Tag: Dysphagia

Dysphagia

Dysphagia

Q. 1

Progressive dysphagia initially for solids and later for liquids is the hallmark feature of carcinoma of:

 A

Oropharynx

 B

Hypopharynx

 C

Nasopharynx

 D

All

Q. 1

Progressive dysphagia initially for solids and later for liquids is the hallmark feature of carcinoma of:

 A

Oropharynx

 B

Hypopharynx

 C

Nasopharynx

 D

All

Ans. B

Explanation:

Progressive dysphagia initially for solids and later for liquids is the hallmark feature of carcinoma of hypopharynx and cervical esophagus.

Hypopharynx lesions usually presents with sore throat, hoarseness, otalgia and foreign body sensation. 

Classic causes of Intermittent dysphagia are diffuse esophageal spasm and schatzki ring.


Q. 2

Intermittent dysphagia is caused by?

1. Stricture
2. Reflux esophagitis
3. Achalasia cardia
4. Pharyngeal diverticulum
5. Diffuse esophageal spasm
 A

1,2 & 3

 B

2,3 & 4

 C

4 & 5

 D

3,4 & 5

Q. 2

Intermittent dysphagia is caused by?

1. Stricture
2. Reflux esophagitis
3. Achalasia cardia
4. Pharyngeal diverticulum
5. Diffuse esophageal spasm
 A

1,2 & 3

 B

2,3 & 4

 C

4 & 5

 D

3,4 & 5

Ans. C

Explanation:

 Intermittent dysphagia   Progressive dysphagia
 
  Diffuse esophageal spasm
  Pharyngeal diverticulum
  Schatzki ring
  Esophagitis  
  Carcinoma esophagus
  Stricture
  Achalasia cardia

Also know:

  • Dysphagia more for solid than liquid implies mechanical obstruction (Ca esophagus, stricture, webs)
  • Dysphagia equal for both solid and liquid from the very onset suggests motor disorder i.e achalasia and diffuse esophageal spasm.

Ref: Harrison 17/e, Page 239; CMDT 2005, Page 546.


Q. 3

Intermittent dysphagia is caused by

 A

Stricture

 B

Achalasia cardia

 C

Pharyngeal diverticulum

 D

All

Q. 3

Intermittent dysphagia is caused by

 A

Stricture

 B

Achalasia cardia

 C

Pharyngeal diverticulum

 D

All

Ans. C

Explanation:

Answer is C (Pharyngeal diverticulum)

Progressive

  • Achalasia
  • Progressive systemic sclerosis
  • Peptic stricture
  • Carcinoma

Intermittent

  • Lower esophageal ring/Spatzki ring
  • Diffuse esophageal spasm
  • Zenker’s diverticulum

Q. 4

Investigation of choice for dysphagia for solids:

 A

Barium swallow

 B

Endoscopy

 C

X-ray chest

 D

C.T. scan

Q. 4

Investigation of choice for dysphagia for solids:

 A

Barium swallow

 B

Endoscopy

 C

X-ray chest

 D

C.T. scan

Ans. D

Explanation:

Answer is D (Manometry)

Esophageal manometry is the gold standard test for esophageal motility disorders.

Esophageal Motility Disorders : Manometry is the test of choice Achalasia Cardia

Diffuse Oesophageal Spasm (Discoordinated motility) Nutcracker Oesophagus (Hypercontractile motility)

Hypertensive LES (Hypercontractile motility)

Hypotensive LES(Hypocontractile motility)

Ineffective Oesophageal motility (Hypocontractile motility)

Quiz In Between


Q. 5

A young patient presents with history of dysphagia more to liquid than solids. The first investigation you will do is:

 A

Barium swallow

 B

Esophagoscopy

 C

Ultrasound of the chest

 D

C.T. scan of the chest

Q. 5

A young patient presents with history of dysphagia more to liquid than solids. The first investigation you will do is:

 A

Barium swallow

 B

Esophagoscopy

 C

Ultrasound of the chest

 D

C.T. scan of the chest

Ans. A

Explanation:

Answer is A (Barium swallow)

Presence of progressive dysphagia for both liquids and solids suggest a probable diagnosis of Achalasia Cardia. Barium swallow should be the first / initial investigation.

‘In evaluating a patient with dysphagia. a barium .swallow should be the first test performed’


Q. 6

A 50 year old male presented with intermittent solid food dysphagia.Barium Swallow examination of the esophagus is shown in the image.What can be the most probable diagnosis?

 A

Oesophageal Stricture

 B

Esophageal Carcinoma

 C

Schatzki ring

 D

Esophageal Stenosis

Q. 6

A 50 year old male presented with intermittent solid food dysphagia.Barium Swallow examination of the esophagus is shown in the image.What can be the most probable diagnosis?

 A

Oesophageal Stricture

 B

Esophageal Carcinoma

 C

Schatzki ring

 D

Esophageal Stenosis

Ans. C

Explanation:

Ans:C.)Schatzki ring.

