Dysphagia

Question 1

Define it

Intraluminal causes:

• Infection - 4
• Common in children
• Also found in colon which is precancerous

Answer 1

Difficulty swallowing

Candiadiasis
Pharyngitis
Retropharyngeal abscess
Oesophagitis

Foreign body

Polyps

Question 2

Intramural (in muscular layer) causes:

• What can GORD cause?
• Starts with A
• Can be caused by iron deficiency anaemia
• Similar to above
• you can get these in any muscle of the body

Answer 2

Benign strictures - can also get malignant strictures

Achalasia

Oesophageal web

Oesophageal ring

Oesophageal spasm

Question 3

Extramural causes:

• Something pharyngeal
• A type of hernia
• Possibly involved in every compressive process

Answer 3

Pharyngeal pouch

Rolling hiatus hernia

Malignancy

Question 4

Neurological causes:

List a few

Answer 4

Stroke
Myasthenia gravis 
MS
MND
Parkinson's

Question 5

Mneumonic for history - MUNCH LOT

Answer 5

Movement 
Underweight 
Neck bulges 
Cough on lying 
Heartburn

Liquids
Odynophagia - painful swallowing
Time pattern

Question 6

MUNCH LOT

What does difficulty making swallowing movement mean?

What does being underweight indicate?

What does a bulging neck when drinking indicate?

Answer 6

Bulbar/pseudobulbar palsy - have you had difficulty initiating swallowing

Malignancy - have you unintentional weight recently

Pharyngeal pouch - do you find your neck bulging or some gurgling when drinking?

Question 7

MUNCH LOT

What does a cough on lying down mean? - 2

Has it been a problem with liquids and solids from start?

• Yes???
• No? - solids then liquids

Answer 7

Achalasia
Pharyngeal pouch

(The food is coming back up causing them to cough)

The food is going back up causing them to cough

Motility problem - systemic sclerosis, mysasthenia gravis
Pharyngeal problem

Stricture - benign or malignant

Question 8

MUNCH LOT

What does heart burn indicate?

Do you have pain swallowing? - Yes

Answer 8

GORD

Cancer
Ulcer
Oesophageal spasm - relieved GTN

Question 9

MUNCH LOT

Time:

What does it mean if it is:

• intermittent
• constant/worsening
• both

Answer 9

Spasm

Malignant stricture

Achalasia

Question 10

Signs on examination:

What does cachexia indicate?

What does Virchows node suggest?

What other examinations can you do for systemic disease?

Answer 10

Malnutrition

Intra-abdominal malignancy

Neuro exam - CNS disease

Question 11

Investigations:

Why do FBC and U&E?

Imaging for general upper GI pathology?

Test for pharyngeal pouch?

How to test for dysmotility?

Answer 11

Anaemia
Dehydration

Upper GI endoscopy +/- biopsy

Barium/contrast swallow - pouch

Oesophageal manometry

Question 12

Oesophageal spasm

2 symptoms

2 ways to investigate?

Answer 12

Intermittent dysphagia
Chest pain

Contrast swallow
Manometry

Question 13

Achalasia

What is it?

Big differentiating symptom

Answer 13

LES fails to open during swallowing

Regurgitation of food

Question 14

What causes a benign oesophageal stricture?

1 way to treat?

Answer 14

GORD
Surgery
Corrosives
Radiotherapy

Endoscopic balloon dilatation