Dysphagia

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

343

Pages:

5
Author:

Mariam A. A.

Dysphagia Causes Oropharyngeal Motility Causes Structural Causes Neurological Stroke Most common overall Benign or malignant lesions/tumours of head and neck Neurodegenerative Most common structural Parkison disease Local infection Brain Epiglottis, acute tonsillitis tumor Corrosive injury Zenker diverticulum Cerebral palsy Oropharyngeal cancer GBS Head and neck dissection MSK Deep neck infection Myasthenia Gravis Osteophytes Progressive muscular dystrophies Paraneoplastic syndrome Sarcoidosis Oesophageal Motility Causes Structural Causes Intraluminal Foreign body Food bolus Mucosal Esophagitis – infectious, eosinophilic Achalasia Oesophageal webs GERD Oesophageal cancer Most common cause Oesophageal diverticulum Oesophageal hypermotility disorder Autoimmune conditions e.g. CREST syndrome Mixed connective tissue disease Extrinsic Thyromegaly Substernal thyroid Hilar lymphadenopathy Neoplasia Cardiac dysphagia Approach History Distinguished between oropharyngeal and oesophageal dysphagia Observe a swallow If coughing in swallowing -> high risk of aspiration If nasopharyngeal regurgitation -> oropharyngeal dysphagia Identify red flags Age more than 50 at onset Clinically significant unintentional weight loss Loss of more than 5% of normal weight within 6 to 12 months. Symptom progression over a short period -> less than 4 months Evidence of GI bleed Recurrent vomit History of cancer Physical exam Complete Neurological exam Examination Absent gag reflex and facial asymmetry-> CN palsy e.g. due to stroke Ptosis, diplopia, tongue deviation -> ALS Key Info Elderly patients with recent pneumonia should be screened for dysphagia Dysphagia that is mainly solids -> structural disorders and cancers Dysphagia that is mainly liquids -> oesophageal motility disorder Dysphagia should be differentiated from xerostomia, globus pharyneus and presbyphagia Clinical Features Type Description Features Coughing or chocking sensation early in the swallowing process Reduced cough reflex Drooling Mainly in the throat/neck Nasal regurgitation May have repeated attempts at Oropharyngeal swallowing Voice changes Nasal speech, wet voice Recurrent pneumonia -> aspiration pneumonia Malnutrition and/or anorexia Neurological changes e.g. dysarthria Cough late in the swallowing process Halitosis A few seconds after Oesophageal Unpleasant Odor Experienced retrosternal Sign of food retention Bolus impaction May be worse by cold foods Intermittent episodes of progression over long duration Motility Mainly with liquids Regurgitation of undigested foods Systemic features of underlying disease E.g. scleroderma May be worse by large food bolus and dense food Red flags for cancer Structural Mainly solids Fever if infectious Features of GERD in reflux esophagitis Initial Investigations Oropharyngeal Modified barium swallow Endoscopic evaluation of nasopharynx Oesophageal Patients 50 or more and patients less than 50 with any red flag features for dysphagia -> EDG Patients less than 50 with no red flags -> 4-week trial of acid suppression prior to EDG When doing a EDG biopsies should be taken Consider barium swallow as the first line when there is high chance of oesophageal stricture High resolution oesophageal manometry Gold standard for oesophageal motility disorders Thoracic imaging If extrinsic oesophageal compression is suspected