Dysphagia

Question 1

What is dysphagia?

Answer 1

It is when a patient has difficulty with swallowing. Specifically referring to the sensation of having food becoming stuck as it passes through the pharynx or oseophagus.

Question 2

What is odynophagia?

Answer 2

It is when there is pain on swallowing. It may occur with dysphagia.

Question 3

What are the two main types of dysphagia?

Answer 3

1. Oropharyngeal dysphagia

2. Oesophageal dysphagia

Question 4

What is Oropharyngeal dysphagia?

Answer 4

• difficulty with initiation of the swallowing process

Question 5

What are some causes of Oropharyngeal dysphagia?

Answer 5

• diseases that affect the pharynx and upper oseophagus

- -> stroke, parkinson’s disease, MS

Question 6

What would a patient with Oropharyngeal dysphagia report?

Answer 6

• food becomes stuck immediately upon swallowing and may feel it most in the cervical region.

Question 7

What are some associated features of Oropharyngeal dysphagia?

Answer 7

• coughing or choking and nasal regurgitation

Question 8

What is Oesophageal dysphagia?

Answer 8

• arises when the passage of food or liquid through the oesophagus to the stomach is hindered by a pathological process.

Question 9

What would a patient with Oesophageal dysphagia report?

Answer 9

• symptoms after initiating a swallow and may localise the symptom to the retrosternal area.

Question 10

What are the two categories of Oesophageal dysphagia?

Answer 10

• -> categorised according to the underlying mechanism
  1. Motility disorder
  2. Mechanical disorder

Question 11

With regard to Oesophageal dysphagia, explain motility disorders.

Answer 11

• the patient has difficulty swallowing both solids and liquids from onset
• usually caused by a motility (or neuromuscular) disorder such as achalasia (disease in which there is a loss of peristalsis in the distal oesophagus)

Question 12

With regard to Oesophageal dysphagia explain mechanical disorders.

Answer 12

• the patient has difficulty swallowing solids only at the onset often due to mechanical obstruction such as cancer of the oesophagus
• diffulty with swallowing liquids can occur later in development of the obstruction

Question 13

Which cardinal features is of particular importance for dysphagia? Why?

Answer 13

TIME COURSE

• rapid pregression over weeks to months raises the possibility of malignancy.
• long-standing and intermittent symptoms are more likely to be due to benign conditions such as oesophageal spasm.

Question 14

What are some common conditions that may be associated with mechanical obstruction causing oesophageal dysphagia?

Answer 14

• lapband surgery –> overeating
• tumours
• foreign bodies

Question 15

What are some important questions to ask about dysphagia?

Answer 15

• Where is it getting stuck?
• Solids or liquids?
• What happens next? coughing, regurgitation, gets through
• Time progression?
• Assocaited features?