FN: Dysphagia Flashcards Preview

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Flashcards in FN: Dysphagia Deck (32):
1

Causes

Inflammatory
Neuroogical/ Motility disorders
Mechanical Obstruction

2

Inflammatory causes

tonsilitis pharyngitits
Oesphagitits: GORD, candida
Oral candiadiasis
Apthous ulcers

3

Neurological/Motility disorders local

Achalasia
Diffuse oesophageal spasm
Nutcracker oesophagus
Bulbar/pseudoblbar palsy (CVA, MND)

4

Neurological/Motility disorders systemic

Systemic sclerosis/CREST
Mg

5

Mechanical Obstruction categories

Luminal
Mural
Extra-mural

6

Luminal causes

FB
LArge food bolus

7

Mural

Benign stricture
Malignant stricture
Pharyngeal pouch

8

Benign stricture causes

Web (e.g. Plummer-Vinson)
Oesophagitits
Trauma e.g. OGD

9

Malignant stricture

Pharynx, oesophagus, gastric

10

Extra-Mural causes

Retrosternal goitre
Rolling hiatus hernia
Lung Ca
Mediastinal LNs (e.g. lymphoma)
Thoracic aortic aneurysm

11

Investigations

Upper GI endoscopy
Ba swallow
Manometry

12

Achalasia pathophysiology

- Degeneration of myenteric plexus (Auerbach's)
Reduced peristalsis
LOS fails to relax

13

Achalasia Cause

primary/idiopathic: commonest
Secondary: Chagas disease (T. cruzil)

14

Achalasia PResentation

Dysphagia: liquids then solids
REgurgitation (esp @ night)
Sibsternal cramps
Wt. loss

15

Achalasia Complications

Oesophageal SCC in 3-5%

16

Achalasia investigations

BA swallow
Manometry
CXR
OGD

17

Achalasia Ba swallow show

Dilated tapering oesophagus - bired beak

18

Achalasia manometry

Failure of relaxation and reduced peristalsis

19

Achalasia CXR

widened mediastinum, double RH border

20

Achalasia OGD shows

Exlcude malignancy

21

Achalasia Rx

Med: CBBs, nitrates
Int: botox injection endoscopic balloon dilation
Surg: Hellers cardiomyotomy (open or lap)

22

Pharyngeal Pouch: Zenkers Diverticulum definition

Outpuching between crico- and thyro-pharyngeal components of the inf. pharyngeal constrictor - area of weakness = Killians dehiscence

23

Pharyngeal Pouch: Zenkers Diverticulum defect occurs

usually posterioorly but swealling usually bulges to left side of he neck

24

Pharyngeal Pouch: Zenkers Diverticulum why dysphagia

Food debris leads to pouch expansion and oesophageal compression that causes dysphagia

25

Pharyngeal Pouch: Zenkers Diverticulum Presentation

Regurg, halitosis, gurgling sounds

26

Pharyngeal Pouch: Zenkers Diverticulum Rx

Excision, endoscopic stapling

27

Diffuse oesophageal spasm

Intermittant severe chest pain ± dysphagia

Ba swallow shows corkscren oesophagus

28

Nutcracker Oesophagus

- Intermittant dysphagia ± chest pain
- Raised contraction pressure with normal peristalsis

29

Plummer-Vinson Syndrome

Severe IDA - hyperkeratinisation of upper 3rd of oesophagus - web formation
Pre-malignant: 20% risk of SCC

30

Oesophageal Rupture

- Iatrogenic (85-90%) : endoscopu, biopsy, dilatation
- Violent emesis: Boerhaves syndrome
- Carcinoma
- Caustic ingestion
- Trauma: surgical emphysema ± pneumothorax

31

Oesophageal Rupture features

Odonphagia
Mediastinitis: tachypnoea, dyspnoea, fever, shock
Surgical emphysema

32

Oesophageal Rupture Mx

Iatrogenic: PPI, NGT, Abx
Other: resus, PPI, Anxm antifungal, debridement + formation of oesophago-cutaneous fistula w/ T- tube

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