Year 3 - Met3a > Dysphagia > Flashcards

Dysphagia Flashcards

(57 cards)

Study These Flashcards
1
Q

Name oesophageal symptoms

A
  • Dysphagia
  • Odynophagia
  • Heartburn
  • Regurgitation
  • Waterbrash
  • Chest pain
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2
Q

Define dysphagia

A

difficulty swallowing

- things might be stuck in the throat

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3
Q

define odynophagia

A

pain on swallowing

- something is painful

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4
Q

What is heartburn

A
  • reflux in the chest
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5
Q

describe how oropharyngeal swallowing works

A
  • when you swallow
  • tongue presses up to the roof of your mouth
  • soft palate blocks the nasal cavity
  • epiglottis blocks the trachea entrance
  • opens passageway to the oesophagus
  • then the nasal cavity and trachea opens up again
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6
Q

How does oesophageal swallowing works

A
  • Gravity pushes it down
  • orientated contraction of muscles that helps push the food down
  • propels food down into the stomach
  • has to go through the LOS
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7
Q

What does the LOS do

A

prevents gastric contents from refluxing back into the oesophagus but allows food in

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8
Q

What happens when oesophageal swallowing fails

A
  • feel food that sticks in your chest
  • things move down slowly
  • drink a lot of water to push it through
  • or induce vomiting when things dont go through
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9
Q

What are the two types of causes of dysphagia

A
  • Obstructive

- Non obstructive

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10
Q

What are the types of obstructive dysphagia

A

Intraluminal
- foreign body

Within walls

  • cancer
  • strictures
  • rings
  • webs

Extraluminal

  • lymphadenopathy
  • compression from heart and aorta - anuerysms
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11
Q

What are non obstructive causes of dysphagia

A

Oesophageal

  • motility problems
  • neuromuscular problems
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12
Q

What should you take in a history with dysphagia

A
  • sudden v gradual
  • duration
  • lipids v solids
  • other oesophageal symptoms
  • red flags
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13
Q

What are the red flags of dysphagia

A
  • weight loss
  • anaemia
  • family history
  • smoking
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14
Q

What are the causes of oesophageal stricture

A
  • Untreated GORD (10-20% risk)
  • Radiotherapy
  • Caustic injury - e.g. bleach

Drugs

  • Bisphosphanates
  • NSIADS
  • tetracyclines
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15
Q

What drugs can cause oesophageal strictures

A
  • Bisphosphanates
  • NSIADS
  • tetracyclines
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16
Q

what are the two types of cancer effect the oesophagus

A
  • adenocarcinoma

- squamous cell carcinoma

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17
Q

what is the more common cancer that effects the oesophagus

A

adenocarcinoma

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18
Q

where do the two types of cancer that affect the oesophagus arise from and what part of the oesophagus are they in

A
  • adenocarcinoma = from columnar glandular epithelium in the lower 1/3 of the oesophagus
  • squamous cell carcinoma = from squamous epithelium in the top 2/3rds
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19
Q

What are the risk factors for squamous cell carcinoma

A
  • Smoking
  • alcohol
  • chewing betel nut
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20
Q

What can squamous cell oesophageal cancer effect around it

A
  • usually very aggressive
  • can invade the trachea, causing fistuale
  • effect the laryngeal nerve causing hoarseness and dysphonia
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21
Q

Where does squamous cell oesophageal cancer metastasise to

A
  • bone
  • brain
  • liver
  • lungs
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22
Q

