Dysphagia Flashcards
Dysphagia associated with weight loss, anorexia or vomiting during eating.
PMHx may include Barrett’s oesophagus, GORD, excessive smoking or alcohol use
Oesophageal Cancer
History of heartburn
Odynophagia but no weight loss
systemically well
Oesophagitis
Dysphagia with a history of HIV or other risk factors such as steroid inhaler use
Oesophageal candidiasis
Dysphagia of both liquids and solids from the start
Heartburn
Regurgitation of food - may lead to cough, aspiration pneumonia etc
Achalasia
Common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
If large, then a midline lump appears in the neck that gurgles on palpation
Typical symptoms:
dysphagia
regurgitation
aspiration
chronic cough
Pharyngeal Pouch
Dysphagia with other features of CREST syndrome:
- Calcinosis
- Raynaud’s phenomenon
- oEsophageal dysmotility
- Sclerodactyly
- Telangiectasia
Systemic Sclerosis
Dysphagia with liquids AND solids
Other symptoms:
- extraocular muscle weakness
- ptosis
Myasthenia Gravis
History of anxiety
Intermittent symptoms relieved by swallowing
Painless
Globus Hystericus
Extrinsic causes of dysphagia
Mediastinal masses
Cervical spondylosis
Oesophageal wall causes of dysphagia
Achalasia
Diffuse oesophageal spasm
Hypertensive lower oesophageal sphincter
Intrinsic causes of dysphagia
Tumours
Strictures
Oesophageal web
Schatzki rings
Neurological causes of dysphagia
Stroke/TIA
Parkinson’s disease
Multiple Sclerosis
Brainstem pathology
Myasthenia Gravis
Investigations for dysphagia
- upper GI endoscopy
- fluoroscopy for motility disorders
- FBC
- Manometry for achalasia
