Dysphagia: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
''Must distinguish between transfer dysphagia and transport dysphagia'' | |||
===Transfer dysphagia (oropharyngeal)=== | |||
===Work-Up=== | |||
*Neck x-ray (AP and lateral) | |||
**Helpful in presumed transfer dysphagia and proximal transport dysphagia | |||
*CXR | |||
**Helpful in presumed transport dysphagia | |||
===Evaluation=== | |||
====Transfer dysphagia (oropharyngeal)==== | |||
*Discoordination in transferring bolus from pharynx to esophagus | *Discoordination in transferring bolus from pharynx to esophagus | ||
*Etiology | *Etiology | ||
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*Symptoms | *Symptoms | ||
**Gagging, coughing, inability to initiate swallow, need for repeated swallows | **Gagging, coughing, inability to initiate swallow, need for repeated swallows | ||
===Transport dysphagia (esophageal)=== | ====Transport dysphagia (esophageal)==== | ||
*Improper transfer of bolus from upper esophagus into stomach | *Improper transfer of bolus from upper esophagus into stomach | ||
*Etiology | *Etiology | ||
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*Symptoms | *Symptoms | ||
**Food "sticking," retrosternal fullness w/ solids (and eventually liquids), odynophagia | **Food "sticking," retrosternal fullness w/ solids (and eventually liquids), odynophagia | ||
==Treatment== | ==Treatment== | ||
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==See Also== | ==See Also== | ||
== | ==References== | ||
[[Category:GI]] | [[Category:GI]] | ||
Revision as of 07:20, 6 June 2015
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
Work-Up
- Neck x-ray (AP and lateral)
- Helpful in presumed transfer dysphagia and proximal transport dysphagia
- CXR
- Helpful in presumed transport dysphagia
Evaluation
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
Treatment
- Referral to GI or ENT for direct laryngoscopy or video-esophagography