Dysphagia

Question 1

Define dysphagia

Answer 1

Difficulty swallowing d/t problems with transit of food/liquid from mouth to hypopharynx or esophagus

Question 2

Define Aphasia

Answer 2

Inability to swallow likely d/t an esophageal obstruction

Question 3

Define Odynophagia

Answer 3

Painful swallowing typically d/t mucosal lacerations

Question 4

Define Globus Pharyngeus

Answer 4

Foreign body sensation localized in the neck but does not interfere with swallowing. Typically relieved by swallowing

Question 5

Define Transfer dysphagia

Answer 5

Nasal regurgitation or pulmonary aspiration

Question 6

Define phagophobia

Answer 6

Fear of swallowing

Question 7

Describe the physiology of dysphagia

Answer 7

Musculature of the oral cavity, pharynx, upper esophageal sphincter, and cervical esophagus are striated and directly innervated by lower motor neurons. Typically a neuronal innervation issue.

Question 8

Which two cranial nerves innervate the oral cavity muscles?

Answer 8

CN 5 and 7

Question 9

Which CN innervates the tongue

Answer 9

CN 12

Question 10

Which two CN innervate the pharyngeal muscles

Answer 10

9 and 10

Question 11

UES musculature innervation that facilitates opening during swallowing is due to which 3 CN?

Answer 11

5,7,and 12

Question 12

What are the two causes of dysphagia and the subtypes?

Answer 12

Structural: Oversized bolus, narrow lumen
Propulsive or motor issues: Abnormalities of peristalsis, impaired sphincter relaxation
Multiple mechanisms: Scleroderma, peptic strictures

Question 13

What are causes of oropharyngeal phase dysphagia (4)

Answer 13

Iatrogenic, Neurologic, structural lesions, poor food bolus formation and control

Question 14

What are examples of iatrogenic causes of dysphagia

Answer 14

Surgery
Radiation

Question 15

What are Neurologic causes of dysphagia

Answer 15

CVA, Parkinson’s, ALS

Question 16

What are examples of structural lesions that cause dysphagia

Answer 16

Zenker’s diverticulum, cricopharyngeal bar, and neoplasia

Question 17

What are causes of dysphagia in the pharyngeal phase

Answer 17

Retention in pharynx, poor tongue propulsion, UES obstruction

Question 18

What is the average esophageal lumen size in a healthy adult and in a constricted adult?

Answer 18

Healthy: ~ 2
Unhealthy: <13mm

Question 19

What is the most common cause of esophageal dysphagia

Answer 19

Schatzki’s rings

Question 20

Define Schatzki’s rings

Answer 20

Circular band of mucosal tissue that forms at the distal end of the esophagus narrowing.

Question 21

Define eosinophilic esophagitis

Answer 21

Chronic immune system disease
Eosinophils build up in the esophagus lining.

Question 22

What are different diagnostic tests for dysphagia

Answer 22

Upper endoscopy w/ biopsy and histology is the most useful
Esophageal mammography (can confirm dysmotility if inconclusive upper endo)
Barium radiography

Question 23

Treatment plan for therapeutic, cancers/achalasia, infectious, and eosinophilic dysphagias

Answer 23

Therapeutic: esophageal dilation
Cancers/Achalasia: surgery vs endoscopic techniques
Infectious: Antimicrobials, tx underlying immunosuppressive state
Eosinophilic: Eliminate dietary allergens, swallow topically acting glucocorticoids