How do you treat squamous cell oesophageal cancer

A
  • radiotherpy

- +/- chemotherapy

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23
Q

What are the risk factors for adenocarcinoma

Study These Flashcards
A
  • GORD

- beretts oesophagus

24
Q

how aggressive is adenocarcinoma oesophageal cancer

Study These Flashcards
A

less aggressive than squamous cell carcinoma

25
Where does adenocarcinoma oesophageal cancer metastasise
Liver | Lymph nodes
26
What is the treatment for adenocarcinoma oesophageal cancer
- Surgery - resect a lot of the oesophagus | - +/- chemotherapy
27
What are the complications after adenocarcinoma oesophageal cancer surgery
- vagal damage - reflux - due to loss of gastro oesophageal junction (LOS). - feel full quickly - nausea
28
What happens in surgery of adenocarcinoma oesophageal cancer
- oesophagus is shortened - stomach sits in the chest - loss of LOS
29
What can you use to help symptoms in non curative oesophageal cancer
- place stents in the oesophagus - pushes the walls open to keep it open
30
How does a hiatus hernia cause reflux
- Hernia can occur due to weakness in the muscles - sliding hiatus hernia - when it slide up you loose LOS - things are more likely to reflux up into the chest
31
How do you know it is a sliding hiatus hernia
= see two restrictions | - LOS and diaphragm
32
how do you manage a stricture
- dilatation - balloon dilatation - balloon is completely deflated - with X ray guidance you inflate the balloon - and stretch open the stricture - end up with the lumen that is bigger than before
33
What does a rolling hiatus hernia cause
rolling hernia can cause pain but doesnt tend to cause reflux
34
What is the most common hiatus hernia
Sliding hernia
35
What does achalasia look like in a barium swallowing
- birds beak
36
What is achalasia
Oesophageal motility disorder - happens when the LOS fails to relax - tight and gone into spasm - problem with the neurones
37
What is achalasia associated with
- Regurgitation - food stasis - oesophageal dilatation
38
What is achalasia associated with
aperistalsis - absence of peristalsis
39
What is aperistalsis
absence of peristalsis
40
what do you have an increased risk of when you have achalasia
- increased risk of squamous cell carcinoma
41
why can you digest solids more easily in achalasia
- solids have more weight so they push open the LOS | - liquids will just sit on top
42
What is the management of achalasia
- Surgical - cut open the muscle - Endoscopic - can use botox into the LOS which will paralyse the muscle and cause it to relax also can use a balloon to widen the LOS
43
What is it called when you get rings in the oesophagus
- oesophageal trachealisation
44
What can cause oesophageal trachealisation
eosinophilic oesophagitis
45
How does eosinophilic oesophagitis present
- dysphagia and food impaction - leads to dysmotility - associated with atopy
46
What is the treatment of eosinophilic oesophagitis
- Dietary elimination - Medication (steroids) - topical steroids - Endoscopic for strictures
47
does eosinophilic oesophagitis present in men or women more
men
48
What questions in dysphagia history do you ask
History: - Onset: Sudden vs gradual - Duration - Liquids vs solids - Red flags: Weight loss, anaemia, family history, smoking Systems enquiry: - Heartburn, odynophagia, regurgitation , cough Past Medical History - GORD, atopy, cancer Medications: - Bisphosphanates, radiation Social history: - Smoking, alcohol
49
How do you classify dysphagia
- is it pharyngeal or oesophageal - is it obstructive or non-obstructive Obstructive - problems with lumen - problems in walls of lumen - problems outside lumen
50
What questions help you narrow what the cause of dysphagia is
- onset - duration - difficulty swallowing solids or liquids - associated symptoms and signs and pathology
51
What is the - onset - duration - difficulty swallowing solids or liquids - associated symptoms and signs and pathology of cancer
- onset = gradual - duration = short - difficulty swallowing solids or liquids = solids - associated symptoms and signs and pathology = weight loss, cachexia, anaemia
52
What is the - onset - duration - difficulty swallowing solids or liquids - associated symptoms and signs and pathology of strictures
- onset = gradual - duration = short - difficulty swallowing solids or liquids = solids - associated symptoms and signs and pathology = reflux
53
What is the - onset - duration - difficulty swallowing solids or liquids - associated symptoms and signs and pathology of achalasia
- onset = gradual - duration = long - difficulty swallowing solids or liquids = liquids - associated symptoms and signs and pathology = cough, regurgitation, weight loss
54
What is the - onset - duration - difficulty swallowing solids or liquids - associated symptoms and signs and pathology of eosinophillic oesphagitis and food bolus
- onset = gradual - duration = long - difficulty swallowing solids or liquids = solids - associated symptoms and signs and pathology = rashes, allergy, atopy
55
What are the key questions to ask for dysphagia
Key questions to ask 1. Was there difficulty swallowing solids and liquids from the start - If yes then motility disorder such as CNS, achalasia - If no and only solids then stricture benign or malignant 2. Is it difficult to initiate a swallowing movement? - If yes bulbar palsy 3. Is it painful to swallow? - If yes – viral infection, candida, malignancy, oesophagitis, suspected ulceration 4. Is the dysphagia intermittent or is it constant and getting worse? - Intermittent – suspected oesophageal spasm - Constant and getting worse – oesophageal malignancy 5. Does the neck bulge on drinking? - Yes pharyngeal pouch
56
What is the difference between a sliding and paraoespheageal hiatal hernias
Sliding - Gastrooephageal junction slides up into the chest Paraesophageal - Gastrooesophageal junction remains in the abdomen but a bulge in the stomach goes up into the chest
57
How do you treat a hiatus hernia
Imaging - Upper GI requires endoscopy Treatment - Loose weight - Treat GORD
Year 3 - Met3a
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