Dysphagia: Difference between revisions
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*Discoordination in transferring bolus from pharynx to esophagus | *Discoordination in transferring bolus from pharynx to esophagus | ||
*Etiology | *Etiology | ||
**Neuromuscular disease | **Neuromuscular disease (80% of cases) | ||
***CVA, scleroderma, MG, Parkinson's, botulism, lead poisoning | ***CVA, scleroderma, MG, Parkinson's, botulism, lead poisoning | ||
**Localized disease | |||
***Pharyngitis, aphthous ulcers, PTA, Zenker diverticulum | |||
*Symptoms | *Symptoms | ||
**Gagging, coughing, inability to initiate swallow, need for repeated swallows | **Gagging, coughing, inability to initiate swallow, need for repeated swallows | ||
| Line 15: | Line 17: | ||
*Improper transfer of bolus from upper esophagus into stomach | *Improper transfer of bolus from upper esophagus into stomach | ||
*Etiology | *Etiology | ||
**Obstructive disease | **Obstructive disease (85% of cases) | ||
***Foreign body, carcinoma, webs, stricures, thyroid enlargement | ***Foreign body, carcinoma, webs, stricures, thyroid enlargement | ||
**Motor disorder | |||
***Achalasia, peristaltic dysfunction (nutcracker esophagus), scleroderma | |||
*Symptoms | *Symptoms | ||
**Food "sticking," retrosternal fullness w/ solids (and eventually liquids), odynophagia | **Food "sticking," retrosternal fullness w/ solids (and eventually liquids), odynophagia | ||
Revision as of 23:46, 31 July 2011
Background
- Most pts w/ dysphagia have an identifiable, organic cause
- Assume malignancy in pts >40yo with new-onset dysphagia
Diagnosis
- Must distinguish between transfer dysphagia and transport dysphagia
Transfer dysphagia (oropharyngeal)
- Discoordination in transferring bolus from pharynx to esophagus
- Etiology
- Neuromuscular disease (80% of cases)
- CVA, scleroderma, MG, Parkinson's, botulism, lead poisoning
- Localized disease
- Pharyngitis, aphthous ulcers, PTA, Zenker diverticulum
- Neuromuscular disease (80% of cases)
- Symptoms
- Gagging, coughing, inability to initiate swallow, need for repeated swallows
Transport dysphagia (esophageal)
- Improper transfer of bolus from upper esophagus into stomach
- Etiology
- Obstructive disease (85% of cases)
- Foreign body, carcinoma, webs, stricures, thyroid enlargement
- Motor disorder
- Achalasia, peristaltic dysfunction (nutcracker esophagus), scleroderma
- Obstructive disease (85% of cases)
- Symptoms
- Food "sticking," retrosternal fullness w/ solids (and eventually liquids), odynophagia
Work-Up
- Neck x-ray (AP and lateral)
- Helpful in presumed transfer dysphagia and proximal transport dysphagia
- CXR
- Helpful in presumed transport dysphagia
Treatment
- Referral to GI or ENT for direct laryngoscopy or video-esophagography
Disposition
See Also
Source
Tintinalli