The above esophagram show a Schatzki ring (red arrow) at the distal esophagus.

Schatzki Ring

  • Distal Esophageal rings are usually associated with episodic solid food dysphagia and are called Schatzki rings.
  • Patients typically present older than 40 years, consistent with an acquired rather than congenital origin.
  • Schatzki ring causes intermittent food impaction, also known as steakhouse syndrome.
  • Symptomatic rings are treated by dilatation.



Q. 7

A patient presented with dysphagia to solids and liquids.Barium Swallow examination is shown.What can be the most probable diagnosis?

 

 A

Esophageal Ring

 B

Esophageal Carcinoma

 C

Esophageal Tear

 D

Achalasia Cardia

Q. 7

A patient presented with dysphagia to solids and liquids.Barium Swallow examination is shown.What can be the most probable diagnosis?

 A

Esophageal Ring

 B

Esophageal Carcinoma

 C

Esophageal Tear

 D

Achalasia Cardia

Ans. B

Explanation:

Ans:B.)Esophageal Carcinoma.

Image demonstrate an irregular, somewhat nodular filling defect (white arrows) stretching for a considerable part of the distal esophagus, narrowing the lumen. There is a shelf-like defect approximately where the tumor begins (red arrows).

Esophageal Carcinoma

Predisposing factors for carcinoma esophagus:
For adenocarcinoma:
  • Chronic gastric reflux (Barrett’s esophagus)
For squamous cell carcinoma:
  • Alcohol
  • Cigarette
  • Mucosal damage from physical agents: long term ingestion of hot liquids, lye (caustic ingestion), radiation induced strictures and chronic achalasia
  • Other ingested carcinogens: Nitrates, nitrites, nitrosamines, smoked opiates and fungal toxins in packed vegetables.
  • Plummer-Vinson-paterson-kelly syndrome (esophageal web + glossitis + Iron deficiency)
  • Tylosis palmaris et plantaris (congenital hyperkeratosis and pitting of palms and soles)
  • Human papillomavirus
  • Bulimia (repeated microtrauma due to vomiting, may contribute to the malignant transformation of the esophageal tissue)
  • Esophageal diverticula


Quiz In Between



Dysphagia

DYSPHAGIA


DYSPHAGIA

  • Dysphagia is difficulty with swallowing.

Classification-

I) Based on location-

  1. Oropharyngeal dysphagia- transfer of food from oral cavity to upper oesophagus. Occurs in voluntary phase.
  2. Esophageal dysphagia- transport food into the stomach. Occurs in involuntary phase.

II) Based on onset-

  1. Acute- common in children
  2. Chronic

III)  Based on progression-

  1. Progressive
  2. Intermittent

Causes-

 Clinical features-

  • Pain and difficulty in swallowing
  • Nasal regurgitation
  • Coughing or gagging while swallowing
  • Dysarthria
  • Loss of weight

Carcinoma oesophagus or haropharynx

Investigations-

  • Barium swallow examination- pharyngeal pouch, webs & strictures
  • Oesophagoscopy (1st investigations) & gastroscopy- strictures or achlasia
  • CT scan- for malignancy stages, for solid
  • Endoscopic ultrasound- abnormalities within the wall
  • 24hr pH monitoring for GERD
  • Manometry- achlasia, DES

Treatment-

  • Drug therapy for GERD, motility disorders
  • Endoscopy- foreign body removal
  • Chemoradiation
  • Dilation- stricture, achlasia
  • Surgery

Exam Important

Classification-

I) Based on location-

  1. Oropharyngeal dysphagia- transfer of food from oral cavity to upper oesophagus. Occurs in voluntary phase.
  2. Esophageal dysphagia- transport food into the stomach. Occurs in involuntary phase.

II) Based on onset-

  1. Acute- common in children
  2. Chronic

III)  Based on progression-

  1. Progressive
  2. Intermittent

Causes-

Classification-

I) Based on location-

  1. Oropharyngeal dysphagia- transfer of food from oral cavity to upper oesophagus. Occurs in voluntary phase.
  2. Esophageal dysphagia- transport food into the stomach. Occurs in involuntary phase.

II) Based on onset-

  1. Acute- common in children
  2. Chronic

III)  Based on progression-

  1. Progressive
  2. Intermittent

Causes-  

 Clinical features-

  • Pain and difficulty in swallowing
  • Nasal regurgitation
  • Coughing or gagging while swallowing
  • Dysarthria
  • Loss of weight

Investigations-

  • Barium swallow examination- pharyngeal pouch, webs & strictures
  • Oesophagoscopy (1st investigations) & gastroscopy- strictures or achlasia
  • CT scan- for malignancy stages
  • Endoscopic ultrasound- abnormalities within the wall
  • 24hr pH monitoring for GERD
Don’t Forget to Solve all the previous Year Question asked on DYSPHAGIA

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