Dysphagia

Question 1

mechanical dysphagia is

Answer 1

oesophageal dysphasia

Question 2

an oesophageal stricture is

Answer 2

a narrowing of the oesophagus

Question 3

reasons someone might have an oesophageal stricture

Answer 3

• prolonged GORD
• previous surgery
  radiation therapy
• swallowing a substance that harms the oesophagus eg. button battery
• cancer
• chron’s disease
• scleroderma
• eosinophilic oesophagitis

Question 4

what are the symptoms of an oesophageal stricture

Answer 4

trouble swallowing and solid foods getting stuck in the throat
trouble swallowing liquids also (only in very severe condition)
heartburn
burning in throat
raspy voice or sore throat
cough for no reason

Question 5

tests for oesophageal stricture

Answer 5

barium swallow
endoscopy

Question 6

barium swallow

Answer 6

x rays used to see if the barium gets stuck or slowed down on the way through your oesophagus

Question 7

endoscopy

Answer 7

a thin tube (endoscope) down the throat and into stomach
has a light and tiny camera on the end

Question 8

two general categories of stricture cause

Answer 8

inflammatory (peptic/GORD)
malignant (cancer)

Question 9

define dysphagia

Answer 9

difficulty swallowing

Question 10

define odynophagia

Answer 10

pain on swallowing

Question 11

two categories of dysphagia

Answer 11

1. oropharyngeal (following stroke or neuromuscular disorder)
2. oesophageal (either mechanical or neuromuscular)

Question 12

typical presentation/history of an oropharyngeal dysphagia

Answer 12

uncoordinated initiation of swallow
may feature drooling, choking, coughing, pocketing of food between teeth and cheek, poor voice quality, inability to suck from straw, nasal regurgitation, aspiration with respiratory infection, malnutrition

Question 13

typical causes of oropharyngeal dysphagia

Answer 13

stroke (pseudo-bulbar palsy)
bulbar palsy (motor neurone disease)
multiple sclerosis
brain injury
pharyngeal diverticulum

Question 14

neuromuscular causes of oesophageal dysphagia

Answer 14

scleroderma (esp. with CREST)
chaga’s disease (trypanosomiasis)
achalasia (aganglionosis)
oesophageal spasm/presbyoesophagus

Question 15

what is scleroderma with CREST

Answer 15

Calcinosis
Raynaud’s phenomenon
oEsophageal dysfunction
Sclerodactyly
Telangiectasia

Question 16

mechanical causes of oesophageal dysphagia

Answer 16

swallowed foreign body
stricture (inflammatory or neoplastic)
extrinsic pressure
abnormalities of the wall
schatski’s rings

Question 17

extrinsic pressure as a mechanical cause of oesophageal dysphagia

Answer 17

thyroid swellings
pharyngeal pouch
thoracic aortic aneurysm
mediastinal tumours
paraoesophagheal (rolling) hiatal hernias
abnormal aortic arch

Question 18

shcatski’s rings

Answer 18

narrowed ring og mucosal tissue

Question 19

an alarm symptom on dysphagia history

Answer 19

weight loss

Question 20

some less obvious symptoms that may show up on history

Answer 20

social changes in eating
frequent throat clearing
food avoidance
prolonged mealtimes
recurrent chest infectons
change in respiratory pattern after swelling
atypical chest pain
wet voice quality

Question 21

key exam findings

Answer 21

supraclavicular nodes/neck mass
regular hepatomegaly
angular stomatitis
glossitis
tongue fasciculation
oral ulceration
temp
vocal cord paralysis

Question 22

complications of long term GORD

Answer 22

oesophagitis
ulceration
stricture
barrett’s
cancer
asthma
pneumonia
pulmonary fibrosi
hoarseness
dental caries
halitosis

Question 23

what is achalasia

Answer 23

hypertrophy of circular muscle layer
degeneration of Auerbach’s plexus
affects nitrinergic nerves
clinically
- dysphagia
- regurgitation
- aspiration pneumonia
- carcinoma
- malnutrition

Question 24

treatment of achalasia

Answer 24

endoscopic
- balloon dilatation
- botulinum toxin
- POEM (per-endoscopic myotomy)
surgical
- laparoscopic cardiomyotomy (lowest recurrence)

Question 25

two main types of oesophageal carcinoma

Answer 25

squamous cell carcinoma adenocarcinoma (rapid increase in incidence in recent decades)

Question 26

risk factors for squamous cell carcinoma of oesophagus

Answer 26

achalasia plummer-vinson corrosives head and neck SCC scleroderma smoking soils hot drinks alcohol

Question 27

risk factors for adenocarcinoma of oesophagus

Answer 27

reflux or barrett's obesity

Question 28

diagnosis of oesophageal cancer

Answer 28

endoscopy with biopsy barium swallow (rarely used) staging: endoscopic USS, CT scan, laparoscopy, PET scan

Question 29

PET advantages

Answer 29

disease staging prevents futile surgery allows monitoring response to therapy non-invasive less radiation

Question 30

PET disadvantages

Answer 30

misses small volume of disease patient has to lie still for up to an hour and a half claustrophobic expensive

Question 31

treatment of oesophageal cancer

Answer 31

often too late: palpation, chemo, XRT resection if: fit, local disease (short segment, no invasion), local nodes only

Question 32

EMR

Answer 32

endoscopic mucosal resection for barrettes and mucosal disease only

Question 33

palliation for oesophageal cancer

Answer 33

stent alcohol laser photodynamic therapy argon plasma coagulation

Question 34

carcinoma of cardia

Answer 34

is an oesophageal/gastric cancer affecting cardia of the stomach requires surgery - oesophagogastrectomy dysphagia prominent incidence increasing

Question 35

stomach cancer

Answer 35

unlike cardia cancer, incidence is decreasing indolent (causes no pain) diagnosis on endoscopy role of helicobacter possible requires surgery

Question 36

MALT-oma

Answer 36

Mucosa Associated Lymphoid Tissue lymphoid tissue is not normally in the stomach this is a response to a chronic stimulus eg. H pylori may lead to non-hodgkins lymphoma management

Question 37

symptoms of oesophageal rupture

Answer 37

pain, difficulty swallowing, SOB

Question 38

causes of oesophageal rupture

Answer 38

tumour, GORD with ulceration, previous surgery, swallowing a substance, injury, violent vomiting

Question 39

another name for oesophageal rupture

Answer 39

boerhaave's syndorme

Question 40

what's the difference between mallory-weirs tear and boerhaave syndrome

Answer 40

mallory weiss tear causes vomiting of blood but doesn't tear all the way through the wall of the oesophagus boerhaave syndrome ruptures the full thickness of the oesophageal wall (transmural tear)

Question 41

prognosis for oesophageal rupture/boerhaave syndrome

Answer 41

death unless dramatic intervention