Dysphagia

Question 1

Oropharyngeal dysphagia

Answer 1

• causes: stroke, Parkinson’s, ALS, myasthenia gravis, muscular dystrophy, Zenker diverticulum
• work-up: video fluoroscopy is most effective

Question 2

Esophageal dysphagia

Answer 2

• food sticking or discomfort
• solid food most commonly structural abnormality
• solid food and liquid dysphagia or just liquids suggests and esophageal motility abnormality
• evaluating esophageal dysphagia usually requires endoscopy

Question 3

Achalasia

Answer 3

• cause: degeneration of my enteric plexus with loss of inhibitory neurons causing LES to not relax
• birds beak sign on barium swallow
• chagas dz can cause achalasia if hx of travel to South America
• diagnostic evaluation:
  1) barium swallow
  2) esophageal manometry
  3) egd to rule out adenocarcinoma
• treatment: surgical myotomy, pneumatic dilatation are first line. CCB, nitrates, Botox are alternative if surgery not an option

Question 4

2 types of dysphagia

Answer 4

• oropharyngeal:

- esophageal: