Dysphagia

Question 1

Causes

Answer 1

1. Mechanical
2. Motility
3. Others
   Esophagitis
   Globus hystericus

Question 2

Types of mechanical block

Answer 2

1. Malignant stricture
Esophageal cancer
Gastric cancer
Pharyngeal cancer
2. Benign strictures
Esophageal web
Peptic stricture
3. Extrinsic pressure
Lung cancer
Mediastinal nodes
Retrosternal goiter
AA
Left atrial enlargement
4. Pharyngeal pouch

Question 3

Motility disorders

Answer 3

Achalasia
Diffuse esophageal spasm
Systemic sclerosis
Myasthenia gravis
Bulbar palsy
Pseudobulbar palsy
Syringonulnia
Bulbar poliomyelitis
Chagas

Question 4

Key history questions

Answer 4

1. Difficulty swallowing solids and liquids
   If both->motility
   If solids->liquids= stricture
2. Difficulty making swallowing
   Bulbar palsy
3. Painful
   Cancer, ulcer, spasm
4. Intermittent, constant and getting worse
   Intermittent: suspect oesophageal spasm
   Constant and worsening: suspect malignant stricture
5. Does the neck bulge or gurgle on drinking
   If yes, suspect pharyngeal pouch

Medication, radiation

Question 5

What is achalasia

Answer 5

The lower esophageal sphincter fails to relax->dysphagia, regurgitation, substernal cramps, weight loss.

Treatment with with endoscopic balloon dilitation and PPI

Question 6

Multidisciplinary team

Answer 6

1. GP
2. Otolaryngologists
3. Speech and swallowing therapists
4. Gastroenterologist
5. Radiologists

Question 7

Investigations

Answer 7

TFTs
CSF (MS)
Botulinum toxin assay
Liver enzymes
Ceruloplasmin, 24 hour copper
CK
ACHr Antibodies->MG
AntiDNA, ANA->scleroderma

Endoscopy->OGD
Barium swallow->structural when OGD fails to identify