Dysphagia

Ben Savage

Objectives What is dysphagia History Examination Tests Differential diagnosis

What is dysphagia Dysphagia is a difficulty swallowing Causes are:

Oral Pharyngeal Oesophageal

The causes can be mechanical or motility related.

History Take a full detailed history Key questions for PC

Was there difficulty with swallowing solids and liquids from the onset?

Is it difficult to make swallowing movement? Is swallowing painful? (odynophagia) Is dysphagia intermittent or constant and getting worse? Does the neck bulge or gurgle on drinking?

Other key areas are PMH and FH

Examination Relevant examination, GI, Neuro. Look for signs of systemic illness

Do they look cachectic or anaemic Feel neck and supraclavicular lymph nodes.

Virchow’s node L supraclavicular and suggests intra-abdo malignancy

Palpable abdominal masses

Tests Bloods

FBC, U&E, LFT, TFT, Serum Glucose, CRP CXR Barium sallow Endoscopy +/- biospy CT/MRI

Differential Diagnosis Mechanical Block can occur in 3 places:

In the lumen: Foreign body obstruction- ill fitting dentures Pharyngeal pouch

In the wall: Malignant Benign – oesophageal ring

External pressure: Lung cancer Vascular – Aortic aneurysm, left atrial enlargement

Differential Diagnosis Motility disorders

Achalasia Diffuse oesophageal spasm Cerebrovascular incident Bulbar palsy Myasthenia gravis

Other Oesophagitis – infection, reflux

Thank you

Any Questions