Dysphagia

• Difficulty in swallowing

Causes

Diseases of mouth and tongue

• tonsilitis

Neuromuscular disorders

• Myasthenia Gravis
• Bulbar Palsy
• Bulbar poliomyelitis

In the lumen

• Foreign body

In the wall

• Congenital atresia
• Inflammatory stricture - reflux oesophagitis
• Caustic stricture
• Achalasia
• Carcinoma
• Plummer-Vinson syndrome
• Scleroderma
• Post-irradiation

Outside the wall

• Mediastinal lymphadenopathy
• Bronchial carcinoma
• Retrosternal Goitre
• Pharyngeal pouch
• Paraoesophageal (rolling) hiatus hernia
• Thoracic aortic aneurysm
• Dysphagia lusoria (vascular ring)
• enlarged left atrium

General causes

• Hysteria

History

• Obvious cause?
• Previous history of oesophagitis
• Young, worse for liquids - think achalasia
• Rapid onset with weight loss in elderly - malignancy
• May be able to accurately locate site at which food sticks (actually site is often lower than this)

Examination

• May be little to find
• Evidence of weight loss & anaemia with malignant strictures
• Glands
• Palpate abdomen to exclude liver secondaries
• Pharyngeal pouch

Investigations

• Hb
• FBC
• ESR
• U&E's
• LFTs
• CXR
  • mediastinal mass
  • bronchial carcinoma
  • thoracic aortic aneurysm
  • gas shadow behind heart - hiatus hernia
• Barium swallow
• Fibre-optic oseophagoscopy (not if pharyngeal pouch)
• Biopsy
• CT scan

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