FN: Dysphagia Flashcards Preview

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Flashcards in FN: Dysphagia Deck (23):
1

Definition

Difficulty swallowing

2

Causes

Inflammatory
Mechanical Block
Motility Disorders

3

Inflammatory causes

􏰀 Tonsillitis, pharyngitis
􏰀 Oesophagitis: GORD, candida
􏰀 Oral candidiasis
􏰀 Aphthous ulcers

4

Mechanical Block

Luminal
Mural
Extra-Mural

5

Luminal causes

􏰁 FB
􏰁 Large food bolus

6

Mural

􏰁 Benign stricture
- 􏰃 Web (e.g. Plummer-Vinson)
- 􏰃 Oesophagitis
􏰃 - Trauma (e.g. OGD)
􏰁 Malignant stricture
- 􏰃 Pharynx, oesophagus, gastric
􏰁 - Pharyngeal pouch

7

Extra-mural causes

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

8

Local motility Disorders

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

9

systemic motility disorders

􏰁 Systemic sclerosis / CREST 􏰁 MG

10

Presentation

􏰀 Dysphagia for liquids and solids at start 􏰁 Yes: motility disorder
􏰁 No, solids > liquids: stricture
􏰀 Difficulty making swallowing movement: bulbar palsy
􏰀 Odonophagia: Ca, oesophageal ulcer, spasm
􏰀 Intermittent: oesophageal spasm
􏰀 Constant and worsening: malignant stricture
􏰀 Neck bulges or gurgles on drinking: pharyngeal pouch

11

Signs

􏰀 Cachexia
􏰀 Anaemia
􏰀 Virchow’s node (+ve = Troisier’s sign)
􏰀 Neurology
􏰀 Signs of systemic disease (e.g. scleroderma)

12

Ix

􏰀 Bloods: FBC, U+E
􏰀 CXR
􏰀 OGD
􏰀 Barium swallow ± video fluoroscopy
􏰀 Oesophageal manometrry

13

Achalasia pathophysiology

􏰁 Degeneration of myenteric plexus (Auerbach’s) 􏰁 ↓ peristalsis
􏰁 LOS fails to relax

14

Achalasia cause

􏰁 1O / idiopathic: commonest
􏰁 2O: oesophageal Ca, Chagas’ disease (T. cruzii)

15

Achalasia presentation

􏰁 Dysphagia: liquids and solids at same time 􏰁 Regurgitation
􏰁 Substernal cramps
􏰁 Wt. loss

16

Achalasia comps

Chronic achalasia → oesophageal SCC

17

Achalasia Ix

􏰁 Ba swallow: dilated tapering oesophagus (Bird’s beak)
􏰁 Manometry: failure of relaxation + ↓ peristalsis
􏰁 CXR: may show widended mediastinum
􏰁 OGD: exclude malignancy

18

Achalasia Rx

􏰁 Med: CCBs, nitrates
􏰁 Int: endoscopic balloon dilatation, botulinum toxin injection
􏰁 Surg: Heller’s cardiomyotomy (open or endo)

19

Pharyngeal Pouch: Zenkers Diverticulum

􏰀 Outpouching of oesophagus between upper boarder of cricopharyngeus muscle and lower boarder of inferior constrictor of pharynx
􏰁 Weak area called Killian’s dehiscence.
􏰀 Defect usually occurs posteriorly but swelling usually
bulges to left side of neck.
􏰀 Food debris → pouch expansion → oesophageal
compression → dysphagia.

20

Pharyngeal Pouch: Zenkers Diverticulum presentation

regurg
Halitosis
Gurgling sounds

21

Pharyngeal Pouch: Zenkers Diverticulum Rx

Excision
Endoscopic Stapling

22

Diffuse oesophageal Spasm

􏰀 Intermittent dysphagia ± chest pain
􏰀 Ba swallow shows corkscrew oesophagus

23

Nutcracker Oesophagus

􏰀
↑ contraction pressure ̄c normal peristalsis

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