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Dysphagia

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Dysphagia

  1. 1. Dysphagia Ben Savage
  2. 2. Objectives  What is dysphagia  History  Examination  Tests  Differential diagnosis
  3. 3. What is dysphagia  Dysphagia is a difficulty swallowing  Causes are:  Oral  Pharyngeal  Oesophageal  The causes can be mechanical or motility related.
  4. 4. 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
  5. 5. 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
  6. 6. Tests  Bloods  FBC, U&E, LFT, TFT, Serum Glucose, CRP  CXR  Barium sallow  Endoscopy +/- biospy  CT/MRI
  7. 7. 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
  8. 8. Differential Diagnosis  Motility disorders  Achalasia  Diffuse oesophageal spasm  Cerebrovascular incident  Bulbar palsy  Myasthenia gravis  Other  Oesophagitis – infection, reflux
  9. 9. Thank you Any Questions

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