Dysphagia

Question 1

{Can fluids be drunk as fast as usual, except if food is stuck?}

What does it mean if the answer is yes or no?

Answer 1

Yes - suspect stricture (benign/malignant)

No - think of motility disorders (achalasia, neurological causes)

Question 2

{Is it difficult to make the swallowing movement?}

What does it mean if the answer is yes?

Answer 2

Yes - suspect bulbar palsy especially if cough on swallowing

Question 3

{Is the dysphagia constant and painful?}

What does it mean if the answer is yes?

Answer 3

Yes (either feature) - suspect a malignant stricture

Question 4

{Does the neck bulge or gurgle on drinking}

What does it mean if the answer is yes

Answer 4

Suspect a pharyngeal pouch (food may regurgitate)

Question 5

Investigations

Bloods

Imaging

Answer 5

FBC
ESR

Barium swallow
CXR

Question 6

Investigations

Special tests - 2

Answer 6

Endoscopy with biopsy

Oesophageal motility studies

Question 7

What can be done if symptoms are severe until problem is solved?

Answer 7

Nutritional support

PEG feed

Question 8

Oesophageal Carcinoma

What is it associated with?

Presentation

Rx - 2

Answer 8

Achalasia
Alcohol
Smoking
Barrett’s oesophagus

Dysphagia
Weight loss
Hoarseness
Cough

Surgery +/- chemo/radiotherapy

Question 9

Benign oesophageal stricture

Causes

Rx

Answer 9

Oesophageal reflux
Swallowing corrosives
Foreign body
Trauma

Dilatation

Question 10

Pharyngeal Pouch

Pathophysiology

What is the name of the area where the oesophagus herniates into to form the pouch?

Answer 10

Pharyngeal mucosa herniates through an area of weakness

Killians Dishiscence