What is a pharyngeal pouch also known as?

A

Zenker’s Diverticulum

28
Q

What is a pharyngeal pouch?

A

An outpouching between crico- and thyro-pharyngeal components of the inferior pharyngeal constrictor

29
Q

What is the area of weakness where a pharyngeal pouch can form called?

A

Killian’s dehiscence

30
Q

In what direction does a pharyngeal pouch occur?

A

The defect usually occurs posteriorly, but the swelling usually bulges to the left side of the neck

31
Q

How does a pharyngeal pouch lead to dysphagia?

A

Food debris leads to pouch expansion, which leads to oesophageal compression and therefore dysphagia

32
Q

How does pharyngeal pouch present?

A

Regurgitation
Hallitosis
Gurgling sounds

33
Q

How is a pharyngeal pouch managed?

A

Excision

Endoscopic stapling

34
Q

How does diffuse oesophageal spasm present?

A

Intermittent severe chest pain, with or without dysphagia

35
Q

What does barium swallow show in diffuse oesophageal spasm?

A

Corkscrew oesophagus

36
Q

How does nutcracker oesophagus present?

A

Intermittent dysphagia, with or without chest pain

37
Q

What happens in nutcracker oesophagus?

A

There is an increase in contraction pressure of the oesophagus, with normal peristalsis

38
Q

What is Plummer-Vinson syndrome?

A

When severe iron deficiency anaemia leads to hyperkeratinisation of the upper 3rd of the oesophagus, leading to web formation

39
Q

Why is Plummer-Vision syndrome significant?

A

It is a pre-malignant condition q

40
Q

What is the risk that Plummer-Vision syndrome will develop into SCC?

A

20%

41
Q

What are the causes of oesophageal rupture?

A 
Iatrogenic
Violent emesis
Carcinoma
Caustic ingestion
Trauma
42
Q

What % of cases of oesophageal rupture are iatrogenic?

A

85-90%

43
Q

What are the iatrogenic causes of oesophageal rupture?

A

Endoscopy
Biopsy
Dilatation

44
Q

What is it called when the oesophagus ruptures due to emesis?

A

Boerhaave’s syndrome

45
Q

What are the clinical features of oesophageal rupture?

A

Odonophagia
Mediastinitis
Surgical emphysema

46
Q

What are the symptoms of mediastinitis?

A

Tachypnoea
Dyspnoea
Fever
Shock

47
Q

How is iatrogenic oesophageal rupture managed?

A

PPI
NGT
Abx

48
Q

How is oesophageal rupture managed when it the cause is not iatrogenic?

A 
Resus
PPI 
ABx
Antifungals
Debridement and formation of an oesophago-cutaneous fistula

ANKI GI (43 decks)

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