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Flashcards in Dysphagia Deck (14)
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1
Q

What does dysphagia mean?

A

Dysphagia simply means difficulty with swallowing.

Unless associated with a sore through it is a serious symptom that warrants swift investigation.

2
Q

What is the term given to painful swallowing?

A

Painful swallowing is termed odynophagia

3
Q

What causes dysphagia?

A

Malignant – oesophageal, pharyngeal, gastric cancer or extrinsic pressure from lung, or nodal cancer.
Neurological – bulbar palsy, lateral medullary syndrome, myasthenia gravis or syringomyelia
Other – benign structures, pharyngeal pouch, achalasia, systemic sclerosis or iron deficiency anaemia

4
Q

What questions should you ask in the history of someone with dysphagia?

A

Dyspepsia, weight loss, lumps or progressive?
Is it solids or both fluids and solids – if both this suggests motility disorders, if just solids this suggests a stricture
Is making the swallowing movement difficult – suggests bulbar palsy
Is it painful – suspect malignant stricture or ulceration secondary to an infection
Is it constant or intermittent – constant and worsening suggests malignancy, intermittent suggests spasm
Does the neck bulge or gurgle – pharyngeal pouch

5
Q

What investigations should be done in a patient with dysphagia?

A
FBC
Upper GI Endoscopy and biopsy 
CXR
Barium swallow 
Important to assess nutrition as it could be causing malnutrition
6
Q

What causes benign oesophageal strictures?

A

Causes – reflux, swallowing corrosives, foreign body and trauma

7
Q

How are benign oesophageal strictures managed?

A

Treatment – dilation via endoscopy under GA

8
Q

What is achalasia and how does it present?

A

Problems with coordinated peristalsis and failure of LOS to relax.

Symptoms – dysphagia or both solids and liquids, variable severity, heartburn, regurgitation – leading to cough and aspiration.

9
Q

How is achalasia managed?

A

Treatment – botulinum toxin injection, endoscopic balloon dilation or heller’s cardiomyotomy, followed by PPI

10
Q

What is a pharyngeal pouch?

A

Herniation of pharyngeal mucosa through Kilian’s dehiscence (triangle between the thyropharyngeus and cricopharyngeus muscles possibly due to incoordination of swallowing

11
Q

What are the symptoms of a pharayngeal pouch?

A

Symptoms – dysphagia, regurgitation, halitosis, aspiration pneumonia, gurgling when eating and a lump in the neck.

12
Q

How should a pharyngeal pouch be investigated?

A

Investigate with barium swallow and endoscopy to exclude malignancy within pouch

13
Q

What is the management of a pharyngeal pouch?

A

Treatment – endoscopic surgery

14
Q

What does globus pharyngeus mean?

A

Term used to describe the sensation of a lump in the throat when swallowing. Unclear why it occurs although could be related to muscle tension.
Treatment is simply reassurance and advice to try and ignore it/think about it less.